Insurance association is using tools created by Paris-based Shift Technology
The Canadian Life and Health Insurance Association (CLHIA) is using artificial intelligence tools from Paris-based Shift Technology to detect insurance fraud in group benefits plans, the association announced Monday.
Benefit fraud is when a plan member or service provider intentionally submits false information to a carrier for a pure financial gain, Joanne Bradley, vice-president of anti-fraud at CLHIA said in an interview. “A trend that is more and more common is collusion, [where] a plan member and a provider work together to submit claims falsely and… [split] that payout.”
In response to this and other methods of fraud, the CLHIA started pooling deidentified data from Canadian life and health insurers in 2021. Although carriers already have their own internal systems to detect suspicious claims, Shift will generate alerts from the pooled data that help insurers identify wider patterns.
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