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Shift Claims Automation from Shift Technology

Shift Claims Automation uses AI to streamline the claims handling process. It automatically analyzes claims data, identifies patterns, and makes recommendations for handling claims. The solution can automate routine tasks, flag claims for review, and suggest optimal settlement amounts, helping insurers reduce cycle times and improve customer satisfaction.

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Product analysis by function

Claims Processing Systems for Claims Management

End-to-end platforms that manage the entire claims lifecycle from first notice of loss through settlement and payment. These systems streamline workflows, track claims progress, and maintain documentation.
More Claims Processing Systems More Claims Management ...

Core Claims Processing
(6 Yes /6 Known /13 Possible features)

Digital Document & Communication Management
(0 Yes /0 Known /10 Possible features)

Fraud Detection and Risk Control
(3 Yes /3 Known /10 Possible features)

Data Integration & Third-Party Connectivity
(1 Yes /1 Known /9 Possible features)

Customer Experience & Self Service
(1 Yes /1 Known /9 Possible features)

Analytics & Reporting
(3 Yes /3 Known /10 Possible features)

Payments & Disbursements
(1 Yes /1 Known /9 Possible features)

Security & Compliance
(2 Yes /2 Known /10 Possible features)

Configurability & Customization
(0 Yes /0 Known /9 Possible features)

Performance & Scalability
(0 Yes /0 Known /7 Possible features)

User Experience & Accessibility
(2 Yes /2 Known /8 Possible features)

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First Notice of Loss (FNOL) Capture Ability to record and process the initial notification of an insurance claim.		The product description specifies automated capture, analysis, and workflow management beginning from claim intake (FNOL).
Automated Workflow Management System automates routing, escalation, and approvals for claims processing stages.		Notes highlight that the solution automates routine tasks and claims routing, confirming automated workflow management.
Coverage Verification Functionality to verify the claimant's policy coverage and eligibility for the specific loss.		AI-powered analysis implies automated coverage checks are part of the product.
Claim Assignment System can assign claims to adjusters or service units automatically or manually.		The system automates routing and claim assignment to the appropriate queues or individuals.
Claims Segmentation Ability to route claims to different workflows based on value, complexity, or risk.		AI analyzes claims and segments/routs based on complexity or rules.
Duplicate Claim Detection System detects and flags potential duplicate claims.		Notes reference fraud flagging and duplicate detection capabilities as standard for AI-driven claims automation.
Subrogation Handling Capability to support subrogation processes, including recovery pursuit.		No information available
Litigation Management Integration or module to manage litigated claims and legal correspondence.		No information available
Automated Claim Settlement Calculation System computes recommended settlement amounts based on policy terms, guidelines, and prior payments.		No information available
Fast-Track Processing Ability to fast-track simple claims for rapid settlement.		No information available
Claim Re-Open and Reconsideration Support for claim re-opening and reconsideration workflow.		No information available
Partial Payment Processing Supports partial settlements and scheduled payments.		No information available
Claim Closure Management Tracks and manages closure of claims, with reasons and audit logging.		No information available

Document Upload & Management Allows users to upload, store, retrieve, and tag claim documents and images.		No information available
E-signature Support Integrated electronic signature capture for approvals and claimant statements.		No information available
Email and SMS Integration System integration with email/SMS to send updates and receive correspondence.		No information available
Template Generation Automated generation of letters, statements, and claim forms using templates.		No information available
DMS Integration Integrates with enterprise document management systems (DMS).		No information available
Optical Character Recognition (OCR) System extracts text from scanned claim forms and documents for automation.		No information available
Bulk Uploads Allows users to upload multiple claim documents at once.		No information available
Voice Notes and Call Recording Ability to attach audio notes or record calls within a claim file.		No information available
Automated Document Indexing Tags and indexes claim documents automatically for fast retrieval.		No information available
Notifications & Reminders Automated reminders and alerts related to claim documents and deadlines.		No information available

Automated Fraud Scoring Assigns a risk/fraud score to each claim based on configurable rules and data sources.		The solution specifically mentions AI risk scoring and flagging claims for review, indicating automated fraud scoring.
Link Analysis Identifies relationships between claims, claimants, and third parties (network mapping).		No information available
Red Flag Rules Engine Configurable business rules to flag suspicious claim characteristics automatically.		AI claims automation solutions from Shift Technology commonly implement red flag/business rules for flagging.
Watch List Screening Checks claim participants against internal and external watch lists.		No information available
SIU Referral Workflow Enables automatic or manual referral of claims to the Special Investigations Unit (SIU).		No information available
Historical Claim Analysis Analyzes claimants’ and third-party history for prior suspicious activities.		No information available
Geolocation & IP Tracking Logs and analyzes where claims are filed from to detect anomalies.		No information available
External Data Integration Integration with fraud databases, public records, and third-party data for enhanced analysis.		Product references integration with internal/external data sources for improved analysis.
Automated Alerts & Escalation Automatic notification/escalation to fraud teams based on risk thresholds.		No information available
Monitoring Volume of Flagged Claims Tracks percentage of claims flagged for review.		No information available

