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

Klear AI helps in preventing fraudulent workers comp claims

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