Fintech
Medscheme Transforms Claims Management Efficiency using FICO Decision Technology
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- Medscheme has created a modern decision platform for its Medical Aid Administration business, which reviews some 400,000 claim lines per day, based on FICO® Blaze Advisor
decision rules management system - Medscheme won the 2018 FICO® Decisions Award for Decision Management Innovation
- Medscheme is one of South Africa’s largest providers of administrative and health risk management solutions for the healthcare sector
Medscheme, one of South Africa’s largest providers of administrative and health risk management solutions for the healthcare sector, has created a modern decision platform for its Medical Aid Administration business, which reviews some 400,000 claim lines per day. The innovative solution, powered by FICO® Blaze Advisor decision rules management system, reduced claim interventions by 15 percent in a six-month period, and has dramatically reduced the time needed to change business rules and strategies.
For its achievements, Medscheme won a 2018 FICO® Decisions Award for Decision Management Innovation.
“Our vision is to create a world with sustainable healthcare, and at the heart of our business is processing medical claims of members and healthcare providers,” said Denise Sleem, general manager and project lead at Medscheme. “By modernizing our claims management capabilities, we have become more agile, more efficient and more effective, which means members and healthcare providers get faster answers on claims.”
“Our focus is on efficient and effective administration services that are optimized and responsive to varying medical scheme needs at any given time,” said Andrew Wright, executive manager for Shared and Support Services at Medscheme. “We thus need to constantly challenge the way we work and where we wish to invest in enhancing our broader healthcare administration capabilities that will ensure they are relevant into the future.
“Furthermore, Medscheme requires flexibility in its claims capability, which is especially important today as we bring on board new clients with thousands of members with their own set of rules. Our claims engine needs to easily accommodate the variety of client scheme needs and integrate seamlessly with our core administration system, with very little room for errors or delays.”
Transforming a Legacy System
In rebuilding their claims management system, Medscheme had clear requirements. They needed modern, scalable technology that could support their needs into the future, integrate well with the rest of their IT infrastructure, and meet stringent SLAs for claim review times. The new system had to make rules and policies visible, be accessible to business and technical teams, and be much easier and quicker to change.
“The business rules that informed our decisions in our claims processing were mostly locked up in code, data and people’s minds,” explained Sleem. “We had to discover them, document them and move them swiftly into the new system. FICO has been a terrific partner for us in this effort.”
Medscheme created a framework using cloud-native technologies including Kubernetes, Docker and Spring Boot, within which the FICO Blaze Advisor decision rules system runs. “This environment is extremely scalable, and can be used either on-premise or with any of the big three cloud provider spaces, and can be run in a hybrid model as well,” said Drikus Britz, lead solutions architect at Medscheme. “The solution allows for zero downtime deployments within a day should the need arise. We are running in an active-active mode across multiple data centers, allowing for almost zero downtime during disaster recovery situations for real-time claims.”
Due to the high volume and complex rules associated with medical claims, Medscheme needed to think carefully about performance. “We use Hazelcast to cache information related to our clinical data that does not have a high frequency of change,” Britz said. “This allowed for the decision engine itself to remain stateless, while having frequently used information a lot ‘closer’ to the engines, which drastically improved speed. To further improve performance, we enhanced the components that serialize and de-serialize the incoming and outgoing requests to and from Blaze Advisor. We also have moved to a semi de-normalized object model inside Blaze Advisor, which gives us the most efficient way of rule writing and execution at runtime.”
Clear Benefits to Modernization
Medscheme has recorded a number of benefits of their new system:
- Fast processing of an average of 400,000 claim lines per day
- Easy to respond to a query about a decision, due to fully documented business rules
- Claim interventions reduced by 15 percent over a six-month period
- 99.9% uptime — a stable product on a stable platform with the ability to do online deployments
- Ability to respond quickly to market changes and varied client requirements
- Multiple resources able to work on multiple changes to the decision services code at a time
- A consolidated rules management repository enables flexibility and traceability of decisions
- More agile rule capabilities for changing benefit designs, allowing for increased volume and complexity
“We are impressed by the technical ingenuity of the Medscheme team,” said Nikhil Behl, vice president of marketing at FICO. “This is a fantastic solution to a common problem — modernizing a legacy system to improve efficiency and customer satisfaction.”
