The Canadian Life and Health Insurance Association (CLHIA) has announced the expansion of its industry-wide fraud detection initiative, leveraging artificial intelligence (AI) to identify suspicious claims with greater speed and accuracy. This move marks a significant step forward in safeguarding the integrity and sustainability of Canada’s group benefits plans.
Building on the 2021 launch of its data pooling program, the CLHIA will now include additional insurers and more comprehensive claims data, enhancing its capability to detect and deter fraud across the life and health insurance sector. The program utilizes Shift Technology’s advanced AI-powered solutions, which analyzes deidentified, industry-wide claims data to generate fraud alerts and detect emerging patterns.
“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.”
While individual insurers continue to use internal analytics to monitor their own claims, CLHIA’s collaborative model delivers an industry-wide lens, empowering insurers to identify fraud that may span across providers and time periods. The enhanced detection capabilities enable earlier intervention and better protection for plan members and sponsors.
“Using artificial intelligence to identify potential fraud has proven incredibly beneficial for individual insurers,” said Jeremy Jawish, CEO and co-founder of Shift Technology. “Our work with CLHIA builds on that success to create a more unified and effective industry-wide approach.”
In 2023, Canadian insurers paid out $36.6 billion in supplementary health claims, with fraudulent activity estimated to cost the industry millions annually. The expansion of this program demonstrates CLHIA’s ongoing commitment to innovation and collaboration in the fight against fraud.
As fraud schemes become increasingly sophisticated, CLHIA’s initiative reflects a proactive strategy to ensure long-term confidence in Canada’s group benefits system delivering value and protection for insurers, employers, and the millions of Canadians who depend on these plans.
