Shift P&C Claims Intake Decisions

1 review

P&C Claims Intake Decisions provides insurance companies with a SaaS solution designed to improve and scale fraud detection.

P&C Claims Fraud Detection

0 reviews

Make Decisions on Suspicious Claims More Quickly and Accurately.

P&C Claims Document Decisions

0 reviews

Shift Claims Document Decisions is an AI-powered solution designed to streamline the insurance claims process by automating the analysis of claim-related documents. By leveraging advanced artificial intelligence models specifically trained on insurance documents, the system accurately extracts relevant information, creating a contextual overview of necessary action items to advance each claim. This automation significantly reduces the time claims handlers spend on manual document reviews, allowing them to focus on more complex and value-added tasks. Key Features and Functionality: - AI-Powered Document Analysis: Automatically ingests and interprets all claims documents, including handwritten notes and typewritten forms, to identify and extract key information. - Contextual Insights: Provides a comprehensive view of each claim by evaluating documents against available data, facilitating informed decision-making. - Timely and Comprehensive Alerts: Delivers relevant alerts on document data requiring review, with detailed breakdowns of confirmed claims information. - Seamless Integration: Integrates with existing claims management systems to enhance workflows with accurate AI-based decisions. - Operational Efficiency: Minimizes manual reviews and directs handlers to claim details requiring action, thereby improving overall efficiency. Primary Value and Problem Solved: Shift Claims Document Decisions addresses the challenge of time-consuming manual document reviews in the insurance claims process. By automating the extraction and analysis of information from claim documents, the solution accelerates claim processing times, enhances accuracy, and improves operational efficiency. This leads to faster claim settlements, reduced operational costs, and an enhanced experience for policyholders.

Healthcare Improper Payment Detection

0 reviews

Shift Technology's Improper Payment Detection is an AI-driven solution designed to help health insurers identify and prevent improper payments, including fraud, waste, and abuse . By leveraging advanced artificial intelligence and business intelligence logic, this automated system analyzes vast amounts of healthcare data to uncover suspicious claims, provider relationships, and member behaviors. It empowers insurers to streamline claim payments, enhance provider network performance, and improve patient outcomes while maintaining regulatory compliance. Key Features and Functionality: - AI-Powered Analytics: Utilizes healthcare-trained AI models to detect suspicious claims and behaviors across multiple entities, including individual providers, provider networks, third parties, and plan members. - Comprehensive Data Integration: Combines enhanced plan data with extensive external data sources to provide actionable insights, enabling faster and more accurate investigations. - Holistic Claims Lifecycle Approach: Identifies improper payments by analyzing behaviors and actions across the entire claims process, uncovering anomalies in care delivery that may impact patient experience. - Actionable Insights: Delivers contextual alerts with recommended actions, allowing investigators to prioritize high-value cases and optimize resource allocation. - Flexible Integration: Designed to work with any data in any format, ensuring seamless integration into existing systems and workflows. Primary Value and Problem Solved: Shift Improper Payment Detection addresses the significant challenge of improper payments in the healthcare industry, which cost health insurers over $100 billion annually. By providing a sophisticated, AI-driven solution, it enables insurers to: - Reduce Financial Losses: Effectively identify and prevent improper payments, minimizing financial losses due to FWA. - Enhance Operational Efficiency: Streamline investigative processes by providing comprehensive, centralized information, reducing the time spent gathering data and improving investigator efficiency. - Improve Patient Care: Detect anomalies in care delivery and member behaviors, leading to better patient outcomes and enhanced member quality of care. - Optimize Provider Networks: Identify suspicious relationships within provider networks, enabling insurers to take corrective actions and improve provider performance. By transforming vast healthcare data into actionable insights, Shift Improper Payment Detection empowers health insurers to proactively combat FWA, optimize operations, and deliver higher-quality care to their members.

