AI-Enabled Claims Transformation: The Power of Clean, Connected Data
Artificial intelligence holds enormous promise for insurers. But its success depends on one element that too often goes overlooked: data.
The models that carriers build and the insights they rely on are only as good as the information feeding them. Without clean, connected, and contextualized data, even the most advanced AI delivers inconsistent results. In the race to innovate, insurers are discovering that real transformation begins not with algorithms but with data engineering.
This topic was at the heart of a recent LinkedIn Live hosted by Insurance Leadership Editor-in-Chief Paul Carroll, featuring CLARA Analytics CEO Heather H. Wilson and Nick Andersen, Vice President of Claims Strategic Transformation at Nationwide. The conversation explored how data quality, agentic reasoning, and human-in-the-loop AI are shaping the next generation of claims management.
The foundation of every AI breakthrough: Data readiness
The value of AI depends entirely on the quality of the data beneath it. In insurance, that means every policy and claim must be accurate, consistent, and complete. Yet many organizations still face siloed systems, legacy formats, and inconsistent data capture—all of which limit AI performance.
To unlock true intelligence, carriers must start by creating a unified, trustworthy data foundation. That’s the role of data engineering: to ingest, cleanse, validate, and standardize information so that it can power analytics, automation, and decision support with confidence.
CLARA’s Data Engineering as a Service (DEaaS) was built for this purpose. DEaaS helps carriers achieve enterprise-grade data readiness without overhauling their entire tech stack. It unifies structured and unstructured data from across the enterprise, applies intelligent agents to verify accuracy and consistency, and packages it for use in any AI system.
The result: higher data quality, faster time to insight, and the confidence to scale AI adoption across the business.
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From static files to living intelligence
For decades, claims were managed as static files. Adjusters gathered information, set reserves, and revisited the file weeks or even months later when something changed. Today’s claims environment is far more dynamic. New information flows in daily—from medical reports and legal filings to adjuster notes and external data sources.
Modern claims AI platforms transform this constant flow into living intelligence. Instead of waiting for periodic updates, claims teams now receive continuous signals that highlight where attention is needed most. This allows them to adapt strategies in real time, improving both efficiency and outcomes.
Think of it as moving from a snapshot to a live feed: the claim record is no longer a document to be revisited but an evolving ecosystem of data that tells its story as it unfolds.
Agentic Reasoning: Intelligence that works behind the scenes
At the core of this transformation is agentic reasoning—AI that serves up the right information at the right time to support confident, informed decisions.
On the back end, CLARA’s data agents handle the essential work of cleaning, mapping, and standardizing information as it flows through the system, ensuring that every data point is accurate and connected. On the front end, agentic reasoning brings that unified intelligence to life—synthesizing all available information to deliver the most relevant insights to the adjuster exactly when they need them.
This approach bridges the gap between raw data and real-world action. Claims professionals don’t have to dig through endless pages or disparate systems—they receive timely, contextual guidance that helps them focus on what matters most and act with greater confidence.
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Human intelligence at the center
Even as AI grows more capable, one principle remains clear: people make the final decisions.
In claims, AI isn’t about replacing expertise—it’s about amplifying it. With human-in-the-loop design, adjusters stay in control while AI handles the repetitive, time-consuming data work. This partnership allows claims professionals to focus on high-value activities such as strategy, communication, and service.
The result is not only greater efficiency but a better balance of technology and empathy—helping insurers deliver fair, consistent outcomes at scale.
Real-world impact: Turning hours into minutes
When clean data meets intelligent automation, the results speak for themselves. Nationwide partnered with CLARA to tackle one of the most time-consuming aspects of claims management: reviewing lengthy legal demand packages.
Using CLARA Claims DocIntel Pro, files that once required several hours of manual reading can now be summarized and delivered to adjusters in minutes. The solution extracts key facts, highlights relevant medical details, catches legal demand deadlines, and organizes insights so claims professionals can focus on analysis rather than administration.
Beyond document review, Nationwide’s collaboration with CLARA has also strengthened data standardization and governance across its claims organization. By feeding cleaner, more consistent data into AI models, the company has accelerated its ability to identify severity trends, detect potential fraud, and prioritize the right cases at the right time.
These real-world gains—faster review, stronger data quality, and more proactive decision-making—translate directly into measurable business value. Claims close sooner, adjusters spend more time applying expertise instead of processing paperwork, and customers experience quicker, fairer resolutions.
This is what speed to value looks like in practice: tangible outcomes that combine efficiency, accuracy, and human judgment at scale.
A smarter, stronger future for claims
AI is transforming how insurers handle claims—but only when it’s built on a foundation of trustworthy data and guided by human expertise. With solutions like DEaaS and agentic reasoning, carriers no longer have to choose between speed and precision. They can have both.
By uniting clean data, intelligent automation, and the judgment of experienced professionals, insurers can scale best-practice decisions across the portfolio—and pave the way for a more adaptive, resilient industry.
The future of claims isn’t just automated. It’s intelligent, connected, and data-driven from the ground up.Let’s build your foundation for AI success together. Request a demo →
