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An insurer is focusing on the artificial intelligence to detect fraud in group insurance



11 March 2019 13:30

Photo : Freepik

Green Shield Canada and its division of solutions for the management of social benefits, HBM+, have launched a strategy for the detection and prevention of fraud, focused on artificial intelligence, hosted on the new banner Claim Watch.

GSC notes that the data on claims, “which constitute a huge volume in all forms and in all directions,” take a long time to analyze. However, the new platform, the artificial intelligence of the company “not only finds and compiles all sorts of data at lightning speed, but also identifies patterns and special cases less obvious at a level deep enough to detect suspicious activity sooner than in the past,” said the company in its announcement.

A revival in the detection of fraud

“We are very proud of what Green Shiled Canada and HBM + are in the area of detection and prevention of fraud, points out Brent Allen, vice-president of service operations of Green Shield. In the past, the prevention and detection of fraud involved manual processes. The focus was mainly on the monitoring of a trace paper. We were trying to find a needle in a haystack. “

However, the platform changes the game by collecting all the data on claims, health care providers and plan members to form instant information, ” adds Mr. Allen. “The richness of our data is a true differentiator in our industry, and this haystack is quickly becoming less intimidating with a microscope powered by the artificial intelligence. “

With Claim Watch, the detection of fraud is also reinforced by the fact that the demands are settled through a system unique to the platform without being outsourced, ” says Green Shield. In addition, a registry of providers guarantees that the credentials and applicable licenses are in place for any provider submitting claims through the online portal, providerConnect.

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