MEMIC Selects Gradient AI to Gain Competitive Advantage in Its Workers’ Compensation Claims Operations

Gradient AI, a leading enterprise software provider of artificial intelligence (AI) solutions in the insurance industry announced at WCI 2023 Conference an expanded relationship with MEMIC, an A.M. Best “A” (Excellent) rated workers’ compensation insurer. Having already harnessed Gradient AI’s underwriting solution to enhance risk prediction and capture institutional knowledge, MEMIC has now chosen Gradient AI to enhance its claims management outcomes.

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“We can create guardrails on our reserve levels so that more of our future predictions fall within those parameters, enabling us to be much more consistent than we are today, and delivering more reliable results”

Under this expanded agreement, MEMIC will leverage the advanced capabilities of Gradient AI’s Claims Benchmarking and Total Incurred Prediction solutions. These innovative tools empower MEMIC to identify trends and outliers, improve the decision-making process and refine its reserve management processes so that sufficient funds are set aside to address anticipated claim costs.

MEMIC serves more than 20,000 employers and their estimated 300,000 employees with dedicated safety and injury management service teams from Maine to Florida. With approximately 11,000 open claims at any given time, MEMIC is constantly looking for strategies to improve the efficiency and accuracy of its claims management operations. Recognizing the value of leveraging artificial intelligence and machine learning, MEMIC sought to gain additional insights to optimize claim outcomes, reduce claim costs, and improve the accuracy of caseload reserves. These needs motivated MEMIC to choose Gradient AI’s Benchmarking and Total Incurred Prediction solutions.

Gradient AI’s benchmarking solution leverages an industry-leading data lake containing tens of millions of claims and policies, enabling users to see how their claims’ reserves compare to similar industry claims. Claims managers can then assess whether the reserve for a specific claim is on target or needs attention because it is over- or under-reserved.

“Our claim team is excellent but Gradient AI takes our game to a new level,” said Matt Harmon, SVP of Claims at MEMIC. “The benchmarking tool compares individual claims to similar industry claims. It highlights those claims deviating from norms, enabling us to decide if reserve levels are adequate. Adequate reserves create greater accuracy when calculating experience modification factors, and in turn better serve the interest of the policyholder and MEMIC alike.”

The total incurred prediction solution predicts the future cost on a case-by-case basis. This enables MEMIC’s claims managers to set future reserves within a certain range of the predicted cost.

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“We can create guardrails on our reserve levels so that more of our future predictions fall within those parameters, enabling us to be much more consistent than we are today, and delivering more reliable results,” Harmon added. “We operate under considerable pressure to ensure the utmost accuracy in our case file reserves. While we have engaged with other AI providers, Gradient AI stands apart by introducing reserve-based solutions that are truly game changers. The inclusion of both benchmarking and predictive tools represents new and exciting territory for us. They are filling a previously unmet need, which holds immense promise.”

“MEMIC’s visionary approach to unleashing the potential of data within its workers’ comp claim operations is commendable,” said Stan Smith, CEO and founder of Gradient AI. “Through strategic benchmarking against industry-wide data, and leveraging powerful predictive insights, the company is poised to elevate the precision of its case reserves, amplify claims management effectiveness, and enhance its ability to grow profitably. We are proud to provide industry-leading underwriting and claims management solutions and thrilled to continue to support MEMIC on its journey toward greater excellence.”

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