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Workers' Compensation Severity Prediction Software

Adopt a culture of 'Proactive Claims Management' using Klear.ai suite of products

Adopt a culture of 'Proactive Claims Management' using Klear.ai suite of products

Tangible benefits - 10 to 15% in efficiency gains; 15- 20% by preventing fraud, abuse & waste; Increased customer satisfaction

Improve tactical, operational and strategic decision with Klear.ai predictive power

Quick deployment and easy integration with your existing claims management systems through a library of APIsIt's easy.

Claim Severity Prediction
Leverage the accurate prediction of claim severity to optimize claims traiging

        -  Identify medically complex claims for Nurse Case Mangement

        - Assign experienced adjusters to mange predicted high cost claims

        - Identify providers, who can effectively treat the claimant for the best medical outcome.

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Accuracy of Severity Predictions

Algorithms classifies the severity prediction into High, Medium or Low for every claim. Inherent flexibility let's you categorize the prediction into other band definitions as per layers - Self Retained Limits, Risk Pools / JPA Limits or Reinsurance Limits too.

 

For long tail claims (like Workers' Comp), the system predicts severity as per duration of the claim.  For 0 to 30 days, accuracies of over 80% have been recorded, while higher aging claims have seen accuracies of over 92%.

 

Higher prediction accuracies  gives you the confidence to triage the claims effectively, reducing costs while ensuring better outcomes.

Discover Cost Drivers

Every claim is unique. Over 18 to 20 distinct variables are used to make the predictions. However, the system ranks the contribution of every variable in the ultimate prediction. And displays the top 5 variables that had the maximum predictive value for the underlying claim.

 

Adjuster can cross check the top drivers of a claim. And prepare a strategy to best deal with the specifics of the claim.

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Comorbidities and Restrictive Drugs

It is a known fact that patients' comorbidities drive up the claims cost. Restrictive drugs like Opiates, muscle relaxants and anti-Depressants on the prescription can add to the long term claim costs too.

 

Klear.ai algorithms highlight both these factors along with severity prediction. Text mining algorithms extract these details from Adjuster's Notes and Doctor's Report. In addition to using these factors in making predictions, the system also displays these details to substantiate the prediction.

Severity Insight Dashboard

 

Dashboard view provides deep insights of Severity trends, letting you view severity as per claimant demographics, Injury Types, Employment / Job classification, Seasonality, Adjuster workload and more.

 

Strategizing based on these insights could help you create a effective cost reduction program.

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Configure Severity Notifications

Klear.ai let's you configure notifications for every claim flagged with 'High Severity'. You may define the threshold level of statistical confidence, that should trigger the notification.

 

You may designate the senior adjusters or supervisors, who shall be notified with relevant details to act upon.

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Klear.ai Predictive Suite use highly sophisticated AI and Deep Learning Models to make accurate predictions of critical claims parameters. Models ingest structured as well as unstructured data (like Adjuster's Notes), run them through a proprietary statistical models to give the final inputs.

 

In line with dynamic nature of insurance business, the solutions are trained to monitor the hit ratio. And use this data to self improvise over a period of time - further entrenching into the core of your claims operation.

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Interested in augmenting your business with  Klear.ai ?

Request A Free Demo 

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