Case Study: Large Insurance and Wealth Management Group improves health claims fraud detection with Alessa by Tier1 Financial Solutions

Insurance Claims Monitoring with Alessa

A large North American insurance and wealth management group was struggling to review health insurance claims efficiently, relying on manual assessments, random audits, and email-based follow-up that made it difficult to focus on the highest-risk claims. The company also needed a better way to detect fraudulent claims, reduce unnecessary manual work, and gain clearer reporting on claims performance. It turned to Alessa by Tier1 Financial Solutions to modernize its claims monitoring process.

Alessa implemented automated claims monitoring, data aggregation, risk scoring, fraud detection rules, workflow management, and reporting to help the customer identify suspicious claims faster and route them to investigators with alerts. The solution improved claim review efficiency, reduced manual effort, and helped the insurer detect more fraudulent activity, delivering a return on investment of just over 95% over 12 months. Based on these results, the customer expanded its use of Alessa to reduce false positives, shorten alert resolution times, and improve remediation speed for high-risk claims.