Guiding Claims to Optimal Outcomes with CLARA Next Best Reasoning
In the modern claims environment, adjusters need clear, immediate instructions on how to act. Building on its foundation of explainable AI, CLARA Next Best Reasoning (NBR) provides a powerful guided experience, ensuring every claims professional takes the most optimal path to resolution.
CLARA Next Best Reasoning transforms intelligence into decisive guidance, empowering claims organizations to optimize consistency, accelerate workflows, and achieve superior claim outcomes.
Next Best Reasoning: Supplementing the ‘Why’ with ‘What’s Next’
CLARA Triage’s Risk Notes established the explainability framework (the why). Next Best Reasoning (NBR) completes the loop by delivering holistic guidance (the what to do next) to mitigate risk and drive the file toward its most favorable resolution.
NBR integrates predictive modeling with operational and financial context to provide data-driven instruction at the claim level:
- Financial strategy: Delivering insights on potential severity of a claim (e.g., a nuclear verdict) and recommending immediate strategy adjustments to optimize exposure.
- Reserve guidance: Benchmarking current reserves against millions of comparable claims to establish an accurate and defensible optimal financial path.
- Litigation tactics: Recommending the optimal defense attorney or suggesting targeted discovery actions to strengthen the carrier’s position.
This guidance ensures adjusters move beyond reacting to data and into proactive, outcome-driven decision-making.
The Optimal Path: Foundational Benchmarking for Guided Experience
The core of NBR is the Optimal Path, built on robust operational and financial benchmarking derived from CLARA’s vast contributory database of millions of closed claims.
This foundation allows the system to guide the adjuster toward decisions that align with historical successful outcomes.
- Consistency and compliance: NBR acts as an AI-powered co-pilot, closing the experience gap and allowing every adjuster to manage their caseload with the consistency and acumen of a top performer, while enforcing adherence to best-practice guidelines.
- Strategic alignment: Benchmarking informs reserve decisions, ensuring financial judgment is grounded in accurate predictive analytics and aligned with organizational goals.
Driving Measurable Results and ROI
CLARA’s integrated approach—combining Risk Notes, Claim Event Indicators, and Next Best Reasoning—delivers tangible, bottom-line results by focusing on actionable follow-through and risk mitigation.
The value is clear: a large U.S.-based workers compensation carrier achieved a demonstrated 12.8x return on investment (ROI) by leveraging the integrated intelligence provided by CLARA’s claims capabilities.
The future of claims management is not just about identifying risk; it is about providing the precise instruction needed to eliminate it. CLARA Next Best Reasoning provides that capability, transforming professionals into highly efficient decision-makers who consistently deliver optimal outcomes.
Interested in learning more? Discover how CLARA is redefining intelligent claims handling one insight at a time.
