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FICO: Unleashing Unforeseen Possibilities for Insurers

Will Lansing, CEO, FICOWill Lansing, CEO The signs have been visible for a while that big data is crossing the chasm and moving into everyday operations including the world of insurance. At the heart of the insurance industry, underwriters are evaluating financial data, actuarial data, claims data and risk data more seamlessly than before using predictive analytics. The importance of big data and analytics is going through the roof, as it is leaving profound effects on customer insights, claims and risk management. A corporation that hails from the San Jose, CA, FICO (NYSE: FICO) is seen as a brick and mortar for the affixation of insurance industry and analytics—enabling organizations to make better decisions that drive higher levels of growth, profitability, and customer satisfaction. Founded in the year of 1957, FICO has renowned capabilities in harvesting big data and mathematical algorithms to predict the unforeseen possibilities, which is opening a new chapter in the book of insurance. The company whose solutions are leveraged across 90 countries and multiple industries brings renowned data scientists, user support, and analytics platforms to unlock new doors of opportunities using big data analytics.

Clearing the Fog of Data

The ugliest reality of accidents and disasters is that they happen without any warning. In the light of this truth, it is important to be proactive, and that is why the marriage of healthcare and insurance is vital. Insurers around the world are playing a critical role in making healthcare effective and cost efficient for healthcare organizations and the families. Part of their job is to ensure that payments and claims remain accurate, valid, and compliant with the provider agreements. “We help payers reach unprecedented levels of cost containment by applying adaptive, predictive analytics that assess the validity of healthcare payments,” says Will Lansing, CEO, FICO. It goes without saying that with increase in the number of claims per year and expanding volume of data, payment analysis has simply become too complex for manual interpretation. “Our approach relies on advanced analytics to spot a variety of payment anomalies that slip through the cracks of existing systems,” says Lansing.

This strategy is steward by FICO’s Payment Integrity Platform, which empower organizations to see clearly through the fog created by the heap of data, accumulating in their infrastructure. This platform assesses the validity of healthcare payments and push healthcare payers to reach an unprecedented level of cost containment.


We help payers reach unprecedented levels of cost containment by applying adaptive, predictive analytics that assess the validity of healthcare payments


FICO Payment Integrity Platform is crafted in such a way that gives health care payers an enterprise-class opportunity to reduce claims fraud, and waste and abuse (FWA). “It is a fully integrated solution with a variety of options effectively helping payers to reduce the cost of healthcare across the entire organization,” adds Lansing. The foundation of the Payment Integrity Platform originates from the company’s suite FICO Insurance Fraud Manager. “It is a proven technology built at the nexus of analytics, link analysis, business rules, and case management capabilities, which assists healthcare payers to meet their demands,” says Lansing. Insurance Fraud Manager can analyze up to one million claims per hour while prioritizing where to focus limited review cycles for maximum return.

Ceasing Frauds for Real Bottom Line Impact

Just like most of the verticals today, the life insurance industry is also showing a phenomenal growth in its digital transformation, product development, and improved customer experience. The financial insights shown in the market research of IDC dictums that IT spending of insurers will reach US $101 billion in 2015, a Year-on-Year (YoY) increase of 4.4 percent compared to 2014, with rigorous investments in technologies to boost efficiencies and innovation. In this landscape, global insurers need to know where and how to seek pockets of growth amidst economic uncertainty. In order to regroup and focus on sustainable, profitable growth, organizations will have to confront multiple perils – ranging from reengineering or rebuilding legacy applications, to countering mounting insurance fraud.

For life insurance, annuity and pension providers, FICO has brought FICO Claims Fraud Solution, another module of FICO Insurance Fraud Manager. The platform drives business results and customer satisfaction throughout the entire lifecycle: customer acquisition, originations, underwriting, renewals, claims review, disbursements, and ongoing marketing. “We give our customers an opportunity to maximize their profitability, enhance customer experience, while keeping fraudulent instances at bay,” says Lansing. “The platform provides a completely integrated environment of continuous learning and sharpening that has proven effective in detecting and stopping fraud for real bottom line impact,” says Lansing. Over $90 billion is saved every year by the company’s products and solutions making FICO a commendable partner to choose for subsiding frauds.

Various organizations have doubled their fraud detection performance such as Agis Zorgverzekeringen, one of the five largest Dutch health insurance providers.

With the healthcare industry in the Netherlands undergoing major disruptions in the recent year, Agis was looking forward to deliver high-quality service at competitive price and to subjugate the undetected frauds that was costing the customer millions of dollars each year. After coming in touch with FICO Insurance Fraud Manager, Agis was able to meet their demands vehemently.
"FICO Insurance Fraud Manager was by far the best solution compared to the other two we tested,” said Erik Van Doorn, Manager, Process Quality and Support, Agis Zorgverzekeringen. “And we were impressed by FICO’s strong track record in decision management technology— its predictive analytics and neural network technology." Highmark Inc., a leading Pennsylvania health insurer was also able to uncover vast savings after using FICO Insurance Fraud Manager. Highmark wanted to test the model’s effectiveness compared to its former use of rules and other approaches such as manual reviews and hotline tips. Working with FICO over the past five years, Highmark has taken advantage of FICO Insurance Fraud Manager to improve its fraud and abuse detection.

FICO is also known and acclaimed for its FICO Score product, which is sold in the figure of billions each year. The FICO Score, available at the three major consumer-reporting agencies, helps lenders make accurate, reliable, and fast credit risk decisions across the customer lifecycle. The FICO Score rank-orders consumers by how likely they are to pay their credit obligations as agreed. The most widely used broad-based risk score; the FICO Score plays a critical role in billions of decisions each year.

“FICO Scores provide a consolidated view of how consumers repay credit obligations, including accounts held by other lenders,” says Lansing. The scores are empirically built using consumer bureau data from millions of consumers. FICO Scores are updated regularly to reflect changes in consumer behavior and lending practices. “It gives credit grantors an opportunity to know which consumers to target, how much credit to extend and whether to raise a credit line,” adds Lansing. A FICO Score is generated using multiple scorecards, with each scorecard tuned to assess risk for a specific consumer segment—for instance, consumers with serious delinquencies. To streamline model updates, scorecards are aligned to reflect similar risk across FICO scoring systems and releases.

Numbers Speak For Themselves

In its more than 50 years of data and analytics excellence, FICO has been, and still remains, a trailblazer in the field of analytics, with its results oriented solutions and never to give up motto— implemented not just in insurance or healthcare, but other industries as well. FICO has offices throughout the world serving industries including financial services, health care, insurance, automotive, public sector, retail, pharmaceuticals, telecommunications, travel and hospitality, media and entertainment, high tech and utilities. Today, over 95 percent of the largest financial institutions are the company’s clients where, FICO’s security solutions are used to protect over 2.5 billion credit cards. The credit for FICO’s success also goes to its prominent 2,300 employees and industry experts, spanning across the world that makes the company truly diversified.

- Arunkant
    December 07, 2015