AI holds key to uncovering suspicious claims
For insurers, one of the greatest challenges in claims management is that fraudulent claims often appear legitimate at first glance. High-value losses, detailed explanations, and timely submissions can create a convincing picture of authenticity. This is where artificial intelligence (AI) makes the difference. By analyzing patterns, context, and subtle inconsistencies that humans may miss, Shift’s AI helps insurers uncover suspicious claims before they result in costly payouts.
Seemingly legitimate claim exposed by AI, saving insurer $400,000+
An insurer received a high-value property claim totaling several hundred thousand dollars for stolen materials. At first glance, the claim appeared legitimate.
Using Shift’s AI, the insurer was quickly alerted to multiple red flags that are commonly associated with suspicious claims, This triggered an alert for deeper investigation, uncovering evidence confirming that the claims was not valid.
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$400,000+ in losses prevented by denying fraudulent claim
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Suspicious indicators detected quickly, enabling fast action
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Natural language processing (NLP) of unstructured claims statements identified conflicting claim details
The power of AI: uncovering hidden red flags
Shift’s AI didn’t just flag a single anomaly—it connected multiple suspicious patterns that, when viewed together, strongly suggested the claim wasn’t genuine. Within minutes, the AI surfaced red flags that could easily have been overlooked in a manual review.
- Policy age: The system recognized that the policy had only been active for a short period of time, which is a common characteristic in opportunistic fraud.
- High-value items: The claim involved unusually expensive materials, an indicator that increases the likelihood of exaggeration or fabrication.
- Free-text analysis: Using natural language processing, Shift’s AI detected misleading and inconsistent responses in the claimant’s written explanations—signals that can be difficult and time-consuming for human reviewers to identify.
By synthesizing these insights alongside other contextual data, the AI automatically triggered an alert for further review. This early detection enabled the insurer to focus investigative resources on the claim before making a costly payout.
Learn more from our team of 200+ data scientists
This video is part of a series of interesting cases presented by our insurance-focused team of data scientists. For more examples of Shift Technology's AI-driven results, browse the AI in Action library.
