Shift Technology is all about automating and optimizing decisions. Meanwhile, the SIU has relied on manual decision making throughout most of its history. This can sometimes put the SIU at odds with artificial intelligence.
Meanwhile, the next generation of insurance organizations needs to rely on digital processes. Since 2020, 85% of insurance CEOs have begun to accelerate digitization. No business unit can be left behind.
The SIU plays a valuable role in the claims lifecycle, but it will act as a roadblock for claims if it can’t act at digital speed. Unfortunately, a benchmarking study from 2020 showed the SIU accepting fewer automated referrals. In 2017, 22% of fraud cases were referred from automated systems – but in 2019, that number was just 15%.
Here at Shift, we’ve learned a few lessons about AI adoption. Here are three ways that we can make sure that the SIU embraces assistive technology in the form of AI.
Triaging fraud cases on a per-employee basis
All SIU employees are fraud experts, but some have expertise in different areas. Some might specialize in fraud cases involving PIP claims, and others might specialize in collision repair fraud. There are also SIU team members who may be trying to build skills by taking on more challenging cases.
In a purely rules-based fraud detection approach, SIU team members might get assigned cases as they come in, regardless of specialization. The alternative is to manually assign claims as they enter the queue, which adds time to the investigation process.
AI solutions can automatically triage fraudulent claims towards the investigators that are best positioned to resolve them. In other words, it knows that Bob resolves PIP fraud cases 24% faster than the rest of the team, and it takes fractions of a second to identify PIP cases when they occur and prioritize them in Bob’s queue. Meanwhile, the SIU leader is working with Alice to help her upskill, and the SIU solution assigns specialized claims during occasional moments of downtime.
Assigning claims investigations in this way helps the SIU become used to working with AI. That’s because the AI helps investigators work on the cases they’re better at solving, the cases that they know more about, and the cases they’re trying to learn more about. In other words, it contributes to a more interesting and fulfilling work environment.
Adding context to insurance fraud cases
The nature of insurance fraud investigations is changing whether the SIU adopts AI or not. One big change? A decreasing number of field investigators. From the Coalition Against Insurance Fraud 2020 Survey, the number of desk-based investigators doubled between 2015 and 2016.
For desk-based investigators to work effectively, they need to keep up with claims volumes while having access to a more limited set of intelligence. Instead of going out and taking photos, the default approach is to manually sort through a large volume of uncategorized information, which might include accident photos, social media posts, handwritten notes, etc.
Shift’s AI solution is trained on insurance information and is designed to ingest and categorize unstructured data. The solution adds context to the materials of an insurance fraud investigation, and can flag the data that’s most interesting and useful. For example, Shift can run a daily batch audit on individuals with long-term disability claims and highlight information, such as social media posts, that might indicate that they’re faking illness.
For investigators, this feature makes the investigative process easier. There’s less sorting through materials, less fieldwork, and more closing cases. Here, assistive technology makes investigators’ lives easier.
Recommending the next approach
When an investigator uncovers clear evidence of fraud, the next question is “what do you do next?” Do you try to recover funds or revoke payments? Do you cancel the policy? Do you refer the case for legal action?
Making these decisions is never easy, especially when digital insurance workflows require them to be made faster and more accurately. With AI solutions, these decisions can be made better. Shift’s solution, for example, can provide a recommended action that allows the investigator to make a decision with a single button press. The investigator doesn’t need to send an email, talk on the phone, or file a ticket – these processes are completely automated so that the investigator can proceed smoothly to the next item in the queue.
AI acceptance makes fraud investigations faster, easier, and more interesting
At Shift Technology, we believe that automating and optimizing decisions is key to AI adoption. The resulting benefit isn’t – and shouldn’t be – subtle. Investigators who fully adopt AI need to see that the solution helps magnify the most interesting and rewarding aspects of their role while Shift solves everything else. With acceptance from the SIU, the organization is that much further along the road to full digitalization – and becoming a true next-gen insurer.
Shift Technology provides a fully-supported AI solution that’s specialized for the insurance industry and primed for adoption. For more information, contact us today.
