CLARA Analytics has been recognized by CIOReview Magazine as the recipient of “Top 20 Data Analytics Solution Companies - 2021,” based on our proprietary methodology, reflecting its position in the industry. This profile has been developed by the CIOReview research and editorial team based on insights from an interview with Andy Pinkes, CEO.

CLARA Analytics
Improving Insurance Claims Outcomes With AI

Andy Pinkes, CEO

In the world of property and casualty insurance, success or failure is driven by two things: the capacity to accurately assess risk and an ability to shepherd complex, multifaceted claims to a successful resolution. Until recently, claims management has mostly been an analog process, driven by highly experienced case managers charged with sifting through large volumes of information to reach judgmentsabout which cases require the most attention.

While that human element will always remain important, there is only so much bandwidth thatan expert case manager can dedicate to each claim. That’s where AI technologyenters the picture, supplementingthat human experience with an always-on engine that scans new information, identifies potential high-risk claims, and recommends the steps most likely to lead to a positive outcome.

In recent years, P&C insurers have faced unacceptably high loss ratios driven by increasing claim costs and an explosion in so-called “mega claims.” Effective claims management is about controlling the denominator in that loss-ratio equation. When a company can do a better job of resolving cases successfully, that flows directly to the bottom line.

For years, the insurance industry has relied on data analytics to inform better underwriting decisions.Until now, though, relatively little attention has been paid to the idea ofusing data science to improve claims management. That’s not surprising, given the volume and variety of data that goes into each claim. Much of that information is unstructured. It shows up in the form of doctor’s handwritten notes, legal correspondence, and other documents that don’t easily lend themselves to traditional data analysis.

In this respect, AI and machine learning algorithms are game-changers. AI can scan all of the incoming information about a claim, determine its meaning, and compare it to a vast collection of other cases with similar attributes. AI can spot anomalies. It can learn which factors correlate to a potential escalation and bring that information to the attention of an experienced professional.

Effective claims management isn’t just about minimizing costs, though; it’s also an opportunity to steer cases toward the best possible outcome for claimants. AI is improving patient care by proactively matching patients with the individual healthcare providers who are most likely to produce positive results. That’s good for the insurer,but it’s even better for theclaimant who’s recovering from a serious injury.

CLARA Analytics has pioneered this application of AIto claims management, offering a complete set of tools for the commercial insurance industry. “We like to jokingly say that our products give adjusters the superpowers that allow them to do more things in a better, faster and effective way than they might be able to do on their own,” said Karin Golde, vice president of data science for CLARA Analytics.

We like to jokingly say that our products give adjusters the superpowers that allow them to do more things in a better, faster and effective way than they might be able to do on their own

CLARA’s software encompasses the full spectrum of claims management activities, providing a one-stop solution for adjusters. “CLARA’s applications are designed in a very simple and easy to understand way such that even the people who are not machine learning experts can use it very effectively to do their jobs,” added Golde.

CLARA’s state-of-the-art AI suite—CLARA Triage, CLARA Treatment and CLARA Litigation—improves profitability by helping insurers optimizetheir claims outcomes. CLARA Triage helps adjusters to isolate and track complex claims and to understand the factors driving cost. CLARA Treatment helps them identify the best healthcare provider for each claimant across specific provider networks, specialities and locations. CLARA Litigation alerts claims managers to potential litigation risks and helps them identify the attorneys who are most likely to resolve claims effectively. In short, CLARA’s products help insurers to make better decisions with data-driven recommendations.

CLARA’s clientele ranges from top- 25 carriers like Berkshire Hathaway Home state Companies and QBE to small, self-insured organizations. The common thread for all of CLARA’s clients is the same: AI delivers strong ROI.

Several years ago, leaders at QBE Insurance Group aligned around a strategic objective to make data analytics a priority. They saw an opportunity to eliminate manual processes and lighten caseloads for their claims management team. Each adjuster at QBE was handling approximately70-80 claims each day, which made it difficult to spot potentially problematic claims.

Leaders at QBE engaged CLARA to help solve this problem. The result of that engagement was an estimated 5x return on investment. David Bacon, general manager at QBE,saidthat number might be too conservative and that the actual ROI might be even higher. A mid-sized carrier that uses all three of CLARA’s current products saved over $16 million last year.