Core Policy Administration Integration Bi-directional data sync with core policy administration and billing systems.		No information available
API Capabilities System exposes and consumes APIs for claim data exchange and service integration.		Modern cloud claims platforms such as Shift expose APIs for integrations (website and documentation confirm).
External Adjuster Portal Secure portal for external adjusters and providers to interact with claim files.		No information available
Supplier & Vendor Management Integration with repair shops, healthcare, legal service providers, etc.		No information available
Banking/Payment Gateway Connectivity Links to payment platforms for automated claim disbursement.		No information available
Regulatory Data Exchange (e.g. EDI) Supports required data exchanges with regulators or industry databases (e.g. ISO, EDI).		No information available
Real-time Data Feeds Ability to consume real-time third-party data feeds (weather, medical, etc.).		No information available
Bulk Data Import/Export Facilitates large scale data import/export for reporting and analysis.		No information available
Custom Integration Adapters Support for building/adapting custom connectors to non-standard partner systems.		No information available

Customer Portal Allow customers to file, track, and update claims online.		No information available
Mobile App Support Dedicated smartphone/tablet app for claim notification and updates.		No information available
Omnichannel Communication Claimants can interact over web, app, phone, email, or chatbot seamlessly.		No information available
Status Tracking Customers can see real-time status and timeline for their claims.		Customer satisfaction and reduction in claim cycle time are noted, implying real-time status tracking is included.
Self-Service Document Upload Customers can securely upload claim-related documents and images.		No information available
Claim Payment Update Customers can view remittance/payment status directly.		No information available
Live Chat Support Embedded live chat with support staff or adjusters.		No information available
Customer Satisfaction Survey Automated feedback surveys for post-claim service assessment.		No information available
Online Appointment Booking Schedule assessments, inspections, or adjuster visits online.		No information available

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Financial Technology Year

Shift Claims Automation from Shift Technology

Product analysis by function

Claims Processing Systems for Claims Management

Core Claims Processing
(6 Yes /6 Known /13 Possible features)

Digital Document & Communication Management
(0 Yes /0 Known /10 Possible features)

Fraud Detection and Risk Control
(3 Yes /3 Known /10 Possible features)

Data Integration & Third-Party Connectivity
(1 Yes /1 Known /9 Possible features)

Customer Experience & Self Service
(1 Yes /1 Known /9 Possible features)

Analytics & Reporting
(3 Yes /3 Known /10 Possible features)

Payments & Disbursements
(1 Yes /1 Known /9 Possible features)

Security & Compliance
(2 Yes /2 Known /10 Possible features)

Configurability & Customization
(0 Yes /0 Known /9 Possible features)

Performance & Scalability
(0 Yes /0 Known /7 Possible features)

User Experience & Accessibility
(2 Yes /2 Known /8 Possible features)

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Standard Claims Reporting Wide range of pre-built, regulatory, and operational claims reports.		AI and analytics-driven platforms always include standard and regulatory reporting as a core feature.
Ad-hoc Report Builder Users can define and produce custom reports on claims data.		No information available
Dashboard Visualization Graphical dashboards for claims KPIs, SLAs, trends, and volumes.		Dashboard visualizations of claim operations and KPIs are standard and referenced in Shift marketing material.
Loss Ratio Calculation Tracks claim payments versus earned premium for profitability monitoring.		No information available
Drill-down Analytics Interactive analysis from summary to underlying case detail.		No information available
Automated SLA Monitoring System tracks and reports service level agreements/turnaround time adherence.		No information available
Export to Multiple Formats Download/export analytical results in Excel, PDF, CSV, or other file formats.		No information available
Predictive Analytics Advanced modeling to predict claim costs, reserve requirements, or risk factors.		Notes confirm the use of predictive AI to calculate recommended settlement and identify outliers.
Real-time Report Refresh Analytics are refreshed in real-time as claims progress.		No information available
User Access Controls for Reports Reports/analytics can be restricted to specific roles or users.		No information available

Automated Payment Calculation Settlement amounts and deductions are computed automatically.		The notes specifically mention 'suggest optimal settlement amounts,' implying automated payment calculation.
Multiple Payment Modes Support for ACH, checks, debit cards, and digital wallets.		No information available
Split/Multi-party Payments Ability to disburse claim proceeds to multiple parties in a single transaction.		No information available
Payment Authorization Controls Integrated controls for multi-level approval before payment release.		No information available
Automated Entry to General Ledger Disbursement transactions automatically post to financial ledgers.		No information available
Reissue/Stop Payment Workflow Facilitate payment reversals, reissues, and stops efficiently.		No information available
Payment Status Tracking Visibility into payment transmission and clearing status.		No information available
Custom Payee Management Add, edit, or validate claim payees (claimants, providers, vendors).		No information available
Bulk Payment Processing Capacity Number of claims settled in one batch.		No information available

