CLARA Analytics: AI-Powered Claims Intelligence

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CLARA Analytics

Tyler Jones, Chief Customer and Marketing Officer, CLARA AnalyticsTyler Jones, Chief Customer and Marketing Officer
CLARA Analytics is driven by the mission of using the power of AI to optimize casualty claim outcomes. It’s a leading AI-as-a-Service partner for commercial carriers and self-insured organizations, helping them avoid loss costs, lower claim expenses, and elevate best practices.

In a conversation with CIO Applications, Tyler Jones, Chief Customer and Marketing Officer at CLARA Analytics, shares insights into how the company has been assisting clients with its unique machine learning and AI-powered solutions.

From your perspective, what makes CLARA Analytics stand out?

Our proven AI models have been helping commercial insurance carriers save millions of dollars since 2017 by avoiding loss costs. We have a contributory data model that helps us analyze not only customer data but look into thousands of insurance claims to design better solutions aligning with the market trends. This contributory database is our biggest differentiator in the market.

We are not just a tech company that’s looking to disrupt the insurance industry. Our solutions are built by former insurance executives and risk managers who are accustomed to all the intricacies of the insurance space. They are dedicated to helping their friends and families receive better outcomes. So, we are insiders building solutions for insiders.

Our current CEO, Heather H. Wilson, is a dynamic leader. She has varied experience working in multiple roles, including Chief Data Officer and Chief Science Officer, at leading organizations. Her experience and understanding of the insurance industry are an added advantage to us.

Could you talk about your clients and how does CLARA Analytics help them achieve success?

Our customers are major property and nationwide casualty insurance carriers (including QBE, Amerisure, and AmTrust), large self-insured organizations, and state funds. Carriers are facing inflation, resulting in a surge in loss costs—rising medical expenses, indemnity expenses, and operational expenses.

Inflation is hurting everybody in this space, and they need to really look for opportunities to find efficiencies and keep the claims from escalating.

We offer insurance companies analytics to connect injured workers to the right healthcare service providers. It’s a win-win situation for both the injured workers and the insurance companies.

Our algorithm can look at physicians from thousands of claims and find the ones who did extraordinarily well in getting an injured worker back to work faster. We track the performance of the physicians on their medical costs, claim duration, frequency of opioid prescribing and several other key measures that impact the outcome of the claim.

Another significant matter of concern is the rise of attorney involvement. Claimants often contact an attorney and file some form of a lawsuit, exponentially increasing the claim costs.

This issue can be prevented either by settling earlier or engaging with the claimants in different ways. Our AI solutions read claims data, medical records, bills, and claim notes to help make predictions. This allows us to predict the probability of attorney involvement in the future and provide insurance companies and self-insured organizations with alerts to help them proactively engage with the claim before an attorney gets involved.

Could you tell us about CLARA’s products and how they benefit clients?

Our flagship product is Treatment. It has been designed to help clients identify and select the best providers. Another important product that we provide is Commercial Auto Litigation. We’ve always been focused on workers’ compensation, but this year, we’ve expanded into commercial auto and general liability lines of insurance. Commercial Auto Litigation helps large self-insured organizations and insurance carriers drive down attorney and litigation expenses.

We have recently launched a new, innovative tool, CLARA Optics. This brand-new tool takes medical bills and records that are coming in with an insurance claim in PDF or a TIFF graphic format. We read the documents using OCR and computer vision and collect crucial information. We put it into a structured format that allows adjusters and risk managers to have insights and alerts at their fingertips.

Our proven AI models have been helping commercial insurance carriers save millions of dollars since 2017 by avoiding loss costs

Optics gives clients the ability to quickly search through and find keywords within a document. We also take the medical records and medical bills and put them in a visual treatment timeline. We understand in chronological order where the claimant has been for medical care, what has been diagnosed, what the latest outcomes are and what has been prescribed. Adjusters no longer need to sit and sift through hundreds of pages of documents. Clara Optics does it all for them.

CLARA Optics is not only saving operational expenses but helping clients avoid lost costs by identifying treatments that are outside of guidelines or from previous injuries.

Our goal is to take away the difficult, time-consuming tasks using AI and help adjusters and risk managers focus on the most critical corners where they can add value. We are not trying to replace human workers; we aim to augment their capabilities.

Our customer success managers work in liaison with all the customers. We study and learn the workflows of our customers, and then we change and customize our product to best meet the needs of their use cases. We always listen to our customers and innovate with them. They are the partners that help us develop better products.

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