Fraud, waste and abuse is hard to detect amongst large volume, low value claims. It's hard to justify investigation and even harder to prioritise where to focus limited resources.
Shift’s healthcare-trained AI models unearth suspicious patterns in both provider and member activity, cross checking historic data, invoices, documents and any relevant third party data.
Investigators are here to investigate, not spend time combing through sources for the right data or information. With enhanced provider and member data, combined with extensive external data, Shift gets the right insights to investigators faster.
Investigative detail all in one place
Uncover related providers
Alerts with context and action
Any data, any format
Healthcare fraud, waste and abuse tactics are constantly evolving, and investigators need the right tools to keep up. Shift’s powerful AI goes beyond rules-based methods, uncovering higher value FWA and sharpening accuracy with continuous learning.
Natural language processing
Shift’s automated relationship and network analysis helps investigators identify related entities, suspected kickbacks, collusion and tackle high-value complex schemes.
Simplify complex fraud
Boost team productivity and collaboration, leverage automation opportunities and organize complex casework with integrated case management features.
Assign & triage cases
KPIs & reporting
Powerful detection across the health insurance lifecycle
Shift’s Fraud, Waste and Abuse Detection integrates seamlessly with existing IT landscape without disruption to business operations.
Shift enables Insurers to put great patient care first by automating fraud, waste and abuse detection, routing suspicious behavior directly to investigators with full context whilst straight through processing genuine claims and providers.
Shift reduces the workload of your top performers by automating, and streamlining processes, increasing efficiency up to 4x.