Audit performance evaluation

• US 10,062,122 B2
• Filed: 11/30/2017
• Issued: 08/28/2018
• Est. Priority Date: 12/31/2013
• Status: Active Grant

• Current Assignee: AON Global Operations SE Singapore Branch
• Original Assignee: Aon Global Operations Limited (Singapore Branch) (Aon Plc (Spain))
• Inventors: Combes, Kevin, Braun, Paul, Galusha, Larry Joe
• Primary Examiner(s): Trotter, Scott S
• Application Number:
  US15/827,544
• Publication Number:
  US 20180082382A1
• Time in Patent Office: 271 Days
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/06393 Score-carding, benchmarking or key performance indicator [KPI] analysis
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Audit performance systems and methods can be used to provide objective assessment of the performance of claim administrators. Data from audits performed by one or more insurance broker consultants can be input into the audit performance system, and analyzed, to generate reports that compare the performance of a selected claim administrator to an industry standard level of performance or to one or more other claim administrators.

Claims

1. A system of graphical user interfaces embodied on a non-transitory computer-readable medium and executable on processing circuitry for displaying an objective audit performance evaluation based upon calibrated performance scores, the system comprising:

a non-transitory computer readable medium storing calibration data, the calibration data comprising a set of calibration levels for each criterion of a plurality of criteria;

a basic report graphical user interface, comprising

a claim administrator display region on a user'"'"'s computing device configured for displaying respective cumulative score information for each performance category of a plurality of performance categories, and

a comparison display region on the user'"'"'s computing device configured for displaying client-specific score information beneath a plurality of category headings, wherein each category heading of the plurality of category headings corresponds to a respective performance category of the plurality of performance categories; and

a detailed report graphical user interface, comprising

a plurality of performance evaluation display regions on the user'"'"'s computing device, each performance evaluation display region corresponding to a respective performance category of the plurality of performance categories, wherein each performance evaluation display region is configured for displaying, for each administrator of a plurality of claim administrators, and for each criterion of a subset of the plurality of criteria corresponding to the respective performance category,

at least one of a performance category score, and a comparison of the performance category score to a performance category benchmark score;

wherein, upon selection of a particular category heading of the plurality of category headings of the basic report graphical user interface, instructions, executed by the processing circuitry, cause the processing circuitry to

prepare, for presentation on the user'"'"'s computing device, a corresponding performance evaluation display region of the plurality of performance evaluation display regions of the detailed report graphical user interface, wherein preparing the corresponding performance evaluation display region comprises

analyzing claim audit performance data to determine, for each criterion of the plurality of criteria presented in the corresponding performance evaluation display region, a respective performance benchmark score,

accessing calibration data associated with each criterion, and

for each administrator of the plurality of claim administrators, and for each criterion of a portion of the plurality of criteria,

identifying, in the claim audit performance data, a respective performance score of a respective administrator, and

determining a respective performance rating indicator corresponding to a calibration level of respective calibration data, and

present, on the user'"'"'s computing device, the corresponding performance evaluation display region.

2. The system of claim 1, wherein:

the plurality of performance categories comprises at least three of the following;

an initial contact and investigation category, an operational issues category, a case management category, a documentation category, a medical management category, a negotiation management category, a litigation management category, and a reserves category.

3. The system of claim 1, wherein the cumulative score information comprises a) a cumulative score, b) a benchmark score, and c) a comparison of the cumulative score to the benchmark score.

4. The system of claim 3, wherein the benchmark score is one of an industry standard level of performance and a cumulative possible score.

5. The system of claim 1, wherein the client-specific score information comprises, for each client of at least one client and for each performance category of the plurality of performance categories, respective client score information, wherein the respective client score information includes a comparison of a cumulative client-specific score to a client-specific benchmark score.

6. The system of claim 5, wherein the client-specific benchmark score is one of an industry standard level of performance, and a client-specific cumulative possible score.

7. The system of claim 1, wherein the respective performance benchmark score is an industry standard level of performance.

