The Klear.ai Fraud Detection System is potent and highly accurate.
Our system flags potential abuse and fraud within workers comp claims. Powered by AI and ML, the solution has a library of algorithms built to detect Claimant Fraud, Provider Fraud and Vendor Fraud.
DID YOU KNOW?Typically less than 1% of fraud claims, amount to more than 10% of the total cost of claims.
Add your experience of fraud patterns to existing Klear.ai library of business rules to flag those suspicious transactions.
System identifies unusual patterns, that do not conform to expected behaviors.
Like Neural Network, SVM, Random Forests and Ensemble Methods, working alone or in combination.
Visualizes the transactions as relationships between key players, giving valuable insight into possible collusion.
Goes through the text data like adjuster notes, to spot the keywords that match with Klear.ai’s fraud library.
Severity Prediction Models predict the severity of every claim throughout its’ lifecycle.
Accurate predictions can help lower your claim cost by assigning the right adjuster or by making critical decisions regarding case management early in the claim’s lifecycle.
Proprietary models give targeted reserve recommendations for every claim.
Our recommendations are based on a survey of historical data including claimant demographics, injury specifics, procedures, prescriptions and other compounding factors like comorbidity.
Predicting the likelihood of a claim going to litigation is a valuable tool for your program.
The Klear.ai model provides expected probability along with other top drivers resulting in a probabilistic score which greatly improves the lifecycle management of the claim.
Our model identifies claims with the potential to recover money through subrogation.
The system further prioritizes and channels these claims to designated subrogation specialists within your organization.