P&C Underwriting Risk Detection

0 reviews

Shift Technology's Underwriting Risk Detection is an AI-powered solution designed to help insurers identify and mitigate risks and fraud throughout the policy lifecycle. By leveraging advanced artificial intelligence, this tool enables underwriters to detect complex risks, optimize pricing, and uncover policy risk trends such as agent gaming, ensuring a seamless and secure insurance experience for customers. Key Features and Functionality: - Entity Resolution: Uncovers hidden histories and connections between policyholders, both past and present, to reveal prior claims and potential fraud. - Network Detection: Identifies and analyzes complex fraud networks, enabling insurers to detect and prevent organized fraudulent activities. - Agent Gaming Detection: Recognizes patterns where agents may manipulate policy details to gain unfair advantages, ensuring integrity in the underwriting process. - Real-Time Risk Assessment: Provides immediate analysis during policy quotes and applications, allowing for swift identification of potential risks without delaying the customer experience. - Integration with Core Systems: Seamlessly integrates with insurers' existing core systems and underwriting tools, facilitating efficient workflows and data utilization. Primary Value and Problem Solved: Underwriting Risk Detection addresses the critical challenge of identifying and preventing fraud and misrepresentation at various stages of the policy lifecycle. By implementing this solution, insurers can: - Enhance Underwriting Accuracy: Utilize AI-driven insights to make informed decisions, reducing the likelihood of issuing policies to high-risk or fraudulent applicants. - Improve Operational Efficiency: Automate routine underwriting tasks, allowing underwriters to focus on complex cases and strategic decision-making. - Optimize Pricing Strategies: Accurately assess risk to set appropriate premiums, ensuring competitiveness and profitability. - Protect Genuine Customers: Quickly identify and address fraudulent activities, ensuring that legitimate customers are not inconvenienced by the actions of bad actors. By integrating Underwriting Risk Detection, insurers can proactively manage risks, enhance customer trust, and maintain a robust and profitable underwriting portfolio.

P&C Subrogation Decisions

0 reviews

Shift Subrogation Decisions is an AI-driven solution designed to help Property & Casualty insurers enhance their subrogation processes and maximize recovery outcomes. By leveraging advanced artificial intelligence algorithms, the software analyzes claims data to identify subrogation opportunities that might otherwise be overlooked. This approach enables insurers to reduce claims leakage, improve operational efficiency, and provide a superior customer experience. Key Features and Functionality: - AI-Driven Analysis: Utilizes sophisticated AI to pinpoint claims with high recovery potential. - Prioritized Recommendations: Offers prioritized action recommendations, guiding claims professionals on effective steps for each case. - Timely and Comprehensive Alerts: Delivers prompt alerts to ensure handlers are informed of potential subrogation opportunities. - Reduced False Positives: Minimizes false positives, allowing handlers to focus on productive leads. - Consideration of Local Handling Requirements: Accounts for local handling requirements, ensuring compliance and optimizing recovery efforts within specific jurisdictions. Primary Value and Problem Solved: Shift Subrogation Decisions addresses the significant challenge faced by insurers who miss out on an estimated $20 billion annually in potential recoveries. By automating the detection of subrogation opportunities and providing actionable insights, the solution reduces claims leakage, enhances recovery rates, and improves overall productivity. This leads to faster claim resolutions and a better customer experience, as insurers can efficiently recover costs from third parties, ensuring policyholders are promptly compensated.

P&C Financial Crime Detection

0 reviews

Shift Technology's P&C Financial Crime Detection is an AI-powered solution designed to help property and casualty insurers combat financial crimes such as money laundering and fraud. By automating critical processes like entity identification and compliance checks against sanctions, watchlists, and adverse media, the platform enables insurers to detect and prevent illicit activities in real time, ensuring regulatory compliance and protecting their reputation. Key Features and Functionality: - Automated Compliance Checks: Streamlines Know Your Customer (KYC and Anti-Money Laundering (AML processes by automating screenings against sanctions lists, watchlists, and adverse media sources. - Entity Resolution: Utilizes advanced algorithms to minimize false positives through deduplication and data cleansing, enhancing the accuracy of fraud detection. - Configurable Screening: Allows customization of screening algorithms and the ability to toggle specific lists on or off, tailoring the detection process to specific requirements. - Comprehensive Data Analysis: Aggregates vast amounts of data to provide a 360-degree view of individuals and organizations, facilitating thorough risk assessments. - Audit Trail and Reporting: Maintains a full digital trail with customizable dashboards, enabling efficient monitoring and reporting for audits. Primary Value and Problem Solved: The P&C Financial Crime Detection solution addresses the critical need for insurers to efficiently detect and prevent financial crimes, which are estimated to cost the U.S. approximately $300 billion annually. By automating labor-intensive compliance tasks, the platform accelerates customer onboarding, reduces manual errors, and ensures adherence to regulatory standards. This not only mitigates the risk of costly fines and reputational damage but also enhances operational efficiency, allowing insurers to focus on delivering superior service to legitimate policyholders.

Shift Technology

0 reviews

Shift Technology delivers AI decisioning solutions to benefit the global insurance industry and its customers. Our products enable insurers to automate and optimize decisions from underwriting to claims, resulting in superior customer experiences, increased operational efficiency, and reduced costs. The future of insurance starts with Decisions Made Better. Learn more at www.shift-technology.com