Real-time AI analysis for pre-payment detection
An evolving problem calls for an evolved approach
Healthcare fraud, waste and abuse costs the healthcare industry billions every year. Overwhelmed with suspicious alerts, evolving schemes and scattered data sources, Insurers need to evolve their fight against this growing problem. Shift is revolutionising the detection and management of fraud, waste, and abuse by delivering unparalleled AI-driven insights to help Insurers take action with speed, impact and accuracy.
- Increased accuracy thanks to insurance-trained AI. Shift enables insurance orgnisations to identify suspicious claims, providers, and third parties based on continually updated scenarios.
- Faster investigations powered by explainable AI decisioning tailored to the needs of users throughout the organisation.
- Reduced costs thanks to prioritised guidance focused on maximising revenue preservation
- Improved efficiency in driving better patient outcomes, optimising provider performance, and maintaining compliance.
Claims Fraud Detection
An AI-powered solution that uses healthcare and vast external data to accurately identify suspicious activity while providing detailed contextual guidance to claims handlers and investigators
AI-powered decision support for health and medical insurance
Fraudsters are taking increasingly sophisticated steps to avoid detection. This technology will give insurers the edge they need to identify patterns and connect the dots across a huge pool of claims data over time, leading to more investigations and prosecutions.
— Stephen Frank, President and CEO of Canadian Life and Health Insurance Association (CLHIA)