AI-Native Fraud Detection

AI-Native Fraud Detection for the Global Insurance Industry THE SITUATION: INSURANCE FRAUD COSTS BILLIONS GLOBALLY 10-20% of all insurance claims contain some element of fraud, but only a small fraction of that fraud is detected. Globally, insurers stand to lose hundreds of billions in revenue to this pervasive issue. Historically, detecting fraud has been a costly, inefficient process. That’s why we built FORCE. It’s the only AI-native, SaaS-based fraud detection solution in the world, trusted globally by leading insurers to detect fraudulent claims and organized fraud networks accurately and efficiently at scale. AI + SAAS + WORLD CLASS DATA SCIENTISTS = FORCE FORCE HIGHLIGHTS FORCE detects and provides context for a wide range of fraudulent activities, from opportunistic claim exaggerations to schemes executed by organized crime networks. It’s a SaaS+ solution that combines sophisticated AI and human data science expertise, HIT RATE replicating and multiplying the deductive capabilities of an insurer’s best fraud handlers. 35% (Industry SUSPICIOUS average) CASES AI-NATIVE FRAUD DETECTION WITH A 75% HIT RATE Vs Once FORCE is configured, each claim is run against an evolving library of hundreds of HIT RATE 75% fraud scenarios – statistical patterns trained on historical datasets at the customer and Shift industry levels – to detect claims matching existing fraud patterns. FORCE then applies additional AI techniques to each claim such as “privileged learning” algorithms and natural HIT RATE = language processing (NLP) of text variables. N° OF ALERTS DECLARED SUSPICIOUS BY THE FRAUD HANDLER rd Next, FORCE uses a wide range of 3 party data to develop a full picture of each claim N° OF ALERTS SUBMITTED BY FORCE with speed and accuracy at scale. From weather conditions and satellite imagery to social media monitoring and more, FORCE contextualizes and expands claim data. It then uses this enhanced body of data to assign each claim a numerical score representing • AI-native SaaS solution the likelihood of fraud. • Built by world-class Data Scientists The solution delivers automated alerts to internal team members, who can access claim with deep industry expertise data through FORCE’s flexible, intuitive UI. In addition to scoring, FORCE flags specific • Hundreds of fraud scenarios aspects of the claim for further review, supplies reasoning for all fraud indicators in clear constantly evolving business language, prioritizes investigative avenues, and presents the ‘packaged’ individual claim and network fraud data in a single, customizable dashboard. • Hundreds of millions of claims processed to date FEWER FRAUDULENT CLAIM PAYOUTS, INCREASED EFFICIENCY • Addresses individual claims + FORCE helps insurers detect and reduce payouts on non-meritorious claims accurately network fraud and efficiently. It speeds claim resolution and keeps customer teams focused on the • Transparent Analytics access activities where their skills will be most valuable. At the same time, FORCE playes an to scenarios + data important role in straight through processing (STP), enabling Shift’s Luke solution to fully • ROI in as few as four months automate claims without increasing the risk of fraudulent claim payments. FORCE also identifies and maps organized fraud networks, providing detailed, actionable information to address this critical problem. shift-technology.com