Audit performance evaluation

• US 10,109,018 B2
• Filed: 07/05/2017
• Issued: 10/23/2018
• Est. Priority Date: 12/31/2013
• Status: Active Grant

• Current Assignee: Aon Global Operations Limited (Singapore Branch) (Aon Plc (Spain))
• 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:
  US15/641,593
• Publication Number:
  US 20180025431A1
• Time in Patent Office: 475 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 comprising:

processing circuitry;

a non-transitory computer readable medium storing calibration data, the calibration data comprising a set of calibration scales, including a respective calibration scale for each category of a plurality of performance categories; and

a non-transitory computer readable memory coupled to the processing circuitry, the memory storing machine-executable instructions, wherein the machine-executable instructions, when executed on the processing circuitry, cause the processing circuitry to

receive, from a remote computing device of a user via a network, claim audit data including identification information for a claim administrator and responses to a plurality of claim audit performance questions, wherein each of the plurality of claim audit performance questions is associated with a respective claim performance metric within an audit question category of a plurality of audit question categories,

responsive to receiving the claim audit data,

convert the responses for the plurality of claim audit performance questions into a plurality of performance scores,

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

cause presentation, for the claim administrator, of a graphical user interface for at least one of the plurality of audit question 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, 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.

2. The system of claim 1, wherein the audit performance indications include at least one of a cumulative performance score for each of the plurality of audit question categories, a claim performance metric associated with each of the plurality of claim audit performance questions, and a cumulative performance metric for each of the plurality of audit question categories.

3. The system of claim 1, wherein the plurality of audit question categories include at least one of 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.

4. The system of claim 1, wherein the machine-executable instructions, when executed on the processing circuitry, further cause the processing circuitry to index, within the non-transitory storage medium and responsive to receiving the claim audit data, the claim audit data into one or more categorical groupings based on the identification information for the claim administrator.

5. The system of claim 4, wherein the identification information for the claim administrator includes one of an insurance carrier and an industry market segment.

6. The system of claim 4, wherein the machine-executable instructions, when executed on the processing circuitry, further cause the processing circuitry to calculate, from the indexed claim audit data, claim performance metrics for each of the plurality of claim audit performance questions, wherein the claim performance metrics include minimum acceptable scores for each of the plurality of claim audit performance questions.

7. The system of claim 6, wherein the machine-executable instructions, when executed on the processing circuitry, further cause the processing circuitry to calculate, from the performance metrics associated with each of the plurality of claim audit performance questions, cumulative performance metrics for each audit question category of the plurality of audit question categories.

8. The system of claim 1, 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.

9. The system of claim 1, wherein the tabular format for first interface section includes, for each of the plurality of audit question categories, a description of each of the plurality of claim audit performance questions.

10. The system of claim 9, wherein, for the description of each of the plurality of claim audit performance questions, the first interface section includes a respective performance metric, and a visual indication of whether the respective performance metric was met.

11. The system of claim 10, wherein the visual indication of whether the respective performance metric was met includes a respective text color.

12. The system of claim 1, wherein the tiered graphical display of the second interface section includes, for each of the plurality of audit question categories, a colored representation of the one or more audit performance levels over a range of performance values, wherein each of the one or more audit performance levels is represented by a different color.

13. The system of claim 12, wherein the second interface section includes at least one visual performance score indicator overlaid on the colored representation of the one or more audit performance levels.

14. The system of claim 13, wherein the at least one visual performance score indicator corresponds to at least one of a cumulative performance score and a cumulative performance metric for a respective audit question category.

15. The system of claim 1, wherein the bar graph representation of the third interface section includes, for each of the plurality of claim audit performance questions within a respective audit question category, a comparison of an industry standard performance metric to a respective performance metric.

16. The system of claim 1, 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 at each of the one or more interface sections.

17. The system of claim 1, wherein causing presentation of the graphical user interface with the one or more interface sections includes displaying average audit performance indications of a plurality of claim administrators.

18. The system of claim 1, wherein:

the set of calibration scales comprises a respective calibration scale for a plurality of criteria of each category of the plurality of performance categories; and

determining the respective performance rating indicator comprises determining the respective performance rating indicator corresponding to the calibration scale of a respective criterion of the plurality of criteria of the respective audit question category.

19. The system of claim 18, wherein the plurality of criteria comprises at least one of i) completion within thirty days, ii) three-point contact completion, and iii) claim indexing and documentation.