Identify suspicious claims, providers and third parties based on continually updated scenarios.
Improper Payment Detection
Fraudsters certainly aren’t playing by the rules - your detection strategy shouldn’t either. Designed to go beyond traditional rules-based detection methods, Shift Improper Payment Detection uses enhanced data, combined with healthcare-trained AI models to uncover 4x more fraud, waste and abuse, increase detection accuracy and boost the efficiency of investigators.
- Combines claims data and 100+ external data sources for real-time AI analysis that identifies potential improper payments with speed and accuracy
- Dynamic, prioritized alert scoring for high-value prepayment and post-payment detection
- 100% explainable alerts, with context and supportive documentation to empower investigators
- Integrated case management for a seamless, efficient workflow without having to leave the platform
Transform claims and external data into actionable, investigative insights - increasing the efficiency of the SIU by 200%