8. The system of claim 1, wherein each performance evaluation display region is configured for displaying, for each administrator of the plurality of claim administrators, and for each criterion of a subset of the plurality of criteria corresponding to the respective performance category, a performance category graphical rating indicator.

9. The system of claim 1, wherein determining the respective performance benchmark score further comprises analyzing claims data.

10. The system of claim 1, wherein the performance rating indicator represents a general indication of level of performance in relation to the respective performance benchmark score and the respective performance score.

11. A non-transitory computer readable medium having instructions stored thereon, wherein the instructions, when executed by processing circuitry, cause the processing circuitry to:

access, from a non-transitory storage medium, claim audit records including responses to a plurality of claim audit performance questions related to a claim administrator, wherein

each question of the plurality of claim audit performance questions is associated with a respective category of a plurality of performance categories;

convert the responses for the plurality of claim audit performance questions into a plurality of performance scores, each score of the plurality of performance scores having the respective category of the plurality of performance categories of the corresponding claim audit performance question;

access calibration data comprising a set of calibration scales, including a respective calibration scale for each category of the plurality of performance categories;

for each performance score of the plurality of performance scores, determine a respective performance rating indicator corresponding to a calibration scale of the respective performance category; and

cause presentation, for a user of a remote computing device via a network, of a graphical user interface for at least one of the plurality of performance categories to a remote computing device, wherein the graphical user interface includes one or more interface sections configured to display audit performance indications including performance rating indicators for the claim administrator relative to each of a plurality of claim performance metrics.

12. The non-transitory computer readable medium of claim 11, wherein the one or more interface sections include at least one of a) a first interface section configured to present the audit performance indications within a tabular format, b) a second interface section configured to present the audit performance indications within a tiered graphical display indicating one or more audit performance levels of a respective calibration scale of the sets of calibration scales, and c) a third interface section configured to present the audit performance indications within a bar graph representation.

13. The non-transitory computer readable medium of claim 11, wherein the audit performance indications include at least one of a cumulative performance score for each of the plurality of performance categories, a respective claim performance metric of the plurality of claim performance metrics associated with each of the plurality of claim audit performance questions, and a cumulative performance metric for each of the plurality of performance categories.

14. The non-transitory computer readable medium of claim 11, wherein the instructions, when executed on the processing circuitry, cause the processing circuitry to, prior to converting the responses, receive the claim audit records from the remote computing device via the network.

15. The non-transitory computer readable medium of claim 11, wherein the claim audit records are associated with identification information for the claim administrator including at least one of an insurance carrier and an industry market segment.

16. The non-transitory computer readable medium of claim 15, wherein the instructions, when executed by the processing circuitry, further cause the processing circuitry to, prior to accessing the claim audit records, index the claim audit records into the one or more categorical groupings based on the identification information for the claim administrator.

17. The non-transitory computer readable medium of claim 11, wherein the instructions, when executed by the processing circuitry, further cause the processing circuitry to calculate, from the claim records, respective one or more claim performance metrics of the plurality of claim performance metrics for each of the plurality of claim audit performance questions, wherein the respective one or more claim performance metrics include minimum acceptable scores for each of the plurality of claim audit performance questions.

18. The non-transitory computer readable medium of claim 17, wherein the instructions, when executed on the processing circuitry, further cause the processing circuitry to calculate, from the respective one or more performance metrics associated with each of the plurality of claim audit performance questions, cumulative performance metrics for each category of the plurality of performance categories.

19. The non-transitory computer readable medium of claim 11, wherein converting the responses for each of the plurality of claim audit performance questions into the performance scores further includes calculating percentage performance scores using the calibration data based on a respective total possible score associated with each of the plurality of claim audit performance questions.

20. The non-transitory computer readable medium of claim 11, wherein causing presentation of the graphical user interface with the one or more interface sections includes displaying audit performance indications for a plurality of claim administrators including the claim administrator at each of the one or more interface sections.