CLARA Risk Notes, The Next Gen of Claims AI
CLARA Risk Notes for Advanced Casualty Claim Summaries & AI Alert Explainability
More and more insurance entities are embracing artificial intelligence (AI) throughout the claims value chain. AI-drive claims guidance has emerged as the GPS for the claims professional. Claim executives are realizing that a Claims AI platform can quickly highlight to a claims professional where to look within their caseload and what claim(s) requires proactive attention to review common issues like reserve adequacy, claim severity, medical condition/treatment, potential subrogation/risk transfer and potential fraud. CLARA Triage on CLARAty.ai has been taken to another level with the emergence of “CLARA Risk Notes”, our advanced claim summary and alert explainability feature. CLARA Risk Notes is now included in CLARA Triage for Auto Liability and General Liability claims and Work Comp will soon be available.
What is CLARA Risk Notes? They are new AI models that generate case-level summaries and alert explainability to allow claim professionals to consume, comprehend and trust the results/outputs created by our CLARAty.ai platform. Users now get a narrative summary outlining the key factors of the claim that are driving CLARA alerts including claim severity and litigation predictions. Combining the power of predictive modeling with the latest in generative AI gives claims professionals immediate access to claim background, damages, medical treatment and even risk transfer opportunities.
CLARA’s all-in-one claims guidance and document intelligence platform has been driving optimal claim outcomes since 2017. CLARA Risk Notes will continue to support our key mission of optimizing claim outcomes while driving additional value. What are some of the additional benefits of CLARA Risk Notes, our advanced claims AI explainability to your AI solutions? A recent article by IBM listed three benefits of implementing advanced explainability into your AI Platform:
#1 Drive Adoption of AI With Trust and Confidence
This benefit means your end users will trust the guidance and analysis that your claims AI Platform provides. This benefit also directly addresses one of the common “Challenge of Change” issues many insurance entities face when implementing AI tools.
#2 Accelerate ROI Realization & Reporting
This benefit will allow your team to systematically monitor, manage and evaluate your models to optimize business outcome.
#3 Mitigate Risk and the Cost of Model governance
This benefit means your AI models will consistently be explainable and transparent. This will help your claims organization manage regulatory, compliance, risk and other requirements and mitigate the risks of unintended bias. This benefit also directly addresses another common “Challenge of Change” issue many insurance entities face when implementing AI tools.
Let us dive deeper into what CLARA Risk Notes can do for your claims’ organization. Advanced Claims AI Explainability kicks in after CLARAty.ai gets your claim adjuster’s attention with an alert. The claims guidance alert essentially asks the adjuster to “Look at this claim.” CLARA Risk Notes then provides the “Why” behind the alert with a narrative summary of key factors that are driving alerts. This enables your claim adjuster to review a claim and act. It gives the claims professional the confidence to take action with narratives on Claim Incident Background, Damages, Liability and Potential Risk Transfer or Subrogation. Here are some features of CLARA Risk Notes at the claim-level focused for Auto Liability and General Liability claims:
Claim Background – This narrative category provides a description of the alleged loss, describes the involved parties, names the jurisdiction of the loss, provides information about any emergency transportation needed after the loss and employment/occupational information of the parties if available.
Damages – This narrative category presents key factors about injuries, treatment, prior injuries, non-economic damages including pain & suffering and lost wages. This information will help the adjuster prepare or update their evaluation of the ultimate cost of the claim.
Liability – This narrative categorypresents the key factors about the current liability status of the claim. Is there existing or new information about the alleged loss that needs to be considered by the adjuster to allocate the percentages of liability on this claim?
Risk Transfer/Subrogation – This narrative category presents key factors about this loss that either confirm and eliminate the existence of a potential Risk Transfer or a Subrogation opportunity.
The insurance industry has never had more access to actionable insights and alerts with CLARA Risk Notes. Now is the time to enhance your claims team’s augmented intelligence for casualty claims to take on the rising challenges of rising severity, social inflation, senior claims professionals leaving the workforce. CLARA truly is putting the “AI” in claims!
Schedule a demo to see CLARA Risk Notes on Triage in action.
