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Detect and prevent Fraud Abuse & Waste in

Workers' Comp

KlearAnalytics uses advanced statistical modeling to identify suspicious claims, transactions, and cartels in your network. Searching for a 'needle in the haystack' has never been easier...

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Why KlearAnalytics for Fraud Detection?

Designed for Workers' Comp

Covers a wide variety of uses cases ranging from Claimant Fraud, Provider Fraud, Billing Fraud and a Nexus between multiple actors within your ecosystem

Advanced Statistical Modelling

Uses proprietory statistical algorithms ranging from Neural Networks, Decision Trees, NLP based Sentiment Analysis and  Anomaly Detection

AI with Deep Learning

System is designed to self learn and retune itself - improving the accuracies over time 

Seamless Integration

Identified suspicious claims and transactions are seamlessly moved into designated SIU  queues for detailed investigation

It’s more than just claims software—

it’s peace of mind

Predictive Analytics for Workers Comp Fraud

Our proprietary algorithms are tailored to the Workers' Comp line of coverage, aptly recognizing the peculiarities and complexities of managing the business. 

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Advanced Statistical Models for High Accuracy

klear.ai uses a range of advanced statistical techniques as per underlying use case - Logistic Regression, Neural Networks, Decision Trees, or an Ensemble of multiple techniques.  Picking the correct technique is as much a science as art. 
 

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AI with Deep Learning - Deploy & Forget

"Identifying a fraudulent transaction is like scoring on a moving goalpost". The ingenuity of fraudsters is pitted against the sophistication of algorithms, necessitating the need for constant monitoring and frequent updation of algorithms - just to keep us a step ahead of them!

Tailored for Workers' Comp

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Frequently asked questions

What are fraudulent workers' compensation claims?

Specifically in Workers’ Compensation, insurance professionals may be met with claimant fraud, provider fraud, and vendor fraud that may act as a threat to not only insurance companies, but the average household as well. Misclassification, under reported wages, and inflation of bills are all ways and examples of fraud within Workers’ Compensation claims and can be extremely costly to companies. The risk of Workers’ Compensation fraud can take a huge toll on businesses and lead to higher insurance premiums as well.



How can KlearAnalytics detect fraudulent workers compensation claims early?

Klear.ai’s solution is able to provide valuable insights into your claim data, and with deep learning algorithms, the system is constantly learning from incoming new data which leads to the improvement in the accuracy of the results. Each of the characteristics of the model––business rule driven, anomaly detection techniques, statistical techniques, social network analytics, and natural language processing––all work alongside each other to create an effective visual platform that allows insurance professionals to handle fraud management. All these traits help to keep track of unusual patterns, notify of possible collusion, pinpoint any words that are a part of Klear.ai’s fraud library, and label any suspicious transactions



What is Fraud Prediction Model?

The Fraud Prediction Model is a predictive model that is powered by artificial intelligence to classify the Workers’ Compensation claim as either ‘Suspicious’ or ‘Non-Suspicious.’ With artificial intelligence having the ability to give better insights and act as a faster and more reliable tool, it is also able to calculate the probability of a claim being suspicious or not.



How is the fraud status determined for open claims?

All the incoming new data and information are translated into the system which keeps the fraud status of open claims up-to-date, as well. Since our models are deep learning, the new data and previous performances will allow the algorithms to continue to adjust and become more accurate over time.



How would KlearAnalytics's fraud prediction model help insurance providers and risk managers?

Detecting fraudulent workers compensation claims is often an extensive and difficult task, but with Klear.ai’s thoroughly trained and developed models, insurance providers and risk managers can quickly anticipate any abuse or fraud. With the Fraud Prediction Model, any suspicious claim activity can be detected and the claim will then be flagged as ‘Suspicious.’