Identify suspicious claims, providers and third parties based on continually updated scenarios.
Improper Payment Detection
Helping health insurers break out of the confines of rules-based detection
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
Impact:
Transform claims and external data into actionable, investigative insights - increasing the efficiency of the SIU by 200%
Explainable AI provides decision recommendations tailored to the needs of users throughout the healthcare insurance organization.
Prioritize the largest cases to maximize savings and recoveries.
Easily access external data and manage case workflow all in one platform.
Prioritized Alerts & Contextual Guidance
