Tawuniya selects SAS analytics platform to combat fraud

Saudi Arabia’s Company for Cooperative Insurance (Tawuniya) has picked SAS to bolster its analytics and fraud/waste prevention capability within its medical insurance segment.

Tawuniya has deployed a SAS Insurance Fraud Management system to improve the speed of claims settlement and fraud identification. The insurer will also be able to leverage SAS predictive modeling to detect anomalies and outliers to minimise losses through the use of analytics.

Tawuniya will also benefit from a more efficient medical claim cycle, powered by the SAS AI, analytics and machine learning (ML) capabilities embedded in the solution.

According to Global Health Care Anti-Fraud Network, it is estimated that $260bn, approximately 6 per cent of global health care spending is lost to fraud annually.

Read: First insurance platform graduates from Central Bank of Bahrain regulatory sandbox

SAS Detection and Investigation for Insurance, an analytical and data management platform, allows health insurers such as Tawuniya to probe into fraud, waste and abuse from medical service providers as well as the opportunity to support real-time response to individual claims. For the insurer, it helps identify fraud and error patterns that are difficult to see in the sea of health insurance claims data and helps optimise the efficiency of the insurers’ investigators, in both reducing false-positives and provide clear ‘analytical evidence’ for the investigator.

For the policyholder, it could potentially lead to a reduction in premiums and an overall speedier claims handling process.

“By working with SAS, we want to improve our experience and take advantage of fraud detection technology to control costs and manage medical claims,” said Abdulaziz Hassan Al-Boug, CEO of Tawuniya.

“The incorporation of AI tools within our claims-handling process is essential to help ensure the accuracy and expedition of our claims settlement, which will certainly strengthen our customers’ trust and improve their satisfaction,” he added.