CLARA Analytics

Leading Longshore Workers’ Comp Provider Selects CLARA Analytics to Improve Adjuster Productivity

Monday, June 26, 2023

MOBILE, Ala. & SANTA CLARA, Calif: The American Equity Underwriters, Inc. (AEU), an Amwins Group company, the leading provider of workers’ compensation insurance for waterfront employers, has selected CLARA Analytics (“CLARA”), a leading provider of artificial intelligence (AI) technology for commercial insurance claims optimization, as their partner in a new initiative that will use advanced technology to help adjusters achieve better results, more efficiently, for the employers who partner with AEU.

AEU, as the program administrator for the American Longshore Mutual Association (ALMA), works towards enhancing safety, mitigating risks, and ensuring proper care for injured longshore workers. To achieve these goals, the company has decided to incorporate CLARA's Optics and Triage modules. These modules automate the extraction of essential information from claims documents and provide AI-driven insights to monitor medical claims and proactively manage risks.

Utilizing natural language processing (NLP), the Optics module transcribes and extracts relevant information from medical records and legal demands, highlighting crucial details regarding individual workers' compensation claims. Meanwhile, CLARA's Triage module assists adjusters in promptly identifying high-risk casualty claims and flagging them for proactive resolution. This approach leads to optimal medical outcomes for injured parties, facilitates a swift return to work for workers, and ultimately reduces overall claim costs.

“CLARA’s AI platform is already delivering impressive ROI for workers’ compensation carriers. We see it as a great fit for AEU as well. CLARA’s products will help us improve efficiency and ultimately reduce claims costs for our members. This is a proven path to making AI work for us.”

By integrating CLARA's AI solutions into the Origami Risk claims platform, a comprehensive cloud-based claims management solution, AEU aims to enhance adjuster productivity and improve claims outcomes for its customers. This adoption of integration capabilities between CLARA and Origami Risk represents a significant step forward for AEU's venture..

“At AEU, we’re always looking for ways to better serve our members and their injured workers,” said Adele Hapworth, CEO of AEU. “CLARA’s AI platform is already delivering impressive ROI for workers’ compensation carriers. We see it as a great fit for AEU as well. CLARA’s products will help us improve efficiency and ultimately reduce claims costs for our members. This is a proven path to making AI work for us.”

The core of CLARA's mission aligns with AEU's customer-centric vision. This aspect will be discussed in an upcoming panel at the 4th annual InsurTech Spring Conference in New York, in which CLARA will participate. The presentation, titled "Enhancing Customer Experience through Enhanced Claims Collaboration," is scheduled for March 30th.

“AEU is recognized as a leader in USL&H coverage,” said Heather H. Wilson, CEO of CLARA Analytics. “That’s due in large part to their intensively customer-first philosophy. In that respect, they’re a perfect fit with CLARA, which provides AI tools that not only drive productivity but also better outcomes for all parties. CLARA Triage helps adjusters focus on the claims that need attention while CLARA Optics significantly reduces document review time. These AI tools allow adjusters more time to focus on an injured worker’s needs to help them return to health faster. We look forward to collaborating with AEU.”

CLARA Analytics Raises $24m to Add AI Capabilities

Thursday, October 12, 2023

In the US, insurance sector tech provider CLARA Analytics has raised $24m in a Series C round of funding, which it will use to enhance its platform's capabilities in areas including generative AI, predictive modeling and natural language processing.

CLARA's product suite applies image recognition, natural language processing and other AI-based techniques to unlock insights from medical notes, legal demand packages, bills and other documents surrounding an insurance claim. Clients add historical claims data to the company's database; the firm's AI models then look at new data coming in to prevent loss cost escalation; and claims teams receive daily alerts relating to which claims they should focus on.

The latest funding round has been led by new investor Spring Lake Equity Partners, with participation from existing investors including Aspen Capital Group, Oak HC/FT and QBE Ventures, bringing the total raised to date to $60m. CLARA's CEO Heather Wilson (pictured) comments: 'We're excited to have Spring Lake Equity Partners as our new lead investor. We see this funding as a tremendous vote of confidence, especially in light of the very tight funding environment'.

