Request Demo
Products
CLARA Fraud

Identify Suspicious Medical & Legal Activity

CLARA Fraud uses AI fraud prevention to help identify suspicious activity by examining the relationships between medical providers, legal counsel and claimants across millions of workers compensation claims.
Download product sheet
icon

Suspected Fraudulent Behavior Insights for SIU Referrals

CLARA Fraud analyzes claims data, billing records and legal demands using fraud risk scoring to alert and provide justification for SIU referrals. Eliminate false positives and uncover fraudulent activity from bad actors across millions of claims.
Download product sheet
image
image
image
image
Fraud Heat Maps
Find your “Dirty Dozen” service providers with AI-driven fraud detection. 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, allowing your SIU organization to prioritize investigations based on AI fraud prevention insights. Alerts appear whenever a predetermined risk threshold has been exceeded as the claim develops.
Fraud Indicators That Drive Action
AI fraud prevention tools consider many factors, including servicing locations, claimants having multiple claims open at the same time, the same attorney working on similar claims, and even exaggerated claims. These fraud indicators not only identify potential network fraud but also assist 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, making AI fraud prevention easy to implement.

Identify Suspicious Activity Invisible to the Human Eye

Humans cannot keep tabs on every attorney, medical provider, and claimant, making it virtually impossible to examine the vast number of cases needed to identify patterns of fraud. Let AI-powered fraud risk scoring and claims fraud analysis tools do this for you.

Augmented Intelligence Learns from Millions of Claims

CLARA 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 fraud patterns that even the most senior adjuster could miss.

Stop Bad Actors Quickly and Confidently

Anyone handling a claim can benefit from CLARA Fraud’s speed and accuracy. Feel confident in your SIU and claims management referrals, avoid false positives, and avoid unnecessary loss costs. Use AI-driven fraud detection to justify investigation referrals and stop bad actors.
1 1

Key Benefits

  • Identifying Systemic Fraud Across Workers Compensation Claims with AI Fraud Prevention
  • Streamline SIU referrals with data-informed justification
2 2

The Result?

  • Improved referral acceptance rate
  • Lower claim operational costs
  • Optimized claim outcomes
3 3

Ideal For

  • Investigative Units
  • Roundtable Teams
  • Claims Adjusters
  • Legal Teams

Detect systemic patterns of suspicious behavior

image

Alert adjusters of suspicious activity

Adjusters and claims managers receive customizable alerts with detailed claims fraud analysis explaining what is driving the alert.

Fraud risk scoring 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 claims fraud analysis to justify your SIU and management referrals to accelerate better outcomes.

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

icon

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.
icon

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.
icon

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

Request Demo