Products
CLARA Fraud
Identify Suspicious Medical & Legal Activity
CLARA Fraud uses AI to help identify suspicious activity by examining the relationships between medical providers, legal counsel and claimants across millions of Workers Compensation claims.
Suspected Fraudulent Behavior Insights for SIU Referrals
CLARA Fraud analyzes claims data, billing records and legal demands to alert and provide justification for SIU referrals. Eliminate false positives and uncover fraudulent activity from bad actors across millions of claims.
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Identify suspicious activity not perceivable by the human eye.
Claims adjusters do not examine enough cases needed to identify patterns of fraud from the vast network of legal and medical providers. Claims organizations have to grapple with a mountain of details, making it virtually impossible to keep tabs on every attorney, medical provider and claimant. CLARA Fraud does this for you.
CLARA Fraud provides augmented intelligence from millions of claims for better outcomes.
Fraud adds a second set of eyes on all of your claims by alerting on cumulative fraud indicators across all claims on the CLARA platform. Let AI expose patterns of fraud even the most senior adjuster would miss.
Provide the justification for investigation referrals and stop bad actors.
Anyone touching a claim can benefit from the speed and accuracy of CLARA Fraud. Feel confident in your SIU and claims management referrals, avoid false positives and avoid unnecessary loss costs.
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Key Benefits
- Identifying systemic fraud across Workers Compensation claims
- Streamline SIU referrals with data-informed justification
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The Result?
- Improved referral acceptance rate
- Lower claim operational costs
- Optimized claim outcomes
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Ideal For
- Investigative Units
- Roundtable Teams
- Claims Adjusters
- Legal Teams
Detect systemic patterns of suspicious behavior
CLARA Fraud deploys in weeks with little IT effort
CLARA Fraud has the flexibility to integrate with you
CLARA Fraud is secure with annual certifications
Easy to Deploy
Our cloud-based platform can be up and running in 8-12 weeks after historical data is received, including model tuning, alert configuration, and hands-on training for adjusters.
Seamless Workflows
Adjusters can access claims directly via our cloud-based module at any time from any location, or flex their existing systems with our pre-built APIs for simple integration.
Security is our Priority
Rest easy with HIPAA compliance, annual SOC 2 certification, and data encryption that meets or exceeds industry standards in safeguarding your data.