Q&A: Powering analytics with AI

Machine Learning

Q&A: Powering analytics with AI

Machine learning, large-scale language models, and AI are impacting analytics, as illustrated by Heather H. Wilson, CEO of CLARA Analytics, who explains how the company is using AI in the insurance industry.

Benefits: AI technology continues to evolve, and its usage is expected to continue to evolve as well. How is CLARA Analytics using AI to optimize claims?

Heather H. Wilson: Insurance companies are experiencing rising losses due to both economic inflation and increased litigation activity. Traditionally, claims organizations have focused more on the operational expense side of their business and less on paying losses. This was primarily due to a lack of data and technological capacity.

Traditional business intelligence solutions lacked the predictive power to make an impact early in the claims lifecycle to limit losses. This has changed dramatically with the advent of machine learning and large language models (LLMs). They can now look at millions of claims to detect patterns, predict losses, and provide guidance to claims adjusters that can make a big difference.

How exactly does CLARA Analytics use AI? How can insurers leverage AI across their business to optimize claims outcomes?

CLARA uses predictive and generative AI models to provide augmented intelligence to claims practitioners, allowing them to make data-driven decisions. For example, workers' compensation adjusters can use our platform to find the best doctors in their area to guide injured workers. This creates benefits for both injured workers and insurance companies. Injured workers get the best treatment and return to work faster. Insurance companies pay less for medical care and pay less lost wages due to the time it takes to recover.

AI can be used from the beginning of a claim, from the first notice of loss. It can predict the severity of the claim, assign the right adjuster, and ensure the claimant receives services more quickly. AI can then be used throughout the claim, all the way through to final settlement. AI can search millions of claims, find claim cohorts, and help predict losses, attorney involvement, and even the likelihood of complications from an injury, like opioid addiction. This intelligence allows adjusters to intervene and settle earlier and engage additional experts to optimize care.

How has the adjuster's job been automated, streamlined or transformed? What were the benefits?

One of the best uses of AI in insurance claims is document intelligence. Our CLARA Optics product uses OCR and LLM to read legal documents and medical records; extract, summarize, and provide advanced insights to adjusters. This saves hours of work and immediately highlights problematic legal language. Insurers save operational costs and see improved claims outcomes with AI-generated insights. In essence, the system acts as a senior adjuster working alongside claims adjusters.

How have they balanced the capabilities of AI with the need to maintain a human-centric role?

We believe that AI does not replace humans, but rather augments human capabilities. Recognizing the role of empathy in the claims process is crucial. Having an accident or losing property brings up a lot of emotions. Keeping humans involved drives compliance, increases claimant satisfaction, and inspires confidence that claims will be resolved fairly.

In what areas of business do you foresee AI having the greatest impact going forward? And conversely, in which areas do you think the human touch will remain essential?

While AI will undoubtedly bring big improvements to the sales, underwriting and distribution parts of the insurance value chain, we believe it will have the biggest impact in claims processing. AI will uncover more fraud, improve customer experience, train junior employees, and improve claims outcomes while fairly compensating claimants. We're just beginning to scratch the surface.

While AI will certainly streamline and automate many types of claims, it is unlikely to replace human adjusters when it comes to personal injury claims. There is a significant risk that must be resolved for the injured human on the other side of the claim. Every personal injury claim is different and requires human involvement to achieve an optimal outcome.

[Editor’s note: Heather H. Wilson, chief executive officer of CLARA Analytics, has more than a decade of executive experience in data, analytics, and artificial intelligence, including as global head of innovation and advanced technology at Kaiser Permanente and chief data officer of AIG. She currently sits on Equifax’s board of directors. While at AIG, she was named the Insurance Woman of the Year by the Insurance Technology Association for her data innovation work. Wilson has been a steady supporter of diversity. She launched the Kaiser Permanente Women in Technology group, focused on mentorship and retention for women in math, technology, and science, and at AIG, she launched Global Women in Technology and served as executive sponsor of Girls Who Code. You can contact Wilson via LinkedIn.]

Source link

Leave a Reply

Your email address will not be published. Required fields are marked *