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Optimizing Health Insurance Claims Processing & Fraud Detection with AI
Shift enables health insurers to prevent fraud, waste, and abuse prior to payment.
The healthcare industry has massive amounts of data available in health records, clinical trials, and in billing & claims processing systems. However, it’s still challenging for health insurers to unlock the value buried in this data to accelerate claim payments, reduce fraud, drive better patient outcomes, and maintain regulatory compliance.
Shift Improper Payment Detection
Shift helps health insurers effectively go beyond traditional FWA detection to generate actionable insights to improve the performance of provider networks, enhance member quality of care, and ensure financial stability.
- Shift Enables Health Insurers to:
- Identify more potential fraud, waste, and abuse cases
- Reduce fraud losses and improper payments
- Lower false positives and focus claims handler efforts
- Improve investigator efficiency and shorten decision timeframes
- Pay valid claims quickly, with confidence
Shift Claims Automation for Health
Shift’s AI Claims Automation solution enables health insurers to settle and pay a greater number of high-volume, low-touch claims quickly and confidently.
- Shift Enables Health Insurers to:
- Improve the claims experience
- Settle and pay straightforward, valid claims more quickly
- Increase claims handler productivity
- Reduce claims leakage
- Easily integrate automation with their existing claims platforms
