Tawuniya combats insurance fraud with AI solutions powered by SAS

The Leader in Analytics, has announced a recent partnership with Company for Cooperative Insurance (Tawuniya), the pioneering insurance company in Saudi Arabia, to bolster their Analytics and fraud/waste prevention capability within its medical insurance segment.

As part of the partnership, SAS will offer an end-to-end Insurance Fraud Management system for Tawuniya’s health insurance Line of Business in efforts to improve the speed of claims settlement and fraud identification. Through the use of cutting-edge analytics, Tawuniya will be able to leverage SAS predictive modeling to detect anomalies and outliers to minimize losses. With growing concerns of frauds, scams, and schemes caused by con-artists trying to take advantage of the disruption brought by the COVID-19 pandemic. Even pre-pandemic, the challenge proved difficult worldwide, according to Global Health Care Anti-Fraud Network, it is estimated that $260 billion, approximately 6 percent of global health care spending is lost to fraud annually. This strategy is aligned with the insightful Saudi Vision 2030 and will enable customers to benefit from a more efficient medical claim cycle, powered by the SAS AI, Analytics and Machine Learning (ML) capabilities embedded in the solution.

Commenting on the partnership, Abdulaziz Hassan Al-Boug, CEO of Tawuniya, stated, “

Tawuniya has good experience in combating fraud operations, and applied its system with several indicators to detect fraud and reduce losses resulting from fraudulent claims. By working with SAS, we want to improve our experience and take advantage of fraud detection technology to control costs and manage medical claims. 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 strenghthen our customers’ trust and improve their satisfaction. Utilizing AI and Analytics has taken center stage across our operations, the transformation is incorporated across all areas of our operations. This project is a key initiative within our Digital Transformation program, which will increase efficiency, speed, and reliability across the organization, improving our services for the clients as well as the employees”.

“All types of insurance organizations are vulnerable to insurance fraud especially considering the digital and distanced processes due to the ongoing pandemic. The medical sector, especially, has recently been rapidly targeted. To identify fraudulent activities and expedite internal processes leveraging AI and Analytics solutions are therefore becoming critical. Our industry leading Detection and Investigation for Insurance solution will assist Tawuniya to predict behavior patterns, safeguard customers, and efficiently manage risk to help guarantee and bolster customers’ trust and experience at all touchpoints. Through this strategic partnership with Tawuniya, we aim to accelerate KSA’s digital transformation agenda and capitalize on the momentum to boost the country’s productivity and fast-track its digital-first journey with SAS’ analytics capabilities,” said Zafir Junaid. General Manager – North Gulf at SAS.

SAS Detection and Investigation for Insurance is an end-to-end analytical and data management solution that allows health insurers such as Tawuniya to probe into fraud, waste and abuse from all 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 optimize the efficiency of the insurers investigators, in both reducing false-positives and provide clear ‘analytical evidence’ for the investigator. For the policyholder, the ultimate benefits will be a reduction in premiums and an overall speedier claims handling process.