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.
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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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Fraud Heat Maps
Find your “dirty dozen” service providers. CLARA Fraud combs through claims across our contributory database, identifies suspicious activity and maps the relationships between plaintiff attorneys, medical providers and claimants.
Real-time Claims Monitoring
CLARA Fraud provides an enterprise view of suspect claims giving your SIU organization the ability to prioritize investigations. Alerts appear whenever a predetermined risk threshold has been exceeded as the claim develops.
Fraud Indicators That Drive Action
CLARA Fraud takes into consideration many factors including servicing locations, claimants having multiple claims open at the same time, the same attorney working similar claims and even exaggerated claims. The factors not only identify potential network fraud, but also assists adjusters in justifying referrals to SIU.
Simplify SIU Referrals With Action Plans
CLARA Fraud helps accelerate the SIU or management referral process with summarized claim notes and triggered workflows for different personas.

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?

  • Lower claim operational costs
  • Improved claim outcomes
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Ideal For

  • Claims Adjusters
  • Nurse Case Managers
  • Legal Teams
  • Investigative Units

Detect systemic patterns of suspicious behavior


Alert adjusters of suspicious activity

Adjusters and claims managers receive customizable alerts with detailed explanations on what is driving the alert.

Score fraud across millions of claims

Each claim has a fraud score based on activity across all claims in the CLARA database.

Streamline Investigation Referrals

Use objective data and CLARA’s claim summarization to justify your SIU and management referrals to accelerate and feel confident in your referrals.

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.

It's Easy To Get Started

Optimize claims outcomes with the power of AI