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Health Insurance

Shift enables health and medical insurers to make high-impact decisions with speed and accuracy, using enhanced data and insurance-trained AI

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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.

Featured Product

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

Decisions Made Quickly
Decisions Made Quickly

Real-time AI analysis for pre-payment detection

Decisions Made Accurately
Decisions Made Accurately

Integrated internal and external data sources provide a full picture, with learning models for increased accuracy

Decisions Made Thoughtfully
Decisions Made Thoughtfully

Fair, consistent decisions powered by insurance-specific AI

Decisions made responsibly
Decisions made responsibly

ISO27001 and 27701 certified products and implementation processes

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)

Let's work together to transform insurance decision making!

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