Eastern Alliance Adopts CLARA Analytics AI Platform to Improve Workers’ Compensation Claims Management

Wednesday, August 07, 2024

SUNNYVALE, Calif. & LANCASTER, Pa.---Eastern Alliance Insurance Group (“Eastern Alliance”), a wholly-owned subsidiary of ProAssurance Corporation, has selected the CLARAty.ai platform developed by CLARA Analytics (“CLARA”), a leading provider of artificial intelligence (AI) technology for insurance claims optimization, to enhance medical outcomes for injured workers, improve reserve accuracy, and lighten administrative burdens for claims professionals.

CLARA’s claims intelligence platform integrates the company’s proven predictive analytics with advanced generative AI (GenAI) capabilities to offer a comprehensive claims management solution. The AI models analyze a wide range of data sources, including claims data, claim notes, medical records, and legal documents. This analysis enables the system to provide claims professionals with actionable recommendations for optimal next steps and proactive cost containment strategies, helping to prevent claim escalation.

Eastern Alliance is set to leverage CLARA’s comprehensive platform to address the challenge of escalating medical costs. Their strategy involves implementing a suite of CLARA’s key solutions: CLARA Optics for medical document intelligence, CLARA Treatment to direct care to the best-performing medical providers, and CLARA Triage to help focus on high-severity claims early in the claims’ life cycle.

“CLARA's capability to deliver ROI through their AI platform truly distinguished them from the competition,” stated Kevin Shook, President at Eastern Alliance. “We foresee considerable operational efficiencies and loss reductions that will create substantial value and reduce the manual workload for our claims professionals. Ultimately, this can result in savings for us and our insureds and help injured workers return to wellness and productivity faster. That potential makes this partnership a win-win for everyone involved.”

CLARA’s award-winning AI platform can analyze both structured and unstructured data, performing contextual analysis using natural language processing (NLP) and large language models (LLMs) tuned specifically for insurance claims. The generated insights help claims professionals make sound data-driven decisions. CLARA’s customers consistently achieve remarkable ROI, with most exceeding 500%.

“We are honored that Eastern Alliance has chosen CLARA as their preferred claims intelligence platform,” said Heather H. Wilson, CEO of CLARA Analytics. “This partnership aligns perfectly with our mission to revolutionize claims management. We look forward to supporting Eastern Alliance in their commitment to excellence, helping them deliver superior care to injured workers, streamline operations for their claims team, and ultimately achieve better outcomes for all stakeholders involved in the claims process.”

Workers’ compensation claims often involve extensive documentation, including hundreds of pages of medical records and other legal documents, sometimes spanning months or even years. CLARA Optics uses predictive AI, GenAI and LLMs to automate medical records transcription, extract meaningful details, and deliver actionable insights to claims management personnel. Optics eliminates time-consuming document review, and the AI-generated case summaries lead to faster case resolution, lower workloads, and better outcomes for injured workers and their employers.

CLARA Treatment leverages a vast, nationwide contributory database comprising millions of workers’ compensation claims to deliver data-driven insights on medical provider performance. CLARA Triage, using the same proprietary database, helps claims professionals to promptly identify high-risk casualty claims and flag them for proactive resolution. They are given decision support and guidance when setting reserves, leading to more accurate reserving. Injured workers get the level of service they need for the severity of the injury, and Eastern Alliance’s claims professionals can focus on the claims that matter most.

Top 20 Data Analytics Solution Companies - 2021

Company
CLARA Analytics

Management
Andy Pinkes, CEO

Description
CLARA Analytics has pioneered the application of AI to claims management, offering a complete set of tools for the commercial insurance industry. CLARA’s state-of-the-art AI suite — CLARA Triage, CLARA Treatment and CLARA Litigation — improves profitability by helping insurers optimize their claims outcomes. CLARA Triage helps adjusters to isolate and track complex claims and to understand the factors driving cost. CLARA Treatment helps them identify the best healthcare provider for each claimant across specific provider networks, specialities and locations. CLARA Litigation alerts claims managers to potential litigation risks and helps them identify the attorneys who are most likely to resolve claims effectively. In short, CLARA’s products help insurers to make better decisions with data-driven recommendations

CLARA Analytics Improving Insurance Claims Outcomes With AI