CLARA Analytics, The Leading Provider Of AI-Driven Worker’s Comp Claim Space

Heather has more than a decade of executive experience and leadership in data, analytics, and AI. She was Enterprise Chief Data Officer of AIG, Global Head of Innovation and Advanced Technology at Kaiser Permanente, and Enterprise Chief Data Officer of Citigroup. She sits on Equifax’s Board of Directors and is a member of the Audit and Technology Committees. While at AIG, she was named the Insurance Woman of the Year by the Insurance Technology Association.

In Conversation with Heather H Wilson, CEO of CLARA Analytics

CLARA was started in 2016. Our initial focus was on helping our clients direct their claims to healthcare providers that would obtain the best outcomes: highly effective care for the injured worker and cost effectiveness for the insurer. We also analyze claims as they evolve to help insurers identify when what starts out as a simple claim suddenly turns complex and needs to be handled by a specialist. Those were our original products. Now, we also offer products that help our clients optimize their provider networks and manage attorneys assigned to their cases and are piloting a commercial auto claims management product. We try to stay one step ahead of our clients by anticipating what else we can do to help them with the data they already provide us and what we could do with other types of their data.

How do you manage to offer rapid-turnaround data quality service for insurers? 

The key to our success here is leveraging the knowledge and experience we’ve acquired over years of working with what is now a repository of over $70 bil worth of workers comp claims. Workers comp claims data is vast and complex, and every company’s data is different. The time and resources it can take a company to prep their data for internal use can be enormous. Many companies try to do this on their own and throw up their hands midstream. Some of our clients have even asked us to give their data back to them once we’ve organized, cleaned and standardized it.

What is the future of AI in Insurance?

The future of AI in insurance is very bright, but most companies are finding it harder to build an implement than they anticipated. They are finding that AI isn’t a “magic wand” that can solve problems just by waving it at them. There’s a lot of hard work involved in the trenches before you are even ready to build AI models and systems.  And once they are built, if they haven’t been developed to easily plug into insurance production systems, the road to implementation and value creation becomes very long. CLARA has solved those problems in the workers comp claim domain. Our models work and are utilized by our clients right now.  We can get a company up and running in as little as twelve weeks in most cases. In the insurance industry, that’s fast!

How are you managing to collaborate the different worlds of science and commerce with each other?

This is a big challenge for all companies. We start by hiring people who can navigate in both worlds effectively from the start. I am a big believer in assessing how a new team member will affect the dynamics of the team and ultimately our company culture. I look for individuals who will honor our success and strengths and at the same time help us move forward by bringing new ideas and skills to the table. At an operational level, our data scientists are on a lot of our client calls and we encourage them to build relationships with our clients.

What made you get into the world of analytics and artificial intelligence?

I’m a geek at heart. In the first phase of my career, I wrote a lot of code and loved it.  Starting on the front lines, so to speak, allowed me to see the value of data and its enormous potential. I am intellectually curious about most everything, so it wasn’t long before I wanted to understand the application of data to solve problems which led me more often to the “business” side of things. And then, for me, it became all about maximizing what I could contribute through larger and larger teams and organizations. I have really enjoyed bringing together all the functions in a company necessary for analytics and data science to be successful.  IT, Operations, Sales, Marketing, Claims, and Data Science are often siloed and not used to working closely together. My biggest thrills have come from bringing those functions together to achieve big results as a unified team.

What is special about your program metrics that can help customers successfully?  What services do you provide?

We, like many others, saw the profound opportunities AI and machine learning offered to improve predictions with data; to identify patterns that are not apparent to humans. We chose to focus on insurance, a space that has lagged most industries when it comes to utilizing innovative technology. Years of tuning and refinement, combined with subject matter expertise that is critical to interpret the data, have elevated CLARA to become best of breed when it comes influencing and improving claim outcomes. Our product suite offers end-to-end claim management comprising customer data, cutting-edge AI models, and a fully integrated UX.

What is the most important key to your success? Share the experience.

Customer data shows that application of CLARA tools results in greater insured satisfaction, faster claimant recovery, and carrier cost savings. The key to that success is in the application. Our customer teams provide comprehensive training to ensure proper use of the tools and establish widespread adoption. However, all the insight in the world is useless unless the user takes action, so the CLARA suite is designed to direct users to the target risk areas, and we additionally educate users on the value of specific actions so as to influence behavior. We then deliver ongoing analysis of the effectiveness of the tools, tracking behavior, and quantifying impact.

What are the biggest challenges your company has faced in the initial years?

Today we are the leading provider of AI-driven intelligence in the workers comp claims space. From the beginning we have been pioneers. As such, we’ve tackled many challenges along the way.  From selling people on the notion of building an end-to-end system that not only identifies the best providers to use, but does so in a way that makes their adjusters happier and more efficient, to convincing them to help us build it, to working with their claims, data and IT teams to make it real, we’ve overcome some tough obstacles. Creating tangible value from AI isn’t just about building models, it’s about integrating models into an effective business process and system.  The obstacles to overcome are technical and cultural and we’ve been adept in handling both.

What do you feel are the reasons behind your company’s reputation?

I think it’s pretty straight-forward: CLARA delivers results and does so with high integrity. We retain all of our clients because after they’ve started using our products they see improvement in their measures of success quickly.  Another thing is that we don’t just focus on the AI…we focus on the claims adjuster…on making his or her job easier to do and allowing him or her to share in their company’s success.  Our tools automate some of the decision making involved in adjusting claims and I think there are many more opportunities to do so that we’ve not yet touched.  We love that everyone from chief claims officers, to individual claims adjusters sing our praises.

What are your plans about the future of Clara Analytics?

Right now I am focused on further strengthening the bond with our customers. I am asking them how we can be better and do even more for them.  We want to strengthen the ROI we are delivering and find new sources of it for our customers. I also want to penetrate the workers comp base further. There are a few hundred workers comp insurers in the US, plus hundreds of companies that self-insure, so the opportunity is very large. All these companies struggle in some way with becoming AI-enabled. We enable them to say they are. I think that’s a compelling message.

Anything else you want to say? (Heather & Tom)

These are challenging times for everyone. COVID threw a monkey wrench into people’s lives and the economy. Right now, employers are struggling to find workers. The workers they eventually hire may not have much relevant experience which will lead to more work-related injuries. And workers that were injured previously may not have pursued their treatment as actively as they should have and will require more care. We are proud to play a part in helping workers get the proper care they need to get healthy faster, which ultimately leads to a more efficient economy and everyone benefits from that.