That’s what insurance fraud costs our industry every year according to the FBI.
And, what makes it worse is that these costs are passed onto the policyholder in the form of increased premiums resulting in the average family paying $400-$700 per year to cover fraud.
To help our insurers battle fraud and keep insurance affordable for families, we added Shift Technology to our partner community and existing contingent of fraud fighting superheroes.
Who?
Shift Technology delivers an AI-native, SaaS-based fraud detection solution. The company leverages data science and insurance claims experience to proactively detect fraud on a claim, from intake through to claim payment and closure.
What is its value proposition?
According to Shift, the company’s Force fraud detection solution leverages a large and growing body of data from both internal and third-party sources in their fraud detection models to deliver a 75% Hit Rate. The Hit Rate describes the accuracy of a fraud detection solution in terms of the percentage of claims the solution deems as potentially fraudulent that the insurer then ultimately deems suspicious and worthy of investigation upon human review.
Using AI, Shift claims that Force detects complex fraud patterns and highlights the associated pattern of fraud. Some variables increase suspicion in some fraud scenarios but decrease suspicion in others. The weighting is built into the solution based on known fraud scenarios and informed by hundreds of millions of claims analyzed to date. Shift uses reinforcement learning to improve fraud detection based on the investigator’s or claims handler’s feedback on its alerts.
In the Force Summary screen, a score is generated based upon analysis of claim file details.
The adjuster is provided with the list of variables that were used to formulate the score. My personal favorite? Trying to sell your car right before its stolen… nice try.
This score will then trigger a workflow either human or automated depending upon the insurer’s risk appetite.
The opportunity?
Shift serves many of our customers today.
Using the Shift Ready for Guidewire add-on, Force now integrates with our ClaimCenter solution to generate a fraud score on the claim file after claim data is sent to and processed by Shift. The fraud score is updated based on lifecycle events like adding a party, adding a note, etc. and can trigger automated claims processing within ClaimCenter including referral to an SIU team.
Want more detail?
Click on the image below to watch a demo from DigIn. Start the video at 5:30. This is when the fraud screens are demonstrated.
For more information on other insurtech solutions available for integration with Guidewire today, visit the Guidewire Marketplace at https://marketplace.guidewire.com/.