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Health Insurance

Shifts empowers health insurers to deliver excellent patient care whilst protecting against errors, fraudulent activity and waste and abuse through healthcare-trained AI.

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Staying ahead calls for an evolved approach

Invoice errors, payment dupliation and fraud, waste and abuse costs UK health insurers billions of pounds every year and can negatively impact the care of genuine patients. With a huge backlog of investigations, pressure to pay on time, lengthy manual processes, lack of insights and prioritisation, health insurers need to evolve their approach to meet the growing demand for private health insurance and care.

£B+

£10B+ value of health claims analysed

M+

50M+ Lives Covered Across Shift Customers

£B+

£1B+ Healthcare Fraud, Waste & Abuse Detected

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200+ Insurance Focused Data Scientists

Shift brings AI accross the health insurance claim lifecycle

Helping health insurers deliver a streamlined claims process across member and provider interactions, billing and payments, with the unparalleled support of our cutting-edge AI solutions.

Claims Triage
Prepay FWA Detection
Postpay FWA Detection
Investigation and Document Review
Case Management

Claims Document Decisions

Analyse structured and unstructured data in documents, illuminating inconsistencies and suspicions.

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Financial Crime Detection

Support AML, KYC, and related risk management and compliance processes.

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Fraud, Waste, & Abuse Detection

Generative AI validation of claims and supporting documentation.

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Other Shift health products

Fraud, Waste, & Abuse Detection

Real time scenarios flagging potential FWA ahead of member or invoice payment.

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Other Shift health products

Fraud, Waste, & Abuse Detection

Hundreds of health trained scenarios for flagging potential FWA across health lines.

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Subrogation Detection

Insurance trained AI, illuminating recovery options and third party payment errors that are commonly missed with manual checks.

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Other Shift health products

Fraud, Waste, & Abuse Detection

Full alert context with supporting materials including external data, claims history and documents.

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Financial Crime Detection

Support AML, KYC, and related risk management and compliance processes.

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Subrogation Detection

Insurance trained AI, illuminating recovery options and third party payment errors that are commonly missed with manual checks.

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Other Shift health products

Fraud, Waste, & Abuse Detection

Workflow for rapid case management, audit trails and comprehensive reporting.

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Other Shift health products

Time to shift away from the traditional FWA approach

Overwhelmed NHS services and post COVID queues have driven nearly a quarter of the UK popoulation to seek alternative care from the private system and with it an incerase in the number of fraudsters. Whilst this growth in demand is an oppourtunity for health insurers, it has highlighted that exisiting investigation and audit teams, that were already stretched, need to find a way of ramping up without breaking the budget.

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Shift does in a matter of minutes what would take days for a team of analysts to complete, and Shift does it with incredible accuracy.
Alex Punsalan, Senior Vice President at Assurant
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Learn how Shift AI can help you automate and optimise critical decisions

 

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