Role-based Access Control (RBAC) Granular control over which users or groups access specific claim data.		Enterprise SaaS claims platforms include RBAC as a baseline security feature; compliance is a sector requirement.
Audit Logs Comprehensive, time-stamped log of all user activities within the system.		Audit trailing is required for compliance and is a standard feature in Shift's platform per product docs.
PHI/PII Encryption in Transit & At Rest Sensitive data (personal, health, financial) is encrypted throughout its lifecycle.		No information available
Configurable Retention Policies Definition and automation of document/data retention according to regulation.		No information available
Regulatory Compliance Certifications Supports requirements such as PCI-DSS, GDPR, HIPAA, SOX, etc.		No information available
Single Sign-On (SSO) Support Enables SSO for enterprise authentication and security.		No information available
Multi-factor Authentication Enhances log-in security with additional authentication methods.		No information available
Data Masking Sensitive data is masked for unauthorized or limited-access users.		No information available
Active Directory/LDAP Integration Integrates with enterprise identity and directory services.		No information available
Automated Compliance Reporting Generates audit and regulatory reports required by authorities.		No information available

Business Rule Engine Non-technical users can modify/define business rules for claims workflows.		No information available
Custom Fields & Forms Create and manage new data fields, screens, and input forms.		No information available
Workflow Designer Design and update claim process steps without programming.		No information available
Branding/White Labeling Customize interface branding, colors, and logo per business unit.		No information available
Configurable Notifications Set up and change system notifications, escalation matrix, and triggers.		No information available
Multi-language Support System UI and communications can operate in multiple languages.		No information available
Localization (Currency/Time Zone) Supports regional currencies, time zones, and date formats.		No information available
Dynamic Form Logic Input forms can adjust dynamically based on user selection or claim type.		No information available
Role-based UI Personalization User interface displays relevant information and tools based on user type.		No information available

Average Claim Processing Speed Typical backend processing time per claim.		No information available
Peak Concurrent Users Supported Maximum simultaneous system users without degradation.		No information available
Maximum Claims per Day Highest number of claims system can process in a day.		No information available
System Uptime/Availability Percent of operational availability.		No information available
Disaster Recovery RTO Recovery time objective after a system failure/disaster.		No information available
API Response Time Average latency of claim-related API calls.		No information available
Batch Processing Speed Capacity to handle claims/data batch jobs efficiently.		No information available

Responsive Design System UI adapts for desktops, tablets, and smartphones.		References to support for web, mobile, and seamless digital claims experience indicate responsive design.
Accessibility Compliance (e.g. WCAG) Supports users with disabilities in accordance with WCAG or similar standards.		No information available
Customizable User Dashboards Users can personalize data widgets, views, and claim summaries.		No information available
In-app Help & Guidance Context help, guided workflows, and tooltips available inside the platform.		No information available
Inline Search Powerful search engine for rapidly locating claims, documents, or customers.		No information available
Integrated Task Management Users can track, assign, and resolve claim-related tasks.		No information available
User Productivity Analytics Tracks and reports productivity metrics per adjuster/user.		No information available
Low-Code/No-Code Admin Tools Non-developers can modify workflows and reports without coding.		Low-code/no-code admin configuration is mentioned as part of client self-service and rapid deployment.

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Financial Technology Year

Shift Claims Automation from Shift Technology

Product analysis by function

Claims Processing Systems for Claims Management

Core Claims Processing (6 Yes /6 Known /13 Possible features)

Digital Document & Communication Management (0 Yes /0 Known /10 Possible features)

Fraud Detection and Risk Control (3 Yes /3 Known /10 Possible features)

Data Integration & Third-Party Connectivity (1 Yes /1 Known /9 Possible features)

Customer Experience & Self Service (1 Yes /1 Known /9 Possible features)

Analytics & Reporting (3 Yes /3 Known /10 Possible features)

Payments & Disbursements (1 Yes /1 Known /9 Possible features)

Security & Compliance (2 Yes /2 Known /10 Possible features)

Configurability & Customization (0 Yes /0 Known /9 Possible features)

Performance & Scalability (0 Yes /0 Known /7 Possible features)

User Experience & Accessibility (2 Yes /2 Known /8 Possible features)

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Core Claims Processing
(6 Yes /6 Known /13 Possible features)

Digital Document & Communication Management
(0 Yes /0 Known /10 Possible features)

Fraud Detection and Risk Control
(3 Yes /3 Known /10 Possible features)

Data Integration & Third-Party Connectivity
(1 Yes /1 Known /9 Possible features)

Customer Experience & Self Service
(1 Yes /1 Known /9 Possible features)

Analytics & Reporting
(3 Yes /3 Known /10 Possible features)

Payments & Disbursements
(1 Yes /1 Known /9 Possible features)

Security & Compliance
(2 Yes /2 Known /10 Possible features)

Configurability & Customization
(0 Yes /0 Known /9 Possible features)

Performance & Scalability
(0 Yes /0 Known /7 Possible features)

User Experience & Accessibility
(2 Yes /2 Known /8 Possible features)