Driving Claims Closure and TPA Assessment with CLARA
Claims data rarely tells the full story—until you know where to look.
For a global, self-insured consumer goods manufacturer, traditional reporting showed what was happening in its claims program, but not why.
Dashboards surfaced volumes and timelines, yet left critical questions unanswered:
- Why were certain claims lingering?
- Where were reserves misaligned?
- How consistently was the third-party administrator (TPA) performing across regions and adjusters?
To answer those questions, the organization turned to CLARA.
Background
The customer is a global, top-five consumer goods manufacturer with more than $10 billion in annual revenue. Operating a large self-insured program, the company manages a complex North American claims portfolio that spans multiple jurisdictions, claim types, and operational teams.
As the scale of the program grew, leadership recognized the need for greater transparency and stronger, data-backed oversight of claims performance and TPA effectiveness.
The Challenge
The organization’s primary objective was to conduct a comprehensive evaluation of its TPA to ensure alignment with broader goals around claims efficiency, cost optimization, and operational consistency.
At the same time, the team wanted to gain deeper insight into trends within its current claims landscape, understand how performance compared to industry peers, and develop state-specific strategies informed by real-world claim behavior.
While the organization had access to large volumes of claims data, much of the most valuable insight lived in unstructured sources, particularly adjuster risk notes. Traditional analytics approaches struggled to consistently extract meaning from that information, making it difficult to move beyond surface metrics or take confident, targeted action.
The CLARA Solution
The organization deployed CLARA Triage to unlock insight from unstructured risk notes and translate that information into actionable intelligence. CLARA extrapolated logic and patterns from these notes to develop tailored claim indicators aligned with the client’s specific objectives.
Rather than focusing solely on outcomes, CLARA’s approach emphasized identifying root causes that directly influenced claim duration, closure readiness, and reserving accuracy. This enabled the client to pinpoint claims that were appropriate candidates for closure and distinguish them from those that genuinely required continued attention.
In parallel, CLARA identified meaningful patterns across adjusters, regions, and claim types. These insights supported more objective performance assessment, highlighted opportunities for operational improvement, and strengthened accountability through data rather than anecdote.
Underpinning this work was CLARA’s robust back-end data orchestration. Claims data was cleansed and normalized using CLARA’s common data chassis, ensuring consistent and reliable benchmarking. Machine-learning-enabled contributory models—drawn from CLARA’s continuously evolving model library—delivered near-time insights that reflected current performance across the claims portfolio.
| What CLARA EnabledTranslated unstructured risk notes into actionable claim indicators Identified closure-ready claims with defensible logic Uncovered root causes driving claim duration and reserve misalignment Revealed performance patterns across adjusters, regions, and claim types Delivered clean, normalized data for reliable benchmarking Powered near-time insight with machine-learning-enabled models |
The Outcome
The value of CLARA’s approach became clear during the client’s first structured closure sweep, where insight translated directly into action.
- 15% of open claims were identified as candidates for closure
- Of those claims, 49% prompted meaningful reserve adjustments
- 4.8% of total claim dollars were impacted, underscoring the financial significance of the initiative
- The organization achieved more accurate reserving and realized a 13.2x return on investment
Beyond the measurable results, the organization gained a clearer, more defensible understanding of its claims operation. Claims teams were empowered to act with greater confidence, leadership gained improved visibility into TPA performance, and future strategies could be built on objective insight rather than assumption.
See What CLARA Can Reveal in Your Claims Data
Unstructured data holds the answers to why claims linger, where reserves drift, and how consistently work is performed—but only if you know how to surface it.
CLARA helps claims organizations turn everyday claims data into clear, defensible insight that drives better decisions, faster action, and measurable results.Request a demo to see how CLARA Triage helps you identify closure-ready claims, improve reserving accuracy, and gain deeper visibility into claims performance.
