#Technology#Health Insurance

FICO software platform helps transform efficiency for Discovery Health

South African medical insurance giant Discovery Health (DH) has managed to automate much of their underwriting and decision makingprocessthanks toFICO's...

Stuart Hodge
|May 25|magazine6 min read

South African medical insurance giant Discovery Health (DH) has managed to automate much of their underwriting and decision making process thanks to FICO's bespoke 'decision management' software.

The technology allows them to now process more than 100,000 transactions a day, according to the Silicon Valley developer.

DH, which is South Africa’s largest administrator of medical schemes, began using the FICO software in 2012 when it replaced its previous rules management system and sought to consolidate its underwriting decision-making for the company’s 3.2 million beneficiaries.

The manual processing of anything up to 22,000 paper applications per month across 19 medical schemes required 180 staff, so the company began using FICO Blaze Advisor decision rules management system to make decisions in real-time across platforms and channels.  The software’s functionality assists in various processes, from insurance applications to claims processing, with a mind towards accelerating decisions, saving costs and improving the customer experience. 

The key benefit to using the system is that it means DH can instantly and automatically determine the eligibility of an insurance applicant and their dependents, set terms (such as the waiting periods to be imposed) and determine offers and requirements for acceptance. Underwriters and other staff can also update decision strategies quickly, without the need for specific IT assistance.

“We needed a best-in-class decision engine to improve our performance,” said Kris Tokarzewski, chief information officer at DH. “FICO provided the most powerful decision engine, and it has helped us streamline our business and provide better service to customers.”

Using FICO Blaze Advisor to automate processing for 30 medical conditions, DH has automated around 40% of the previously manual underwriting effort for paper applications, each of which took two to four days to process. Online channels now have the ability to issue near real-time underwriting decision. In 2013, only 11% of health applications were automatically underwritten; today, 100% of online and paper applications are adjudicated by FICO Blaze Advisor, with a 78% auto-adjudication rate.

“The healthcare and medical aid industries form a complicated ecosystem,” said Derick Cluley, who oversees FICO’s operations in Africa. “Running multiple schemes in multiple languages and multiple countries demands the kind of sophisticated decision management that FICO offers. FICO is proud of the part our technology is playing in driving down the cost of healthcare by driving up efficiencies and scale at South Africa’s largest administrator of medical schemes."