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1 - Increase auditors’ and examiners performance exponentially by 

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• Leveraging cutting edge AI to identify claims for audit

• Enable Klear.ai Audit 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.

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2- Enhance Efficiency through ‘Intelligent Automation’

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• 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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3 - Enable Collaboration of Multi-Skilled Teams

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• 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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4- Manage Performance of Auditors & Examiners

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• 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

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5- Integration with klear.ai Predictive Analytics

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• 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 Klear.ai Audit automatically pick such claims for adhoc audits and then push them into designated auditors’ queues.

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6- Appeals Workflow – Flexible and Transparent​

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• Klear.ai Audit 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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7- Insightful Dashboards and Reports

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• 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