FICO® Blaze Advisor decision rules management system gives businesses maximum control over high-volume operational decisions. Blaze Advisor provides companies with a scalable solution that delivers unprecedented agility and actionability for smarter business decisions. FICO Blaze Advisor is part of the groundbreaking FICO® Decision Management Suite for building and deploying decision management applications.
Photo source: SOURCE FICO
As we close out 2024, the fintech industry continues to deliver headlines that underscore its dynamism and innovation. From IPO aspirations to groundbreaking regulatory milestones, today’s updates highlight the transformative power of fintech partnerships, regulatory evolution, and disruptive technologies. Here’s what you need to know.
Chime’s Quiet Step Toward Public Markets
Chime, the U.S.-based financial technology startup best known for its digital banking services, has taken a significant step by filing confidential paperwork for an initial public offering (IPO). As one of the most valuable private fintechs in the U.S., Chime’s move could potentially signal a renewed appetite for fintech IPOs in a market that has been cautious following fluctuating valuations across the tech sector.
With a valuation that reportedly exceeded $25 billion in its last funding round, Chime’s IPO could set a new benchmark for the industry. Observers note that its strong customer base and revenue growth may make it an appealing choice for investors seeking to capitalize on the digital banking boom. However, the timing and success of the IPO will depend on broader market conditions and the regulatory landscape.
Source: Bloomberg
ZBD’s Pioneering Achievement: EU MiCA License Approval
ZBD, a fintech company specializing in Bitcoin Lightning network solutions, has made history by becoming the first to secure an EU MiCA (Markets in Crypto-Assets Regulation) license. This landmark approval by the Dutch regulator positions ZBD at the forefront of compliant crypto-fintech operations in Europe.
MiCA, which aims to harmonize the regulatory framework for crypto-assets across the EU, has been a focal point for industry players aiming to establish legitimacy and expand their offerings. ZBD’s achievement not only validates its operational rigor but also sets a precedent for other fintech firms navigating the evolving regulatory landscape.
Industry insiders view this as a strategic advantage for ZBD as it broadens its footprint in Europe. By leveraging its regulatory approval, the company can accelerate its product deployment and establish trust with institutional and retail users alike.
Source: Coindesk, PR Newswire
The Fintech-Credit Union Synergy: A Blueprint for Innovation
The convergence of fintechs and credit unions continues to reshape the financial services ecosystem. Collaborative initiatives, such as the one highlighted in the recent partnership between fintech innovators and credit unions, are proving to be a potent force in delivering tailored financial solutions.
This “dream team” approach allows credit unions to leverage fintech’s technological expertise while maintaining their community-focused ethos. Key areas of collaboration include digital payments, personalized financial management tools, and enhanced loan processing capabilities. These partnerships not only enhance member engagement but also enable credit unions to remain competitive in an increasingly digital-first financial environment.
Industry analysts emphasize that such collaborations underscore a broader trend of traditional financial institutions embracing fintech-driven solutions to bridge service gaps and foster innovation.
Source: PYMNTS
Tackling Student Loan Debt: A Fintech’s Mission
Student loan debt remains a pressing issue for millions of Americans, and a Rochester-based fintech aims to offer relief through its cloud-based platform. This innovative solution is designed to simplify loan management and provide borrowers with actionable insights to reduce their debt burden.
The platform’s features include repayment optimization tools, personalized financial education, and seamless integration with loan servicers. By addressing the complexities of student loan management, this fintech is empowering borrowers to make informed decisions and achieve financial stability.
As the student loan crisis continues to evolve, solutions like this highlight the critical role fintech can play in addressing systemic financial challenges while fostering financial literacy and inclusion.
Source: RBJ
Industry Implications and Takeaways
Today’s updates underscore several key themes shaping the fintech landscape:
- Regulatory Milestones: ZBD’s MiCA license approval exemplifies the importance of regulatory compliance in unlocking growth opportunities.
