Delivered as a fully-integrated add-on module for the company's award-winning Shift Claims Fraud Detection, Case Management provides an end-to-end workflow designed to meet the specific needs of SIUs as they investigate suspicious claims from referral to closure.
According to the Coalition Against Insurance Fraud, insurers are subject to more than
'When considering how to best combat insurance fraud it is important to remember that finding the suspicious claim is just the beginning of the process for claims professionals and investigators,' commented
Shift spearheaded the use of artificial intelligence (AI) to help insurance professionals make the best decisions possible throughout the claims and underwriting lifecycle. Now, Shift is advancing the state of the art in case management by applying AI to this important business function. Shift's case management solution offers key capabilities including: Unified and Integrated Fraud Investigation Management: The solution supports end-to-end workflow from referral generation to impact management across all lines of business and referral sources. As such, the case management module's UI, workflows and reporting are seamlessly integrated with the fraud detection system already in use which allows for direct access to all of the internal and external data sources relevant to investigating the case. This enables efficient case investigations by eliminating the need for investigators to switch between disparate, siloed environments - which often occurs when using stand-alone case management tools - as they move from the detection to investigation phase.
Designed for Individual and Major Case Investigations: Recognizing that all cases are unique, Shift's case management module includes capabilities designed to support the most complex multi-claim provider and network investigations as well as opportunistic and/or individual fraud. These include tailored workflows, network visualization and exploration, and advanced documentation for understanding case impact on claims losses.
Intelligent Investigation: Shift's AI capabilities support and accelerate case investigation with intuitive tools that cover automated assignment management, identification of team tasks, and structured collection and storage of evidence, among others. Using Generative AI, investigators are also able to search the entire case file, across both structured and unstructured data, to efficiently summarize key documentation and reduce investigation time.
Strategic Insights: The case management module features continuous tracking and reporting of fraud trends and investigation performance, such as dollar impact, time to closure, and task and team/investigator performance analysis. These insights are invaluable to ongoing SIU team training, organization and efficiency.
Compliance and Security: To ensure regulatory compliance, the solution includes detailed audit trail as well as advanced access management and permission features. These can be tailored at a case level and are delivered in a highly secure, confidential environment. Role-based permission and management ensures that individual users are granted secure and role-appropriate access to their respective case data and workflows.
'When a suspicious claim is identified, it is up to the SIU to investigate and determine if it is truly fraudulent or not,' explained
Availability
Case Management for Shift Claims Fraud Detection is available now for current customers. Case management modules for Shift Subrogation Detection and Shift Underwriting Risk Detection are planned for 2024.
About
Contact:
Tel: +1.617.416.9216
Email: rob.morton@shift-technology.com
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