Clearspeed’s one-to-one, in-the-moment assessments unlock a new way for
workers’ compensation insurers to quickly understand who or what to trust.
The road to recovery from a workplace injury and the management of a worker’s return to work can be a long journey, but that shouldn’t apply to risk management. Real-time insights into potential fraud is becoming essential in managing active workers’ compensation claims. Factors that drive claimant escalations and costs often emerge gradually and can be missed in periodic file reviews alone. Unfortunately, these claimant checkpoints offer limited, unverified information, and rely too heavily on self-reporting. These small inconsistencies often turn into costly, long-tail claims. Without good data insurers struggle with confidently understanding who or what to trust.
Better manage potential fraud throughout return-to-work cycles
Clearspeed is purpose built to solve for the tension between speed and accuracy at regular workers’ compensation claim management touchpoints. Our individualized and real-time assessments of risk unlock a new way to understand potential risk of fraud in real time, providing a new insight that enables better, faster decision-making, and remedies the tradeoff between pace and rigor.
Fast, individualized assessments
Clearspeed analyzes the responses to a short set of customized and automated yes/no questions for universal vocal characteristics known to be associated with risk. This delivers a point-in-time, individualized assessment of potential fraud for each claim on a number of key areas where data is previously hard to verify or validate:
- Inconsistent work restrictions or impairment ratings
- Activities contrary to claimant’s injury severity statements
- Excessive symptom reporting
- Delayed or inappropriate care
- Provider patterns of overtreatment or excessive diagnostics
- Unusual billing
- Poor recovery trajectory without clinical explanation
- Avoidance of communication
- Non-compliance with treatment or return-to-work programs
- Personal gains (financial, lifestyle, secondary employment)
- Up-coding and double billing
- Repetitive doctors appearances in other claims
- Claims trending above expected medical/indemnity benchmarks
- Co-worker collusion
Easy insertion into existing workflows
The Clearspeed voice-based risk assessment process starts with claimants being presented with the Clearspeed questionnaire on any voice-enabled device. Clearspeed analyzes the claimant’s vocal response to the case-specific question set, quickly identifying and scoring indicators associated with risk. Individualized results are then returned via API or available with the Clearspeed web app to inform next steps in claims pathing.
Clearspeed Benefits
In an environment where input integrity directly impacts return-to-work timeline and claims cost expectations, real-time insights turn reactive claim management into proactive fraud control.
Make faster, more accurate determinations
• Simplify on-going claims management check-ins
• Get unique risk insights where data is either challenging to find, or lacks accuracy
• Continue high-trust claims on their agreed upon path with confidence
• Undertake additional scrutiny on cases with focused insights on fraud potential
Boost equity and reliability
• Ensure consistent, fair outcomes across all individuals with objective and unbiased assessments
• Improve the customer experience for genuine claimants by eliminating unneeded investigation rigor
Optimize resources and investigation spend
• Reduce investigation cycles for claims where trust is high
• Eliminate unnecessary recorded interviews, surveillance details, detailed social media & open-source intelligence checks, or database sweeps for past injuries, overlapping claims, or serial claimant behavior
• Prevent small inconsistencies from turning into costly, long-tail claims
Discover how Clearspeed can help you make faster, more confident decisions on workers’ compensation claims case management.
Learn more at www.clearspeed.com
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