- Strategic Partnerships: The collaboration between fintechs and credit unions demonstrates the value of combining technological innovation with traditional financial models to drive customer-centric solutions.
- Market Opportunities: Chime’s IPO move reflects a potential revival in fintech public offerings, signaling confidence in the sector’s long-term prospects.
- Social Impact: Fintech’s ability to tackle systemic issues, such as student loan debt, showcases its role as a force for positive change.
The post Fintech Pulse: Your Daily Industry Brief (Chime, ZBD, MiCA) appeared first on News, Events, Advertising Options.
Leading global payments platform SPAYZ.io has confirmed it will be attending iFX EXPO Dubai 2025 on 14 to 16 January. Exhibiting at Stand 64 at Trade Centre Dubai, SPAYZ.io’s team of professionals will be on hand providing live demonstrations of its renowned payment services for payment providers. Attendees will also receive exclusive insight into SPAYZ.io’s plans for 2025 alongside early early access to its upcoming plans for the new year.
SPAYZ.io delivers a host of payment solutions that leverage the latest technological innovations and open access to the fastest growing emerging markets across Africa, Europe and Asia. Over the past year, there has been huge demand for its Open Banking and local payment method services, alongside bank transfers, mass payouts, online banking and e-wallets.
Yana Thakurta, Head of Business Development at SPAYZ.io commented: “We look forward to once again participating at iFX Dubai to expand our network of partners and clients. It’s a fantastic way to kick off the year, connecting with thousands of industry leaders from FOREX platforms to trading companies, and everything in between.
“Our key goal for iFX Dubai EXPO 2025 is to expand our portfolio of solutions and geographies. We’re using this as an opportunity to partner with like-minded entities who share our ambition to provide payment solutions that are truly global.”
Come meet SPAYZ.io’s team at the Trade Centre Dubai at Stand 64. You can also book a meeting slot with a member of a team.
The post SPAYZ.io prepares for iFX EXPO Dubai 2025 appeared first on News, Events, Advertising Options.
Airtm, the most connected digital dollar account in the world, is proud to announce the addition of two distinguished industry leaders to its Board of Directors: Rafael de la Vega, Global SVP of Partnerships at Auctane, and Shivani Siroya, CEO & Founder of Tala. These appointments reflect Airtm’s commitment to innovation and financial inclusion as the company enters its next phase of growth.
“We are thrilled to welcome Rafael and Shivani to Airtm’s Board of Directors,” said Ruben Galindo Steckel, Co-founder and CEO of Airtm. “Their unique perspectives and proven track records will be invaluable as we continue scaling our platform to empower individuals and businesses in emerging markets. Together, we’ll push the boundaries of financial inclusion and innovation to create a more connected and equitable global economy. Rafael and Shivani bring a wealth of experience and strategic insight that will strengthen Airtm’s mission to connect emerging economies with the global market.”
Rafael de la Vega, a seasoned leader in fintech global partnerships and technology innovation, is currently the Global SVP of Partnerships at Auctane. With a proven track record of delivering scalable, impactful solutions at the intersection of fintech, innovation, and commerce, Rafael’s expertise will be pivotal as Airtm continues to grow. “Airtm has built a platform that breaks down barriers and opens up opportunities for people in emerging economies to connect to global markets. I am excited to contribute to its growth and help further its mission of fostering financial inclusion on a global scale,” said Rafael.
Shivani Siroya, CEO and Founder of Tala, is a pioneer in financial technology, renowned for empowering underserved communities through access to credit and essential financial tools. Her leadership in leveraging data-driven innovation aligns seamlessly with Airtm’s vision of creating more equitable financial opportunities. “Empowering underserved communities has always been at the core of my work, and Airtm’s mission resonates deeply with me. I’m thrilled to join the Board and work alongside such a dynamic team to expand access to financial tools that truly make a difference in people’s lives,” said Shivani.
The post Airtm Enhances Its Board of Directors with Two Strategic Appointments appeared first on News, Events, Advertising Options.
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