Eastern Alliance Boosts Workers’ Comp Claims Management with CLARA Analytics

The insurer seeks to enhance medical outcomes for injured workers, improve reserve accuracy, and lighten administrative burdens for claims professionals.

(Image credit: Mike Goad/Pixabay.)

Eastern Alliance Insurance Group (Lancaster, Pa.), a wholly-owned subsidiary of ProAssurance Corporation(Birmingham, Ala.), has selected the CLARAty.ai platform developed by CLARA Analytics (Sunnyvale, Calif.), a 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.

Kevin Shook, President, Eastern Alliance.

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, according to a statement from the vendor. The solution’s 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, according to CLARA.

Eastern Alliance will use CLARA’s platform to address the challenge of escalating medical costs, the vendor reports. The insurer’s 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,” comments Kevin Shook, President, 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 says that its 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, the vendor asserts. CLARA says its customers consistently achieve remarkable ROI, with most exceeding 500 percent.

Heather H. Wilson, CEO, CLARA Analytics.

Shared Mission

“We are honored that Eastern Alliance has chosen CLARA as their preferred claims intelligence platform,” comments 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, the CLARA statement says. 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, the vendor says.

CLARA Treatment leverages a vast, nationwide contributory database comprising millions of workers’ compensation claims to deliver data-driven insights on medical provider performance, according to the vendor. 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, CLARA says. 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.

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Anthony R. O’Donnell // Anthony O'Donnell is Executive Editor of Insurance Innovation Reporter. For nearly two decades, he has been an observer and commentator on the use of information technology in the insurance industry, following industry trends and writing about the use of IT across all sectors of the insurance industry. He can be reached at AnthODonnell@IIReporter.com or (503) 936-2803.

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