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Health Insurance

Shift enables health plans to make accurate, high-impact decisions in real time with enhanced data and powerful, insurance-trained AI that detects fraud, waste and abuse and maximizes savings.

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An evolving problem calls for an evolved approach

Healthcare fraud, waste and abuse costs US healthcare billions of dollars every year. Overwhelmed with suspicious alerts, evolving schemes and scattered data sources, health plans need to evolve their fight against this growing problem. Shift is revolutionizing the detection and management of fraud, waste, and abuse by delivering unparalleled AI-driven insights to help health plans take action with speed, impact and accuracy.

  • Increased accuracy thanks to insurance-trained AI. Shift enables payers to identify suspicious claims, providers, and third parties based on continually updated scenarios.
  • Faster investigations powered by explainable AI decisioning tailored to the needs of users throughout the healthcare insurance organization.
  • Reduced costs thanks to prioritized guidance focused on maximizing revenue preservation.
  • Improved efficiency in driving better patient outcomes, optimizing provider performance, and maintaining compliance.

Featured Product

Healthcare Improper Payment Detection
An AI-powered, high impact approach to fighting fraud, waste and abuse for health plans

Decisions Made Better for Health Insurers

Decisions Made Thoughtfully
Decisions Made Thoughtfully

AI built by healthcare experts for today's challenges

Decisions Made Accurately
Decisions Made Accurately

Integrating internal and external data sources for a holistic view

Decisions made responsibly
Decisions made responsibly

HITRUST-certified security measures protecting all data sources

Decisions Made Quickly
Decisions Made Quickly

Real-time AI analysis for pre-payment detection

Fraudsters are taking increasingly sophisticated steps to avoid detection. This technology will give insurers the edge they need to identify patterns and connect the dots across a huge pool of claims data over time, leading to more investigations and prosecutions.
— Stephen Frank, President and CEO of Canadian Life and Health Insurance Association (CLHIA)

Let's work together to transform insurance decision making!

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