Case Study: one of the top 3 LATAM Health Insurers achieves faster fraud detection and 30M MXN savings with Qantev

Top 3 LATAM Health Insurer - Customer Case Study

Qantev partnered with one of the top three LATAM health insurers, a major provider in Mexico, to address their challenges with fraud, waste, and abuse detection. The insurer was facing an estimated 7% leakage from FWA, driven by an inefficient, manual, and rules-based system that generated a high number of false positives and lacked pre-payment detection capabilities.

The solution involved deploying Qantev's Fraud, Waste and Abuse module and Claims Registration module. This implementation enabled the insurer to generate 30 million MXN in savings from detected suspicious claims, achieve a 70% faster case detection rate, and hit a positive ROI within six months. Qantev's platform also helped the insurer's SIU team increase the number of alerts investigated by 25%.