Increased proven fraud savings of 60%

Client
Santalucia Seguros

Challenge
Establish a comprehensive anti-fraud strategy covering the entire policy lifecycle, harmonising preventive risk management and fraud detection. Fraud solution to support current and future fraud models.

Solutions
• FRISS Claims Analytics
• FRISS Enterprise Investigations

Results
• Increased proven fraud savings of 60% in the first year.
• Return on investment of over 9 times the investment in FRISS solutions.
• Implementation of fraud detection and investigation solutions for 10 branches in 5 months.
• Real-time fraud detection.
• Closure on claim with proven fraud within 6 days.
• Progress towards SaaS/digital processes in a secure and automated way.
• Improve honest customer service with faster response in claims handling.

Client

Santalucía is a Spanish insurance company with a proven track record in the market. Founded in 1922, it has positioned itself as one of the main insurance companies in Spain, offering a wide range of products and services to its customers.

The company focuses on providing insurance solutions for both individuals and businesses. The products Santalucía provides include life insurance, home insurance, health insurance, death insurance, savings and investment insurance, among others. These insurances are designed to cover several needs and offer financial protection in different areas of insured people's lives.

Santalucía stands out for its commitment to customer service, seeking to offer customised and personal service. The company strives to provide fast and efficient service, as well as fast and effective claims and complaints handling.

Santalucía also focuses on innovation and digitalisation, seeking to use technology to improve the customer experience and optimise its internal processes. This includes the implementation of online tools, such as smartphone apps and digital platforms, to facilitate insurance underwriting, policy management and client communication.

The Santalucia Group works to generate security for its customers with the service vocation for which they stand out. An important task is the fight against fraud as part of our commitment to creating an honest insurance environment and fulfilling our social responsibility to promote civic values.

Challenge

Santalucía began a digital transformation plan with the goal of equipping all the group's companies with digital and human capabilities to meet the challenges of business and internal transformation. Artificial intelligence and process automation, together with advanced analytics and the incorporation of new sales and interaction channels have been the group's technological focus in the plan.

Santalucía is constantly seeking to improve customer experience with both digital and traditional points of contact. It is in this improvement that the fight against fraud takes on greater relevance. Accuracy and speed of response enables our honest policyholders to have a better response by reducing unnecessary waiting times.

Israel Garcia Redondo (Fraud Manager at Santalucía) comments, "We were aware of the impact of fraud and the constant innovation of fraudsters, so we decided to implement a solution that would enable a real-time review and analysis of fraud evidence, and that would not impact our honest customers”.

Among the requirements of the technological solution, in addition to those already mentioned above, speed of response and accuracy when assessing fraud, the goal was an easy integration with the technological ecosystem, provide comprehensive coverage of the policy cycle in an insurer, and support current and future fraud.

Solution

The scope of the project was established in two phases covering the entire policy cycle, from contracting to claims management:

a first phase focused on fraud detection and investigation, where commitments were jointly established.
and a second, once the objectives have been met, where the focus is on risk analysis and fraud prevention.

"From the beginning during the decision-making process, we worked in a very operational way and taking into account Santalucia’s starting point, we initially established a joint strategy in the short and medium term. This has been key in achieving a short implementation time and such a good result in a short period of time.” says Raúl Fernández Villota, FRISS Manager in Iberia.

The implementation of a real-time technological anti-fraud solution has been synchronised with cutting-edge data management adapted to the claims management process, which has enabled us to provide people with agile and intuitive tools that enable them to detect and solve fraudulent situations, as well as to deploy our own transversal and comprehensive culture, based on training and communication.

Israel Garcia Redondo, Fraud Manager

Selection

In the selection phase, there was a lot of uncertainty about whether to develop a solution from scratch, build on a previously developed technology base or select a market solution. In the search, Santalucía evaluated several options and FRISS was selected because the solution covered the entire policy cycle, obtained the score in real time and has an ongoing improvement support service. Moreover, the strong support of FRISS during the decision-making process was key in establishing a joint strategy.

Being the first to use the FRISS solution/service in Spain was a risky decision, but one of trust in a team with experience in fraud in the insurance industry and a proven market solution in more than 45 countries.

Result

With the FRISS solution for automated claims fraud detection, Santalucía has standardised its processes across the group and achieved tangible results:

Increased proven fraud savings of 60% in the first year.
Return on investment of over 9 times the investment in FRISS solutions.
Implementation of fraud detection and investigation solutions for 10 branches in 5 months.
Real-time fraud detection.
Closure on claim with proven fraud within 6 days.
Progress towards SaaS/digital processes in a secure and automated way.
Improve honest customer service with faster response in claims handling.

Santalucía is already thinking about the next step, where the head of the Fraud unit Israel Domingo comments, "The Santalucía-FRISS binomial doesn’t stop once the results achieved in the claims process have been analysed, and the next steps are an ambitious project to implement a risk analysis solution in contracting that will prevent fraud before it enters our company. This will enable us to reduce the impact of fraud in the benefits process and focus on the quality of service to our customers.” Garcia Redondo continues.

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