How fraud detection improves buyer expertise


“We matter as a result of we will present a stage of assist … to insurance coverage carriers at the moment to make them extra environment friendly and to supply a greater buyer expertise,” Donovan mentioned.

In different phrases, fraud detection has implications properly past simply detecting fraud.

“In phrases of fraud detection, with the ability to put automated detection on the entrance of our claims course of to assist determine claims, it’s not nearly discovering fraud but it surely’s serving to a consumer to section and determine the meritorious claims as properly,” Donovan mentioned. “You solely need to kick out the claims which have some anomalous sample, or points, or behaviors, related to them. Otherwise, you need that consumer to have a seamless buyer expertise.”

Shift’s know-how permits this by automating and dashing up fraud and claims processes {that a} consumer firm can leverage extra broadly throughout the group, Donovan mentioned.

Shift launched in 2014 in Paris and grew in Europe and Asia earlier than initially increasing to the US market in 2018. Its US headquarters is in Boston.

To date, Shift has raised $320 million in enterprise funding general, cash that has fueled an accelerated enlargement within the US market in addition to a shift into healthcare. The firm employs 500 individuals and counting.

Shift has 135 clients globally, together with greater than 30 within the US alone. In the US, that covers 5 of the highest 10 insurers and quite a few midsize super-regional carriers, based on Donovan. The firm works with European insurers reminiscent of AXA and has additionally generated “a really massive footprint” within the healthcare market there, he added.

Major US clients embody Assurant, CNA, Central Insurance, Falcon Insurance and Elephant.

The tech particulars

Shift’s core product is its claims fraud detection platform, in the marketplace since 2014. Since then, the corporate has developed add-ons targeted on underwriting fraud detection, subrogation detection and claims selections – all a part of an SaaS [software-as-a-service] method.

The core platform takes core knowledge and works with it in advanced methods.

“We use all of a consumer’s knowledge … all the pieces that’s associated to the declare from the primary discover of loss by way of the lifetime of a declare,” Donovan mentioned.

That consists of onerous knowledge fields, in addition to unstructured knowledge reminiscent of declare notes, medical payments, estimates, paperwork and buyer pictures.

Shift manages, normalizes, reconstructs and cleanses the info to organize it for analytics.

The firm’s method stands out, he mentioned, as a result of Shift’s fraud detection focuses solely on insurance coverage and depends closely on knowledge science.

“We spent all of our time constructing our firm round insurance coverage P/C and healthcare, so we’ve received a really massive knowledge science staff and that’s their space of experience,” Donovan mentioned. “With a number of different gamers out there, round fraud specifically, they play in a number of verticals. They’re doing banking and bank cards, they’re doing different stuff … we’re targeted simply on insurance coverage.”

Customer integration

Shift begins a buyer integration course of by having the consumer ship it knowledge for evaluation.

“We do all of the heavy lifting on that, and the consumer can ship us their knowledge in any format. We map it to our knowledge fashions, we clear that knowledge, we do the info reconstruction – we do all that work behind the scenes,” Donovan mentioned.

Next, Shift applies analytics to the info and produces related output for the client.

Here’s the way it can work: Shift has a standalone devoted person interface designed to be simple to make use of for the purchasers. Through that, the corporate would challenge a situation after evaluating the info explaining why it believes fraud is in play, showcasing underlying variables that assist its case.

Customers then get hyperlinks to supporting knowledge pulled both from their claims system or exterior knowledge sources.

At that time, a consumer can select to be built-in into the system, by way of APIs so Shift can push output from its fashions into the person interface straight right into a consumer’s core declare system.

Shift additionally expedites the method by way of partnerships with Guidewire, Duck Creek and Sapiens, amongst others – all firms that offer platforms and methods for a lot of carriers. By doing so, Shift purchasers can linkup extra simply to Shift’s platform.

Integration can run from weeks to a couple months, relying on the consumer.

“There’s usually work the consumer has to do on their facet to arrange their atmosphere for the connector,” Donovan mentioned.


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