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Maine Employers’ Mutual Insurance Company (MEMIC; Portland, Me.), a provider of workers’ compensation coverage, has chosen CLARA Optics, an AI-driven technology platform developed by CLARA Analytics (Santa Clara, Calif.), a provider of artificial intelligence (AI) technology for insurance claims optimization, to help the carrier improve medical outcomes for injured workers, increase claims management efficiencies, and lighten administrative burdens for adjusters and nurse case managers (NCMs).
CLARA Optics uses predictive AI, generative AI (GenAI), and large language models (LLMs) to automate medical records transcription, extract meaningful details, and deliver actionable insights to claims management personnel, according to a vendor statement. By ingesting and analyzing new information as soon as it is available, the technology helps claims managers to stay abreast of changes, summarizing case status and highlighting salient information, CLARA says.
“We anticipate that CLARA Optics will create greater efficiencies across our claim operation,” comments Matt Harmon, SVP, claims, MEMIC. “Our claim handlers and nurse case managers will now have an easier time extracting important details from the high volume of medical records they receive and review while assisting injured workers and policyholders. The up-to-date case summaries and actionable follow-up recommendations will contribute to our ongoing efforts to shorten claim durations and lower claim costs.”
CLARA notes that its AI platform assists claims managers by offering up-to-the-minute case summaries derived from both structured and unstructured contributory data. This leads to faster case resolution, lower workloads, and better outcomes for injured workers and their employers, according to the vendor.
Insurers often struggle to bring new claims managers up to speed or to manage the handoff of cases from one adjuster to another, CLARA adds. The vendor says its CLARA Optics application integrates actionable intelligence into concise case summaries, accelerating the onboarding process and smoothing the transition of claims from one adjuster or NCM to another. CLARA says that its products have also helped many carriers to weather the deluge of lawsuits precipitated by legal changes like those that occurred last year in Florida.
Customers Achieve Significant ROI
CLARA reports that its AI platform is capable of analyzing both structured and unstructured data, performing contextual analysis using natural language processing (NLP), and generating insights that help claims managers make sound data-driven decisions. The vendor asserts that its customers consistently achieve significant ROI, with most exceeding 500 percent.
The vendor adds that the CLARA Optics technology uses machine learning to identify the warning signs associated with so-called “jumper claims” that could present a risk of escalation. The platform incorporates this predictive capacity into its GenAI output to deliver concise, concrete summaries that improve outcomes, CLARA says. With early notice of potential issues, claims managers can take prompt action to get injured workers back on the job quickly.
Designed specifically for use in the insurance industry, unlike many popular GenAI tools, CLARA’s generative technology isolates insurance carriers’ data for both model training and operational purposes, so data remains confidential and fully secure, the vendor adds.
CLARA says it has also designed Optics to deliver high levels of accuracy, basing its conclusions on confirmed internal data sources and performing redundancy checks to ensure that the information it provides to claims managers is unassailably accurate. Incoming data is cleansed, validated and enriched to further enhance the accuracy of the product’s case summaries and recommendations, the vendor elaborates.
Improve Medical Outcomes, Reduce Costs, Empower Adjusters
“MEMIC is widely recognized as a leader in the workers’ compensation space,” comments Heather H. Wilson, CEO, CLARA Analytics. “That’s evident in the fact that MEMIC was one of the first companies to embrace CLARA’s AI technology, using our Treatment and Triage products for several years now. We’re pleased that they have chosen to add CLARA Optics to their toolkit. This will help them to further improve medical outcomes, reduce costs, and empower adjusters to focus on the things that matter most.”