CLARA Analytics – Leveraging Proven Augmented Intelligence Platform for Commercial Insurance Claims

CLARA Analytics improves claims outcomes in commercial insurance with easy-to-use machine learning-based products. The company’s product suite applies image recognition, natural language processing, and other AI-based techniques to unlock insights from medical notes, bills and other documents surrounding a claim. CLARA’s predictive insight gives adjusters augmented intelligence that helps them reduce claim costs and optimize outcomes for the carrier, customer and claimant. CLARA’s customers include companies from the top 25 global insurance carriers to large third-party administrators and self-insured organizations. Founded in 2016, CLARA Analytics is headquartered in California’s Silicon Valley.

Leveraging Best-in-Class Augmented Intelligence-Based Products

CLARA Triage: CLARA Triage employs artificial intelligence (AI) to help adjusters detect and proactively manage casualty claims. Focus on the claims that need attention and streamline the claims that don’t. CLARA Triage can issue several types of alerts when it spots an issue, including claims severity or customizable alerts. Real-time alerts flag high-risk claims before they escalate. CLARA’s AI technology monitors millions of data points, looking for clues that might indicate the claim is about to escalate in severity and cost. CLARA Triage then alerts adjusters to take prompt action. Their cloud-based platform can be up and running in 8-12 weeks after historical data is received, including model tuning, alert configuration, and hands-on training for adjusters. Adjusters can access claims directly via their cloud-based module at any time from any location, or flex their existing systems with their pre-built APIs for simple integration.

CLARA Treatment: It enlists artificial intelligence (AI) to score doctors based on actual outcomes and compare them to thousands of relevant closed claims. CLARA Treatment applies machine learning to identify doctors that are consistently associated with positive outcomes on prior claims. Adjusters, nurse case managers, and network optimization teams can now recommend the right doctor for a specific injury, recognize when injured workers see low-scoring doctors, and ensure care networks are set up to provide the best care for any given claim. An intuitive UI makes providers easy to access any time, from any location. Adjusters can share insights with peers to get a second opinion from right within the application and can download score reports to send to an injured worker to provide a better understanding of available options.

CLARA Litigation: It uses AI to predict litigation risk based on years of prior claims, identifying tightly defined claim cohorts that yield insights about the future direction of a claim. CLARA’s industry-leading AI technology detects the drivers of common cost escalations and delivers actionable recommendations that reduce attorney involvement and litigation rates. CLARA Litigation looks at attorney outcomes on prior claims and scores them based on factors like performance and cost. Adjusters can now keep their current counsel focused on a claim or choose a better fit from a list of high-scoring attorneys nearby. Legal panel managers can benchmark current panels and optimize their mix based on their scores.

CLARA Optics: It automates medical records and legal demands transcription, extraction and organization that highlight important details about each claim using the latest in artificial intelligence (AI) technology. CLARA Optics instantly scans and analyzes claim documents, reducing risk by ensuring important details aren’t overlooked. CLARA Optics combs through case records, applies advanced algorithms to discern the most relevant information, then compiles case summaries for adjusters and nurse case managers (NCMs). CLARA Optics scans documents that come in for changes that could materially impact each claim, then alerts the claim manager whenever a predetermined risk threshold has been exceeded or when new details emerge. Enable a wide range of pre-configured alerts, including using a new ICD code in a patient’s case, new visits pertaining to a claim, gaps in treatment, the use of catastrophic ICD codes, or the application of unusually high-cost treatments. Claims managers have to grapple with a mountain of details, making it virtually impossible to keep tabs on every bit of new information that comes along. Reviewing medical records is time-consuming, and extracting key insights is cumbersome. As a result, significant claims events can go unnoticed—until it’s too late.

CLARA’s MSP Compliance: The module streamlines future medical cost projection report production from weeks to minutes. CLARA’s industry-leading artificial intelligence (AI) technology scans medical records, automatically compiling them into reports that meet Centers for Medicare & Medicaid Services guidelines. CLARA MSP Compliance reduces a weeks-long process to minutes, enabling claims teams to file accurate reports at a fraction of the time and cost of traditional MSA reporting. The CLARA MSP Compliance subscription model allows multiple report versions and report types to be run as early and as often as needed, so claims teams can make better-informed decisions about when medical management might be indicated, when to settle, which settlement path to take, and which reports might be needed.

Heather Wilson | Chief Executive Officer

Heather H. Wilson has more than a decade of executive experience in data, analytics, and artificial intelligence, including as global head of innovation and advanced technology at Kaiser Permanente, Chief Data Officer at Citigroup and Chief Data Officer of AIG. She currently sits on Equifax’s board of directors. At Kaiser Permanente she established the Women in Technology group, focused on mentorship and retention for women in math, technology, and science, and at AIG, she launched Global Women in Technology and served as executive sponsor of Girls Who Code.

"Insurance and data is our passion. We are focused on making a positive impact by providing augmented intelligence solutions that improve outcomes."