A leading provider of travel insurance realized they had a significant problem. They knew fraudulent claims were an issue. They knew fraudulent claims were costing them money. At the same time, they did not have a dedicated fraud team tasked with spotting and investigating potentially fraudulent claims.

They were looking for an intuitive platform that could help their claims handlers think like an SIU by alerting on possible cases, explaining the rationale for why a claim was flagged and giving claims handlers natural “next steps” for investigating the claim. They found that and more in Shift Technology’s Force.

Unlocking the value of structured and unstructured data
Key to their decision to choose Force was the technology’s unique capability to incorporate both structured and unstructured data into their fraud models and scenarios. The travel insurance industry relies on a tremendous amount of unstructured data – often in the form of images and scanned documents – to determine the veracity of a claim.

Advanced metadata analysis
Not only is Force able to make sense of these documents as they relate to a given claim, but also apply analysis of the metadata associated with most images to offer even greater precision in the potential for fraud scores delivered. For example, the ability to recognize that a photograph of damaged luggage was taken prior to when the damage was reported to have occurred is a red flag indicating that a claim might not have merit.

500-600% ROI
Force is currently processing an average of 75,000 claims annually for this client and was able to deliver positive ROI within four months of going live. Within two years, the insurer estimated its yearly ROI for the project at between 500 to 600 percent. The results delivered since the project went live have convinced the insurer to explore how Shift’s efforts in claims automation could positively impact their business.

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Accurate fraud detection is the key to automated claims decisions.

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