Claims Fraud Detection

Make Decisions on Suspicious Claims More Quickly and Accurately.

Shift detects fraud with twice the accuracy of other solutions.

Shift Claims Fraud Detection is a powerful, AI-powered solution that effectively identifies individual and network-perpetrated claims fraud. This automated, SaaS-based solution flags potentially fraudulent insurance claims across all lines of business with a 75% hit rate.

Analyzing claims in real time or in batches, Shift Fraud Detection makes reviewing flagged claims and taking informed, data-driven actions easier for claims handlers. With Shift, you’ll see a comprehensive, prioritized set of suspicions underlying each fraud alert in a single, easy-to-navigate dashboard.

 

  • THE SOLUTION EFFECTIVELY IDENTIFIES:
  • Individual claims fraud suspicions across all lines of business

  • Network fraud from organized crime groups and others

  • Potential provider fraud

  • Likely internal fraud and other suspicious behaviors

  • SHIFT HELPS INSURERS:
  • Stay ahead of emerging fraud scenarios

  • Improve investigative efficiency

  • Reduce fraud losses

  • Lower false positives

How it works

Shift Claims Fraud Detection is built on AI from the ground up. It analyzes insurance claims across all lines of business, identifying potential fraud and providing actionable guidance to help claims handlers and investigators make better decisions faster.

Fast onboarding,
guided configuration

  • Data Scientist-led configuration
    in as little as four months
  • Historical claims data ingested
    and cleansed
  • Denoised data made available
    to every client
  • Initial fraud scenarios developed, calibrated and tested

Accurate, actionable
fraud detection

Shift’s AI analyzes every claim against:

  • Historical claim & policy data
  • Hundreds of fraud scenarios
  • 3rd party data, including social
    media, geolocation & mapping,
    weather, credit & financial, criminal
    history, public images

Specific investigative guidance

  • Clear, prioritized fraud suspicions
  • Flags for network fraud by organized crime groups
  • Alerts for potential provider fraud, including repair shops, physicians, and attorneys

Backed by Shift Data Scientists

  • Insurance-focused Data Scientists tasked with maximizing ROI
  • Continual updates to fraud scenarios to reflect trends
  • Ongoing research and product enhancements

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Shift takes a global view of insurance fraud.

Shift has analyzed hundreds of millions of insurance claims globally since its inception in 2014. This extensive dataset gives Shift clients unmatched insight into the techniques and tools fraudsters are using — knowledge that helps them defeat fraud more effectively every day.

Shift Technology is a strategic partner for us and we are working together to achieve our goals.

Mitsui Sumitomo Seguros (Brazil)

Learn how Shift can help you transform insurance decision making

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Shift Perspectives

Shift Technology Announces Shift Claims Automation on Salesforce AppExchange, the World’s Leading Enterprise Cloud Marketplace

July 21, 2021

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Webinar – The Insurance Customer of The Future – July 28th

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Shift Technology Recognized as the Winner of 2021 Microsoft France Industry Award Partner of the Year

July 12, 2021

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Virtual Event – Claim Innovation USA 2021 – July 13-15

July 6, 2021

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