By Heather H. Wilson, CEO CLARA Analytics

Claims officers make decisions every day – million-dollar decisions that have the potential to change a claimant’s life. If anyone needs a second set of eyes – that helpful colleague with tons of experience and sharp attention to detail – it’s claims officers.

Here’s the thing: even two of the best claims officers with 60+ years of combined experience probably haven’t seen everything (although they may be pretty close). Every day there are new personal injury cases and unseen factors that offer data about the best course for a particular claim.

That’s where AI, or what I like to refer to as “augmented intelligence” comes in. Augmented intelligence is the result of using technology to make data-informed decisions with the help of artificial intelligence. It is a tool that helps claims officers make data-informed decisions to best manage the claim.

Below are a few of the ways AI can serve as that second set of eyes for claims officers.

Keep track of claims with alerts and insights

We rely on AI to keep us informed in numerous ways throughout everyday life. Whether it’s an alert about unusual activity on your credit card or your video doorbell letting you know someone picked up a package, AI works in the background to keep us informed. And it can help with insurance claims too, for example:

• Focus attention on potentially complex claims that are likely to adversely impact the bottom line
• Predict the likelihood of lawyer involvement
• Alert reserve mismatches
• Flag poor-performing medical providers

When officers don’t have to worry about constantly monitoring all the claims on their plate, claims officers can apply their expertise to the most urgent tasks. That’s augmented intelligence.

Know which claims to prioritise and take action before they become too costly

AI technology can instantly monitor millions of claims-related data points, looking for clues that might indicate the claim is about to escalate in severity and cost. If it finds something, it can alert officers to take prompt action. For example, AI can predict lawyer involvement and prompt the officer to proactively engage with the claimant based on the bodily injury, jurisdiction and industry type.

By using AI to spot problems before they happen, officers are better able to focus on reducing complexity, lowering claim costs, and helping workers return to work faster.

Identify the best lawyer for claims in litigation

Just as a patient needs the right doctor, parties involved in litigation need the right lawyer. No offence to lawyers – but wouldn’t it be easier to avoid litigation completely?

AI can predict both lawyer performance and litigation likelihood for claims. It can see the nature of the claim, claimant rapport, and settlement expectations to compute these outcomes, then push timely alerts to keep officers informed.

Equipped with detailed risk explanations, officers can decide on the proper course of action to prevent lawyer involvement – and what to do if the claim escalates to litigation.

Instantly scan and analyse claim documents and medical records

Claims officers 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.

AI combs through case records and applies advanced algorithms to discern the most relevant information. It then compiles case summaries for officers and NCMs, empowering these claims professionals to come up to speed very rapidly on each case.

AI helps you see the big picture

Using AI to manage personal injury claims outcomes is like having a second set of eyes on all of your claims. While claims officers focus on the most pressing and complex claims, AI is working in the background to study, verify, and interpret vast amounts of claims data.

When claims officers harness the power of artificial intelligence and combine it with their claims expertise, they’re using augmented intelligence to deliver optimal claims outcomes. At CLARA Analytics, we have been providing this type of augmented intelligence to leading insurance carriers in the US for measurable financial returns and with injured claimants returning to health faster. A true win-win for all parties involved.  

Give your staff augmented intelligence

The debate around AI isn’t around whether it will replace workers, but rather how the nature of work will change now that AI is enhancing worker output. AI hasn’t replaced driving a car, writing an email, or ordering a meal; instead, it’s helped the people carrying out those tasks make better-informed decisions, and in less time.

AI doesn’t have to mean artificial; when used in conjunction with human expertise, AI becomes augmented intelligence. It is one tool that helps us complete the more routine, mundane tasks in our day, allowing us to focus on work that truly requires our expertise.

CLARA Analytics has expanded its presence in the Asia-Pacific market by forming a strategic partnership in APAC with OPEX Consultants (OPEX), an Australian boutique growth strategy and profit improvement insurance consulting practice. 

OPEX will facilitate the sale and adoption of CLARA’s platform and entire range of personal injury claims solutions in the ANZ market including:

• CLARA Triage helps claims officers to identify high-risk claims and determine the optimal path to resolving them.
• CLARA Litigation offers insights that help insurers reach amicable settlements, thereby avoiding costly litigation.
• CLARA Treatment scores doctors based on actual outcomes and compares them to thousands of relevant closed claims.
• CLARA Optics automates medical records and legal demands transcription, extraction and organisation that highlight important details about each claim.

See how CLARA’s augmented intelligence technology can help you achieve optimal claims outcomes. Request a demo today.

About CLARA Analytics

CLARA Analytics is the leading AI platform for personal injury claims that improves claim outcomes for insurance carriers, MGAs/MGUs, reinsurers and self-insured organisations. The company’s claims intelligence platform applies image recognition, natural language processing, generative AI and other AI-based techniques to unlock insights from claim notes, medical records, legal demand and other data sources surrounding a claim. CLARA’s predictive insight gives claim professionals “augmented intelligence” that helps them reduce claim costs and optimise 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 organisations. Founded in 2017, CLARA Analytics is headquartered in California’s Silicon Valley. For more information, visit www.claraanalytics.com, and follow the company on LinkedIn and Twitter.

About Heather Wilson

Heather H. Wilson, CEO of CLARA Analytics, 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 and chief data officer of AIG. She currently sits on Equifax’s board of directors. While at AIG, she was named the Insurance Woman of the Year by the Insurance Technology Association for her data innovation work. Wilson has been a steady supporter of diversity. She launched the Kaiser Permanente 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.

About OPEX Consultants

OPEX is a boutique growth strategy and profit improvement insurance consulting practice. Founded in 2010, OPEX works with clients to develop customised solutions that solve complex problems. Results are tangible and can be directly related to improved financial performance: revenue growth, margin improvement, or capital efficiency. For more information, visit www.opexconsultants.com