Unlocking the Power of Generative AI: The Future of Insurance Claims

In the fast-evolving landscape of insurance, staying ahead of the curve is crucial. 

Traditional methods of claims processing are rapidly transforming with the rise of artificial intelligence (AI) and machine learning (ML). With the arrival of the next iteration of AI, generative AI, the way we process claims and the skills adjusters will need will look radically different in the not-too-distant future. 

Generative AI is technology capable of generating text, images, or other media, using generative models trained on large datasets (ChatGPT being one of the most prevalent examples of this technology). Generative AI has the potential to automate work activities that currently take up 60–70% of employees’ time. 

This is where CLARA Analytics steps in, providing a platform that’s tailor-made for the intricate needs of insurance carriers.

AI is not nice to have, it’s table stakes

When you think of your business’s core systems, what comes to mind? You probably think of your underwriting and claims platforms. But the definition of “core” is changing. An intelligence system that integrates with your operational workflows within traditional core systems is now table stakes. 

Chief claim officers and chief risk officers are under more pressure economically than ever. It is not just about managing operating expenses, but also being accountable for the claim losses. The claim intelligence platform is becoming the greatest weapon to succeed through inflation and other economic challenges.

Additionally, CEOs and boards of directors are demanding AI integration. Claims leaders need an AI playbook if they want to stay competitive. 

However, integrating an AI strategy isn’t as simple as firing up ChatGPT. These chatbots don’t incorporate predictive models or have a large language model (LLM) that understands insurance. Additionally, chatbots are often trained on outdated data from the internet, and they can’t effectively read and analyze all of the necessary medical records to provide useful information to adjusters. 

That’s why it’s important to have a platform that’s specifically designed for insurance professionals, by insurance professionals. Both machine learning and human expertise play important roles in this process, and any intelligence tool should facilitate collaboration between the two.

Given the pressure to move quickly and to find a tool that will actually deliver ROI, how can you be expected to implement a technology like generative AI that feels so new and unknown?

CLARA Analytics: Your AI playbook

At CLARA, we pride ourselves on going deeper than most when it comes to casualty claims. We offer a mature AI platform that serves as the foundation for growth through generative AI and accelerated adoption. 

Our platform is designed to support a range of products that hang from it, offering the latest in machine learning and generative AI. What sets us apart is that we’ve trained our products on insurance claims data. 

By partnering with CLARA, you gain access to a reliable and cutting-edge technology platform that has been growing and evolving for the past six years. So, instead of just talking about our solutions or products, we invite you to explore our platform and discover the possibilities it holds for your business.

Still, we recognize there’s a lot of hype and fear surrounding generative AI. Some may fear that sensitive information could be revealed with a simple claim number search. At CLARA, we want to emphasize that generative AI is simply the next level of communication that builds upon the already rich AI services we offer. Our platform is fully secure and all data is anonymized. We are HIPAA and SOC2 certified. 

What does the generative AI experience look like with CLARA? Let’s take a peek into the future. 

CLARAfy your claims with generative AI

If you’ve experimented with ChatGPT, you’re familiar with how it works as a chatbot, giving you a complete response to your command (unlike a search engine that pulls up website results and makes you hunt for the information).

With generative AI for insurance claims, your claims adjusters can achieve similar responses tailored to your company and the case. With company-specific insights, adjusters can ask things like, “How many claims do I have in this jurisdiction with this severity?” and receive a complete picture. Or, they can ask about treatment recommendations for a claimant and receive a neat and thorough summary of next steps—not a bunch of data that needs interpreting. 

CLARA provides adjusters with warnings, alerts and intervention notifications to allow users to step back from active management of a claim/caseload.

Some examples of how generative AI can help adjusters CLARAfy claims:

• • Generate a summary of the claims lifecycle in narrative format, i.e., attorney involvement predicted because of x & z in narrative form
  • Group list of recommended actions taken previously and their outcomes
  • Explain and alert issues CLARA finds with claims and help manage outliers
  • Provide a summary of litigation strategies and outcomes 
  • Provide percentages for specific interventions needed based on claim info

Be CLARAvoyant: Predictive and prescriptive AI

At CLARA, we believe in providing our users with a rich and personalized experience. Our generative AI technology will allow us to do just that. Unlike a bulleted list, the information we will provide you is delivered in a narrative form, making it easy to understand and follow. Think of us as your GPS for claims, but smarter. We guide you from point A to point B, taking into consideration the severity of your claim, and we do so in real time. 

Our technology is constantly evolving, and in the near future, you can expect an even more enhanced user experience. With CLARA, you can take the information we provide you, and easily populate your claim notes. Our products recognize specific letters, words, and phrases in order to create meaningful sentences that make logical sense. 

CLARA Claims Document Intelligence Pro (Claims DocIntel Pro), formerly CLARA Optics, is a prime example of how our solutions can evolve with advancing AI technology. With Claims DocIntel Pro 1.0, users are able to read and fill out structured fields, but with Claims DocIntel Pro 2.0, users will be able to generate a narrative summary that can be used in legal summaries and medical records. This provides insurers with a more comprehensive understanding of their claims. 

Other examples of how we help claims adjusters be CLARAvoyent:

• • Allow Generative AI to segment claims based on data instead of a business rules approach
  • Narration of variable interaction driving alert (enhanced explainability)
  • Proactive warning on overall network health relative to claims volume and indicators where claims costs are likely to spike
  • Summarized settlement strategy, including relevant state statutes, and outline of potential outcomes of settling versus proceeding to litigation
  • Generative AI CMS submission 

Embrace the future with CLARA

Welcome to CLARA, your ultimate guide for developing your AI playbook. Our platform is designed to accelerate your AI strategy safely. With our powerful tools, chief claim officers will be able to drive real economic savings, while claims adjusters can focus on empathy instead of data analytics.

As the definition of “core” continues to expand, CLARA’s AI platform is at the forefront of this dynamic shift. Join us today and experience the future of AI-powered insurance claims processing.

How do we build insurance-specific AI models? Keep reading to learn more about the contributory database that powers CLARA solutions.