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P&C Claims Fraud Detection

Make faster, more accurate decisions on suspicious claims

Claims Fraud Detection

Shift Claims Fraud Detection is a best-in-class, AI fraud-fighting solution for P&C insurers. Able to detect claims fraud in real time or in scheduled workflows, this solution can deliver 3X the detection hit rate compared to manual or rules-based implementations. What's more, Shift Claims Fraud Detection delivers transparent findings to users with detailed rationale for all of its conclusions. This  allows investigators to make fraud decisions with speed, accuracy and confidence.

  • Finds previously undetectable fraud with AI analysis of all structured & unstructured claims data backed by the world's largest team of insurance-focused Data Scientists
  • Reduces false positives to drive more efficient workflows
  • Identifies simple cases of individual fraud and more sophisticated network fraud schemes
  • Clear contextual guidance and supporting documentation to speed investigations
  • Seamless API integration with insurer core systems
  • SaaS-based solution; 4 months to full integration and accelerated ROI

Impact:

Enables claims teams to identify potential fraud with unmatched accuracy and conduct faster, more efficient investigations

Increased Accuracy
Increased Accuracy

Increase fraud detection hit rates across all lines of business, uncover fraud networks, and avoid false positives.

Faster Investigations
Faster Investigations

Leverage specific investigative guidance with detailed, prioritized fraud suspicion rationale.

Reduced Cost
Reduced Cost

Improve the bottom line by denying fraudulent claims before they’re paid.

Improved Efficiency
Improved Efficiency

Data integration expertise brings together insurer data and knowledge with leading data partners for optimized fraud decisions.

Efficient, customizable user interface for SIU and Claims teams

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Track your hit rate
Learn how your solution is performing in terms of screening out false positives from your alerts.
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Measure conversions
Obtain real-time metrics regarding the cost savings achieved by stopping fraudulent claims, letting you understand how you’re making an impact at a glance.
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Drill down
Access multiple views, letting you sort and filter your alerts by origin, line of business, assigned handler, and more.

Let's work together to transform insurance decision making!

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