Highmark recently reported that they’ve been able to detect 20% more fraud cases on their books as compared to the previous year. Fraud continues to be a top priority not only for the nation’s insurers but also for the Obama Administration, which just committed close to $100 million to fighting fraud for the coming year.

For its efforts, Boston-based Celent, a research and consulting firm, recognized Highmark as a Model Insurer. The 2010 Model Insurer Report recognizes exemplary, results-producing technology initiatives in the insurance industry. Highmark was recognized specifically for its implementation in its group health insurance practice of Insurance Fraud Manager from FICO, a provider of analytics and decision management technology.

"In this era of thinning margins, efficiency is at a premium across the entire insurance business, from product development to loss prevention," said Craig Weber, SVP of Celent's insurance practice. "Highmark is being recognized for its effective use of technology to address fraud, as its efforts in this area have produced measurable results."

Thomas Brennan, director of special investigations at Highmark, says that automating the detection of fraud, abuse and error adds a layer of protection to the company’s own effective organic methods. "With FICO Insurance Fraud Manager, we are able to identify cases of fraud that may be abnormal and are too hard to spot with the human eye," he said.

 

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