Vitality Integrates FICO Platform to Digitise Health Claims

Vitality, the health and life insurance provider, has implemented FICO Platform to deliver data-driven personalised experiences across its one million member base, transforming its claims processing system.

The partnership has delivered a fully digital claims journey called Care Hub, which includes instant authorisation capabilities, online consultant booking and direct integration with GP referral systems. 

The implementation has reduced telephone-initiated claims to 28%, down from over 90% in 2019.

Vitality has incorporated multiple FICO tools to enable real-time data-driven decision making, minimising manual intervention requirements from agents while improving claims processing efficiency. 

The system spans healthcare services from general practice to physiotherapy, mental health and specialist treatments.

Cloud architecture enhances personalisation

The insurer has adopted a cloud-based microservices architecture—a software development approach where applications are built as independent components that can be deployed and scaled separately—that connects across its various services from life insurance to reward programmes.

This infrastructure enables personalised customer journeys with full traceability of decisions made, ensuring consistent application of decision rules regardless of how customers interact with the company.

Annabel Simmons, Head of Healthcare Programs at Vitality, says: “At Vitality we understand that no two patients are the same. 

“Some members prefer a no-nonsense, straightforward, and self-managed approach to healthcare, while others require more handholding and empathy. We wanted to offer personalised healthcare journeys that cater to these individual preferences.”

The reduced telephone claims volume has freed specialist claims teams to focus on providing support for members with complex claims, such as chemotherapy treatments. 

This reallocation of resources has enabled Vitality to maintain customer satisfaction while reducing operational costs.

Simulation capabilities drive business planning

A key component of the implementation is the FICO Business Outcome Simulator—a tool that models the effects of potential changes before deployment—which allows Vitality to preview rule changes in real-time.

The simulator has proven valuable for understanding how rule modifications and operational changes affect both business outcomes and member experiences before implementation.

“Upgrading our system wasn't just about moving to the cloud—it was about unlocking the potential for growth by allowing our teams to focus on what they do best: providing excellent healthcare services and improving patient outcomes,” Simmons says. 

“We realised we were limiting our possibilities by staying with our old system. Our upgrade with FICO is already paying for itself and will continue to drive value for years to come.”

The Care Hub complements the insurer's specialist claims teams, who remain available to provide support for members navigating complex claims. 

The availability of streamlined digital pathways helps manage demand across the system, enabling service efficiencies while maintaining quality standards.

FICO Platform provides an open architecture with integrated capabilities that span the applied intelligence value chain—from data organisation to insight discovery—implementing this through actions to achieve desired outcomes. 

The company was named as a Leader in the IDC MarketScape: Worldwide Decision Intelligence Platforms 2024 Vendor Assessment report published in August 2024.

Nikhil Behl, President of Software at FICO, concludes: “The collaboration between FICO and Vitality has enabled the kind of personalised digital-first approach that is transforming healthcare services. 

“By focusing on personalisation, automation, and operational efficiency, Vitality is building a future-proof system that meets the diverse needs of its members while driving sustainable growth.”

Explore the latest edition of FinTech Magazine and be part of the conversation at our global conference series, FinTech LIVE. 

Discover all our upcoming events and secure your tickets today.

FinTech Magazine is a BizClik brand