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Workers' Compensation Claims Audit Software powered with Native AI

Automate Workers’ Compensation Insurance Audits for TPAs and Carriers using KlearAudit - Workers comp insurance audit software

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Why KlearAudit?

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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.

It’s more than just audit software—

it’s peace of mind

INTELLIGENT AUTOMATION

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

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ENABLE COLLABORATION

Integrate multiple teams into the workflow of KlearAudit - Your workers' compensation claims audit software

PERFORMANCE MANAGEMENT

Objectively quantify the accuracy, contribution of auditors and the ROI of your audit programs. Claims Adjuster Performance Review Software.

How's your view?

Find out how KlearAudit can automate the way you audit your claims.

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Frequently asked questions

Who can use the KlearAudit?


KlearAudit is designed for Self-Insureds, Insurance Carriers and Third-Party Administrators (TPA) engaged in managing Workers’ Compensation claims.




How can KlearAudit benefit us?


KlearAudit lets you take the audit management process to next level by Automating the audit workflow across auditors, examiners, managers, SIU and external consultants. Artificial Intelligence augments the audit process by letting you pick the right claims for audit, pre-populate the audit checkpoints as per specifics of underlying claims and lets you compare the key variables (like Reserves) between ‘Examiners’ Best Judgement’ versus ‘System Predicted Value’. A ‘Case Management Approach’ to an adverse audit observation, letting multiple teams come together to take the case to its most logical conclusion§ Objectively view the performance of Auditors and Examiners, track the ROI of your audit program. Use the insightful dashboards and reports to track and improve your audit program




How complicated is the deployment of KlearAudit?


KlearAudit, being a ‘cloud-based’ application is extremely easy to activate, configure and manage. Our teams would use an existing API or create a new one to pull the data from your ‘Claims Management System’. That is all you need to get started!




Who is using KlearAudit currently?


KlearAudit is currently deployed at a large Self-Insured organization in addition to a few leading TPAs – each of them deriving significant benefits from the application. We’re glad to share references and additional details to help make your buying decision.




How is KlearAudit priced?


KlearAudit is a ‘Subscription based’ – either monthly or annually as per your budget. A nominal set-up cost may be charged for connecting with your claims management system. Exact pricing varies as per your feature set, environment, and a number of users. Our specialists would work out a compelling commercial proposal based on your specific requirements. Get in touch with our specialists now!




What are the next steps if I want to evaluate KlearAudit?


Please fill in the contact form or send us an email at info@klearai.com. Our specialists would be happy to connect with you to understand your current audit process and advise on the most appropriate configuration of the application for a trial period. Certain features may be limited during the trial period, but we are confident that you’ll be able to judge the value the application can add to your current audit programs. After confirmation, our teams will deploy the APIs to connect with your claims management system to start the actual audit process in production. The entire process takes approximately 3 to 4 weeks.





What our clients have to say about KlearAudit

KlearAudit’s has greatly aided our team in managing the most sensitive and complex audit issues. We have been very impressed.  The AI-based system has automated our end-to-end process, right from the detection of suspicious transactions to their case management. We have already seen a significant improvement in the effectiveness of our limited auditing resources.” 

- Director of Claims Operations & Audits 

7 surprising ways KlearAudit can help you

1 - Increase auditors’ and examiners performance exponentially by 

  • Leveraging cutting edge AI to identify claims for audit

  • Enable KlearAudit to recommend the audit decisions based on business rules or AI-based decision making.

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


2- Enhance Efficiency through ‘Intelligent Automation’

  • 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 

3 - Enable Collaboration of Multi-Skilled Teams

  • 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

4- Manage Performance of Auditors & Examiners

  • 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

5- Integration with klear.ai Predictive Analytics

  • 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.

6- Appeals Workflow – Flexible and Transparent​

  • 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

7- Insightful Dashboards and Reports

  • 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