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Workers’ comp tool mines data sets for fraud 

US-based Clara Analytics has launched an AI fraud detection system that helps identify suspicious claims using large workers’ compensation data sets.

Clara Fraud mines claims data to spot behaviour that, the company says, would not otherwise be apparent.

It provides alerts and “data-driven justification” for special investigation referrals, and gives claim professionals “confidence to refer suspicious claims for investigation with limited false positives, and uncover fraudulent activity from bad actors across millions of claims”.

The Silicon Valley company’s CEO Heather Wilson says the tool helps plug a “significant gap in fraud identification capabilities” in the workers’ compensation industry.

“Most individual adjusters can only see one or two claims from the same attorney at the same time.

“Our platform looks for patterns and clusters of abuse across a very large data set, so it has the potential to discover suspicious patterns that would otherwise remain hidden.”

Clara, which is represented in Australia and New Zealand by OPEX Consultants, says millions of case details, billing records, medical transcripts and legal demand letters are analysed to catch fraudsters.

It focuses on claimants having multiple claims open at one time, the same lawyer working similar claims, and exaggerated claims.