MEMIC Selects CLARA Analytics to Read and Summarize Medical Records With AI

CLARA Optics Streamlines Claims Management With Generative AI

Maine Employers’ Mutual Insurance Company (MEMIC), workers’ compensation insurance specialists, has chosen CLARA Optics, an AI-driven technology platform developed by CLARA Analytics (“CLARA”), a leading provider of artificial intelligence (AI) technology for insurance claims optimization, to help them improve medical outcomes for injured workers, increase claims management efficiencies, and lighten administrative burdens for adjusters and nurse case managers (NCMs).

CLARA Optics uses predictive AI, generative AI (GenAI), and large language models (LLMs) to automate medical records transcription, extract meaningful details, and deliver actionable insights to claims management personnel. By ingesting and analyzing new information as soon as it is available, the technology helps claims managers to stay abreast of changes, summarizing case status and highlighting salient information.

Recommended AI News: Riding on the Generative AI Hype, CDP Needs a New Definition in 2024

“We anticipate that CLARA Optics will create greater efficiencies across our claim operation,” said Matt Harmon, senior vice president of claims at MEMIC. “Our claim handlers and nurse case managers will now have an easier time extracting important details from the high volume of medical records they receive and review while assisting injured workers and policyholders. The up-to-date case summaries and actionable follow-up recommendations will contribute to our ongoing efforts to shorten claim durations and lower claim costs.”

Workers’ compensation claims can sometimes involve hundreds of pages of medical records and other documents, often spanning months or even years. CLARA’s AI platform assists claims managers by offering up-to-the-minute case summaries derived from both structured and unstructured contributory data. This leads to faster case resolution, lower workloads, and better outcomes for injured workers and their employers.

Recommended AI News: Five9 Announces Availability of Intelligent CX Platform on Google Cloud Marketplace

Insurers often struggle to bring new claims managers up to speed or to manage the handoff of cases from one adjuster to another. CLARA Optics integrates actionable intelligence into concise case summaries, accelerating the onboarding process and smoothing the transition of claims from one adjuster or NCM to another. CLARA’s products have also helped many carriers to weather the deluge of lawsuits precipitated by legal changes like those that occurred last year in Florida.

CLARA’s award-winning AI platform is capable of analyzing both structured and unstructured data, performing contextual analysis using natural language processing (NLP), and generating insights that help claims managers make sound data-driven decisions. CLARA’s customers consistently achieve remarkable ROI, with most exceeding 500%.

CLARA Optics uses machine learning to identify the warning signs associated with so-called “jumper claims” that could present a risk of escalation. The platform incorporates this predictive capacity into its GenAI output to deliver concise, concrete summaries that improve outcomes. With early notice of potential issues, claims managers can take prompt action to get injured workers back on the job quickly.

Unlike many popular GenAI tools, CLARA’s generative technology isolates insurance carriers’ data for both model training and operational purposes, so data remains confidential and fully secure.

CLARA has also designed Optics to deliver high levels of accuracy, basing its conclusions on confirmed internal data sources and performing redundancy checks to ensure that the information it provides to claims managers is unassailably accurate. Incoming data is cleansed, validated and enriched to further enhance the accuracy of the product’s case summaries and recommendations.

Recommended AI News: Viant Integrates With PurpleLab

“MEMIC is widely recognized as a leader in the workers’ compensation space,” said Heather H. Wilson, CEO of CLARA Analytics. “That’s evident in the fact that MEMIC was one of the first companies to embrace CLARA’s AI technology, using our Treatment and Triage products for several years now. We’re pleased that they have chosen to add CLARA Optics to their toolkit. This will help them to further improve medical outcomes, reduce costs, and empower adjusters to focus on the things that matter most.”

CLARA Optics is priced on a per-page basis, leaving claims managers free to revisit case details as often as they like, without incurring additional charges. Whenever new information becomes available, Optics captures pertinent case details automatically, giving claims managers vastly improved visibility to important developments as they happen.

[To share your insights with us, please write to sghosh@martechseries.com]