Case Study: Vhi Insurance achieves faster, more profitable claims processing with FICO Blaze Advisor

Ireland’s Leading Health Insurer Overcomes complexity for faster, more profitable claims processing

Vhi Insurance, Ireland’s largest health insurer, faced growing complexity from hundreds of facilities, 10,000 practitioners and more than 300 products with varied coverage rules. Its 30-year-old hard‑coded claims system slowed updates and required heavy IT involvement, so Vhi needed a flexible, agile platform to automate adjudication, handle thousands of daily decisions, and let business users update logic quickly.

Vhi implemented the FICO Blaze Advisor decision rules system to centralize claims logic and empower decision analysts to make changes without IT. The solution automated adjudication and payment calculations, improved consistency and fraud detection, increased auto‑adjudication rates, reduced turnaround times and operational costs, and provided an auditable, easily maintained rules framework.

Vhi Insurance

Damien Malone

Principal Technical Architect