CLARA Analytics: Healing the Injury Claims Arena Better andFaster

The world is flourishing due to unprecedented social, economic, and scientific progress, which is changing the way people interact and use technology on a global scale. But despite the obvious leaps in recent years, adoption challenges still exist, especially the insurance industry. As a result, millions of people are deprived of the efficiency and flexibility experienced in some evolving industries. The workers’ compensation insurance field is one such lagging industry; much of it remains plagued by a “traditional” way of thinking and operating especially in the handling of claims and paperwork.

It is increasingly clear that the solutions to these challenges won’t be found solely by looking to the traditional models of global policymaking, business, and philanthropy. Instead, a new generation of futurists are taking some of the world’s biggest issues head-on —and finding innovative solutions where others couldn’t. They are the changemakers. “Changemakers are philanthropists and innovators who focus on transforming the world around them into a better place for all. They are those who grasp opportunities, come from any walk of life and from anywhere on the planet,” says Heather H. Wilson, CEO, CLARA Analytics. Her company improves claims outcomes in commercial insurance with easy-to-use AI-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. These insights improve the quality of claim adjusters’ jobs by delivering actionable recommendations to them on key decisions needed to handle the claim. She adds, “for their policyholders, we reduce claims costs incurred by the insurer, which ultimately allows them to offer better prices than their competitors.”

Today, CLARA Analytics has over$75 billion of workers’ comp claims in the CLARA data lake. Heather observes, “when we look for insights into the nuances of injury claims, size does matter. CLARA’s customers benefit significantly from models that are tuned to their needs and include insights gleaned from our massive dataset.” But this is only half the disruption that CLARA brings to its customers. CLARA also has developed a deep understanding of industry complexities and is continuously looking for fresh insights to share with customers. For this, CLARA has formed a nexus of data scientists, data engineers, systems specialists, and software designers that most insurance companies cannot afford to dedicate to one set of problems. On a closer look, greater insights lead to optimized outcomes and faster resolutions. She summarizes, “we are unique because we help get healthy employees back to work sooner.”

CLARA Triage is a product that removes complexity and offers unprecedented ease and flexibility to the claim process —a real boon for the insurance field, especially the injuries inspection and claims arena. The product’s DNA is hardcoded by artificial intelligence to assesses a claim’s potential complexity from its origination in order to assign the best-suited adjuster. CLARA Treatment facilitates the best healthcare providers in getting the injured workers healthy faster. In parallel, CLARA Litigation recommends an attorney whose track record in handling similar cases is best-in-class. Heather adds the last piece of the puzzle, “We also have an MSP Compliance product that addresses the complexity of identifying and filing for Medicare reimbursement on the portion of a claim for which Medicare is responsible.” So, CLARA’s customers benefit from fast-tracked claims with 95% accuracy, the ability to understand the factors driving cost, and real-time updates about high-risk claims before they escalate.

CLARA Analytics sports an impressively aggressive appetite for innovation and the way they quickly actualize it through their products. All these are natural upshots of seasoned leadership and an unbending will to challenge the status quo. “Asan inventor at heart, I always look beyond any product’s scope to substantiate the changes it features,” explains Heather. “Over the last 15 years, I have donned many hats: Chief Data Officer of Citigroup, Chief Data Officer of AIG, Chief Data Scientist of L Brands, and Head of Innovation/Advanced Technology at Kaiser Permanente. My constant innovation drive at those firms empowered me to listen to and quickly learn from a customer and start creatively building new products. The insatiable curiosity keeps driving me to constantly deepen my innovation quotient and the ability to formulate new ideas.”

In the future, Heather wants to foster a stronger and more meaningful relationship with data while drawing upon the powerfully expanding CLARA data lake. “We believe significant insights reside in our data that we can share with underwriters, actuaries, and financial analysts at our clients,” she says. The plan is to start with significant claims trends and, ultimately, automate the return of these insights through an API. Also, were are looking into more investments in AI and natural language processing to glean purpose-oriented insights, all to better train the existing models. Another significant area of focus is extending CLARA products to bodily injury claims associated with commercial auto policies. The medical providers and attorneys involved in workers’ comp claims often handle injuries that occur in vehicle accidents. If an accident occurs while an employee is performing their job duties, the commercial auto policy covers the injuries, not the workers’ comp. “All of these efforts are to ensure one thing —so that injured workers can safely return to work quicker than before,” Heather concludes with a passion to change the future for the better.