Real-time analysis to help insurers to combat estimated $40 billion in industry annual fraud losses
Shift Technology, a provider of AI‑native fraud detection and claims automation solutions for the global insurance industry, and Guidewire Software, provider of the industry platform Property and Casualty (P&C) insurers rely upon, announced that Shift’s Force add-on for ClaimCenter, created using the Guidewire DevConnect developer environment, is now available in the Guidewire Marketplace. Shift’s Ready for Guidewire add-on provides Guidewire customers on ClaimCenter a seamless integration between Shift’s Force fraud detection solution and ClaimCenter, enabling the efficient transfer of claims data between the two solutions and facilitating real-time fraud detection.
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The total cost of insurance fraud in the U.S. is estimated to be more than $40 billion per year and costs the average family $400-700 per year in increased insurance premium according to the FBI. To address the growing and complex issue of insurance fraud and control premiums for policyholders, Shift’s Ready for Guidewire Force add-on, integrated with Guidewire ClaimCenter, automatically triggers fraud alerts in the ClaimCenter electronic claim file and directs the workflow into the appropriate automated or human-based process best suited for the type and level of suspected fraud.
Shift offers insurers technology solutions that use artificial intelligence and advanced data science to identify claims that may be fraudulent. Using a combination of insurers’ internal data, and external, third-party data, the company’s Force solution makes correlations between these multiple sources to identify suspicious behavior that may indicate that a claim is not legitimate.
“The ability to share data and information between ClaimCenter and Force, in real time, offers tremendous benefits to our joint customers,” stated Jeremy Jawish, CEO and co‑founder, Shift Technology. “By knowing if a claim is suspicious or not, and just how suspicious it is, claims professionals will be better empowered to make business-critical decisions. For example, should they apply ‘straight through processing’ and pay the claim at the time of FNOL or carry out standard processing by the claims handling team? Perhaps they should bring in an expert to verify particular details or refer the claim to the fraud investigation team. Our partnership helps give claims professionals the knowledge to make the best decision possible.”
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The Force add-on for ClaimCenter allows insurers to:
- Send claims from ClaimCenter to Force for real-time fraud analysis;
- Keep ClaimCenter up to date with the status of fraud investigations; and
- Customize the level of information provided to claims representatives.
“While speed and accuracy are critical elements to delivering an exceptional customer experience in the insurance industry, the prospect of fraud within the claims process often limits just how quickly a claim can be settled,” explains Becky Mattick, vice president, Global Solution Alliances, Guidewire. “With a fraud assessment available in seconds, through Shift’s Ready for Guidewire integration, Guidewire customers can make smarter, faster and more efficient decisions about how to triage claims, unlocking greater opportunities for straight-through processing, shortening the claims process, and delivering on policyholder expectations.”
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