The Canadian Life and Health Insurance Association (CLHIA) is expanding its data pooling program and increasing its use of artificial intelligence (AI) to support fraud detection across group benefits claims. The move aims to improve the industry's ability to identify potentially fraudulent activity across a broader range of data.
The announcement builds on a program launched in 2021 that gave participating insurers access to analysis based on aggregated, de-identified claims data. The program uses fraud detection technology developed by Shift Technology, enabling insurers to identify suspicious activity beyond what is possible through internal systems alone.
“Improved fraud detection benefits all Canadians,” said Stephen Frank, President and CEO of CLHIA. “By strengthening the financial stability of the insurance industry, insurers can protect the affordability and accessibility of vital group benefits programs.”
The updated program will expand to include additional providers and a larger volume of claims data. While individual insurers continue to use their own analytics to monitor for irregularities, the pooled data initiative provides an industry-wide view, offering another layer of analysis.
“Using artificial intelligence to identify potential fraud has proven incredibly beneficial for individual insurers,” said Jeremy Jawish, CEO and co-founder of Shift Technology. “The work we are doing with the CLHIA builds on those individual efforts to provide a more comprehensive, industry-wide perspective on suspicious behavior, benefitting all member organizations in their fight against fraud.”
In 2023, Canadian insurers paid $36.6 billion in supplementary health claims. Although specific figures are not disclosed, industry estimates suggest that fraudulent activity represents a significant cost each year. CLHIA said the expansion reflects a continued focus among its members on addressing these risks.
CLHIA is a voluntary association representing insurers that make up 99 per cent of Canada’s life and health insurance market. Its members provide life, health, and retirement products to nearly 30 million Canadians and manage more than $1 trillion in assets.
Shift Technology provides AI-based tools to insurers globally, with a focus on fraud detection, claims management, and operational efficiency.
