AI for Insurance Carriers

Powered by AI and ML, the solution has a library of algorithms built to prevent fraudulent workers compensation claims from the Claimant, Provider or the Vendor.


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Overview predictive analytics for Workers’ Compensation and GL claims improves a customers’ risk oversight and other internal processes as well as provides access to insights for proactive mitigation. The early identification of “red flags” and other problematic scenarios gives our customers the targeted and effective opportunities for the proper assignment of claims as well as the direct insight into “costly” impacts to bottom line forecasts. Our predictive platform helps our customers make better decisions more efficiently, which allows them to quickly "leverage" insights into their WC and GL lines to develop a more profitable business, minimize claim costs, and reduce errors, omissions, and other inefficiencies.

Fraudulent workers compensation claims

We‘ve developed and implemented several innovative approaches to AI modeling and Machine Learning algorithms that we believe are “game-changers” for severity, fraud, and reserve setting predictions. Additionally, our data-science teams have produced significant and robust advances around litigation, subrogation, and settlement modeling.

Klear ai Technology that can help

  1. Severity Scoring Modeling

  2. Reserve Prediction Modeling

  3. Claimant / Provider Fraud Modeling

  4. Litigation Probability Modeling

  5. Subrogation Modeling

  6. Settlement Predicition & Estimation

Fraud workers compensation claims Detection.webp
  1. Claims Triaging - Assign adjusters based on predicted loss characteristics and likely scenarios.

  2. Loss Reserving - Accurately calculate loss reserves by statistically comparing a loss with similar ones – reduce under or over reserving

  3. Detect Abuse & Fraud  - AI based models, using a combination of rules, statistical modeling, text mining, database searches and exception reporting

  4. Litigation - Provides a model driven litigation propensity score, helping you reduce litigation-related expenses by assigning senior adjusters

  5. Subrogation - Models pinpoint subro opportunities earlier to help you maximize loss recovery while reducing claims expenses

  6. Settlement - Models indicate optimum settlement amounts helping you reduce claims cycle times and significant savings


Why is AI adoption essential?

AI brings new possibilities and important capabilities to one of the major cost impacts to claims management.The technological evolution of AI in Insuance is undenabile in large part due to it’s ability to deliver new and improved solutions that meet clients’ needs today and lay a strong foundation for tomorrow.

How can help in litigation?

Our solution helps risk managers understand their underlying legal costs and – by placing the focus on performance rather than hourly rates or billing practices – determine the relative efficiency of the defense firms they engage.

Will your system generate ‘automatic’ pleadings?

This feature is not currently available in our system. However, the insights garnered from the platform will greatly aid and inform any legal determination regarding the claim(s) in question.

How accurate are you at “predicting” legal outcomes?

All of our Predictive Insights are “scored” initially upon FROI and subsequently “re-scored” throughout the claims lifecycle and as appropriate to the particular situation. Our predictive platforms routinely score in the 80% range

What is a KPI?

A KPI stands for Key Performance Indicator and provides any KPI’s that your organization might need in order to visualize data effectively with customization capabilities.

How do we create new KPI’s?

KPIs can be created by clicking the “+” sign on the top right corner. This will load a new window where you will be able to create any KPi your organization may need.

How many views of the claim analytics dashboard are there?

Currently, we have a Claims Management Dashboard as well as a Risk Management dashboard to add more versatility to the BI platform.

What type of business entities can this product be used for?

This platform works best with TPA’s, risk pools, government entities, insurance companies, self-insured firms, and Professional Employment Organizations.

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