Santam Insurance implemented a predictive analytics solution to improve their claims processes and prevent fraud. They recruited an executive from banking to lead the effort and gained buy-in from all stakeholders. The solution scores risk for each claim based on details like time, location, claimant attributes. Claims are then routed down different process flows, from fast-tracking low-risk claims to triggering investigations for high-risk ones. In the first six months, it uncovered several major fraud rings and saved the company $2.4 million in fraudulent payments.

1. Client Case Reference
SANTAM INSURANCE
Bolsters Customer Service. Prevents Fraud.
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2. Client Case Reference
How Santam Insurance got smarter
Mindful of a rising new class of competitors, Santam’s
CEO tasked top execs to create a roadmap for improving
processes and claims.
They looked around the world at what their peers
were doing and concluded that predictive analytics
– to measure and define risk – was a must-have tool.
To drive the deployment effort, they recruited Anesh
Govender from the banking industry, where he had
played a key role in using rules-based modeling to
improve credit scoring practices.

3. Client Case Reference
A path to consensus
Backed by strong executive support, Govender acted
to get buy-in from all the key stakeholders in the claim
process, including process experts, actuarial and
analytics specialists and key IT staff.
The culture of close collaboration that had long
prevailed between IT and the business side proved
to be an essential bridge to building a consensus
for change.
“IT wasn’t viewed as an afterthought or a reluctant
partner, but an integral part of where we were going.”

4. Client Case Reference
Playing by the rules to manage risk
It took Santam six months to implement
a solution that “scores” risk from
information gathered at the instant a
claim is filed – such as time of day,
place, age, auto make and year.
Based on each claim’s risk score and on
business rules captured from Santam’s
claims specialists, each claim is routed
down one of five process flows, ranging
from “fast-tracking” or immediately
paying the claim, to the triggering of
an investigation

5. Client Case Reference
Vigilance through analytics
Though fraud reduction wasn’t a core goal,
it proved to be one of the biggest and most
surprising pay-offs.
Just a month after going live, the system
uncovered a major motor insurance fraud
syndicate that until then had escaped
detection.
In just the first six months, the discovery
of this and several other fraud scams saved
the company US$2.4 million in fraudulent
payments.

6. Client Case Reference
Santam Insurance’s solution uses…
Software:
IBM SPSS Decision Management
Business Partner:
Olrac SPSolutions