Analytics firm strengthens insurance claims research with new AI

According to the company, it uses AI to accurately identify workers comp claims much earlier and more effectively than conventional techniques, while also optimizing medical networks to help find the right doctors for each claim.

Jeff Rowe | May 22, 2020 01:13 pm

Even as providers continue their front-line struggle with the coronavirus, healthcare stakeholders behind the clinical scene are preparing to deal with inevitable consequences such as an expected onslaught of insurance claims in the wake of myriad treatments.

With those users in mind, CLARA Analytics, an AI provider to the commercial insurance industry, has announced $25 million in new funding that will be used to extend its product offerings.

The company uses both structured and unstructured data to extract information from medical notes, bills, and other documents to generate valuable predictions and other insights for claims teams. 

"We are reshaping the entire claims process by analyzing millions of data points and generating meaningful and actionable insights in a matter of seconds," said CLARA analytics CEO Gary Hagmueller in a statement

The new financing is ideally timed, as COVID-19-related disruptions have generated rising interest in AI as insurers look for new tools and additional data to navigate rapid changes in claims, litigation, and healthcare delivery. 

According to the National Council on Compensation Insurance, estimates related to COVID-19 could add upwards of $81.5 billion to the cost of workers compensation claims across the 38 states on which it tracks data. By leveraging CLARA’s cross-industry data lake and AI capabilities, CLARA says organizations can gain access to deeper data and insights and make faster, more calculated decisions that adapt to rapidly changing conditions. 

Adjusters, for example, can identify claims where medical notes don’t include a COVID diagnostic code but reference terms such as "shortness of breath" and "fever" for claimants based in locations with high infection rates and engage the right specialist on their team to ensure those claims are handled in a prescribed way.

The company says it will invest heavily in customer-facing sales and support teams and augment existing expertise in workers compensation, noting that while a share of those claims starts out routinely, it rapidly increases in cost and severity due to unexpected medical and legal expenses. 

Said Steven Jones, Chairman and Managing Partner at Aspen Capital Group, which lead the funding effort, ”We see dozens of different ways CLARA’s AI can be applied. We are impressed with the depth of product functionality, deep customer relationships, and the demonstrable return on investment that CLARA’s solutions deliver to customers in workers compensation, and we believe CLARA is well positioned to drive similar breakthroughs in other insurance lines of business."


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