February 7, 2022

Green Shield Canada’s Claim Watch to participate in data pooling to reduce benefits fraud

Green Shield Canada’s Claim Watch to participate in data pooling to reduce benefits fraud

TORONTO, ONTARIO, FEBRUARY 7, 2022 – Green Shield Canada (GSC), and its Claim Watch fraud investigation team are joining other benefit carriers in a new data pooling initiative led by the Canadian Life and Health Insurance Association (CLHIA). The aim of the initiative is to enhance how benefits fraud is detected and investigated using advanced AI technology.

Claim Watch has used an AI platform to analyze claims and identify benefits fraud since 2017 with positive results and, through our HBM+ division, has cooperated with other national carriers and third-party administrators to advance our fraud detection capabilities and outcomes. The CLHIA program establishes a more formal arrangement across the industry in which participating carriers share de-identified health claims data via one central AI platform. While Claim Watch can access data related only to GSC claims, data pooling allows for a greater volume and wider scope of health claims and provider information to be analyzed and delivers a more in-depth view of suspicious activity. Carriers can then work together on an investigation based on the AI’s analysis.

“With more sophistication being brought to efforts to defraud plan sponsors’ benefits plans, this project is valuable for the entire industry,” says Brent Allen, executive vice president, Insurance Operations, GSC. “The Claim Watch team has always maintained that collaboration leads to positive outcomes. We look forward to working with our colleagues at the participating companies.”  

The data pooling project offers our Claim Watch experts and the other participants an opportunity to undertake joint investigations that will lead to more success in reducing fraud and greater cost savings for plan sponsors, plan members, and all other industry stakeholders.

For more information:

GSC Media Department
1.800.268.6613 ext. 3409

About Green Shield Canada (GSC)

GSC is Canada’s fourth-largest health and dental benefits provider and is uniquely structured as a social enterprise with the purpose of making it easier for people to live their healthiest lives. From coast-to-coast, our service delivery includes drug, dental, extended health care, vision, hospital, and travel benefits for groups and individuals, as well as administration and benefits management services. Supported by outcomes-based sustainability strategies, advanced technology, and exceptional customer service, GSC creates innovative programs for more than four million plan participants nationwide, as part of our ongoing commitment to fostering better health for all Canadians. greenshield.ca