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Are you looking to automate your worker's compensation claims audit?

KlearAudit AI powered Audit Management Platform for Workers' Comp

Designed for Self-Insureds, Insurance Carriers and TPAs engaged in managing workers’ compensation claims.

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Why use KlearAudit!

Augment Intelligence, Automate Workflow, Seamlessly Collaborate, Ensure Adherence and Achieve Operational Excellence 

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Automation

Enhance Efficiency through Automation of Audit Programs for Workers Comp Claims Management

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Artificial Intelligence

Leverage cutting edge AI to identify claims for audit; Enable the system to recommend the audit decisions

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Collaboration

Extend the audit program by seamlessly integrating multiple teams into the workflow

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Performance Management

​Objectively quantify the accuracy of examiners, the contribution of auditors, and the ROI of the audit program to your organisation.

How does KlearAudit solve my auditing challenges

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Leverage the power of ‘Artificial Intelligence’

Increase auditors’ productivity exponentially by 

  • Leverage cutting edge AI to identify claims for audit

  • Enable KlearAudit to recommend the audit decisions based on business rules or AI based decisioning.

  • Expand the audit effectiveness by utilizing the KlearAI predictive outputs with respect to Severity, Reserves, Fraud, Litigation and Subrogation. Know More.

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Enhance Efficiency through ‘Intelligent Automation’

Enhance Efficiency through Automation of Audit Programs for Workers Comp Claims Management 

 

  • Random and Business-Rule driven sampling of claims for audit

  • Flexible and configurable audit workflow as per underlying objectives – Quality Audit, Operational Audit, Fraud Audit or Statutory Audits

  • Queue Management – For each of the actors within the program. Widgets display the status of audits along with numbers and tags.

  • Configurable audit scorecards, letting you define your own checkpoints, weightages (High, Medium, Low), Scores and Monetary Impact of non-compliance.

  • Ability to reassign audits to other auditors at a click 

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Enable Collaboration of Multi-Skilled Teams

Extend the audit program by seamlessly integrating multiple teams into the workflow 

  • Let’s you create queues for Auditors, Examiners and Managers. Additionally, you may create queues for SIU Teams, Legal Team and even the External Auditors – seamlessly integrating each of the disciplines for enhancing the effectiveness of your audit program

  • Ability to reassign an audit or just refer an audit to other personnel to keep them in the loop for important and sensitive audit observations

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Manage Performance of Auditors & Examiners

Objectively quantify the accuracy of examiners, contribution of auditors and the ROI of your audit programs

  • Provides valuable insights into examiner performance through heat maps, highlighting their strengths and weakness 

  • Quantifies Auditors’ Contribution to the program with respect to gaps identified and adverse monetary impact of those gaps.

  • Consolidates the performance of each of the player and translates it into an overall ROI of audit program

Integration with Klear.ai Predictive Analytics

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Extend the audit program by seamlessly integrating multiple teams into the workflow 

  • Klear.ai Predictive Analytics Suite has highly advanced and sophisticated algorithms to predict the key cost drivers of a workers’ comp programs - Severity, Reserves, Fraud, Litigation and Subrogation.

  • Auditors may compare the case level predictive outputs with the examiners’ own best judgements. If the difference between the two is abnormally high, then those claims can be picked up for audit. Infact, you may create a business rule to let KlearAudit automatically pick such claims for adhoc audits and then push them into designated auditors’ queues.

Appeals Workflow – Flexible and Transparent

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Has configurable workflow to manage appeals as per your existing guidelines

  • KlearAudit lets you define the ‘Appeals Workflow’ during an ‘Audit Plan’ creation

  • Option to choose from ‘No Appeal’, ‘Single Level Appeal’ or ‘Multiple Levels of Appeal’ as per underlying audit type

  • Define if appeals need to be routed to same or a different auditor. 

  • Designated personnel (typically managers) can override the appeals in order to finalize the audit
    Feedback from appeals is transparently captured in reports

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Insightful Dashboards and Reports

KPIs are updated on a real time basis to reflect the key aspects of your audit program

  • Audit Status – Pending Audits (with Aging), Work-in-progress or Closed Audits – each categorised as per Audit Type, Auditor-wise or Timewise.

  • Gaps Identified – Consolidated view of gaps (non-adherence) identified.

  • Monetary Impact – Notional or actual dollar impact of non-adherence.

  • Performance – KPIs to view individual auditors’ contribution and examiners’ quality scores.

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Cloud based SaaS Application

KPIs are updated on a real time basis to reflect the key aspects of your audit program

  • Hosted in Azure Cloud, KlearAudit is robust, scalable, highly secure, and economical. Upgrades deployed via new releases are faster and easier to administer.