System for claim load balancing

• US 10,217,170 B2
• Filed: 10/31/2014
• Issued: 02/26/2019
• Est. Priority Date: 09/05/2014
• Status: Active Grant

• Current Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Original Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Inventors: Edwards, Paul J., Shemesh, Keren
• Primary Examiner(s): Robinson, Kito R
• Application Number:
  US14/530,063
• Publication Number:
  US 20160071217A1
• Time in Patent Office: 1,579 Days
• Field of Search: 705 2, 705 4, 705 35, 717999104, 718105
• CPC Class Codes: G06Q 10/063116 Schedule adjustment for a person or group
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

According to some embodiments, data may be received indicative of a plurality of insurance claims along with an indication of an appropriate claim segment classification for each insurance claim. A first claim handler may then be automatically selected for a first insurance claim based at least in part on: (i) a first segment classification associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, and (iii) load factors associated with claim handlers. An indication of the selected first claim handler may then be transmitted.

Claims

1. A system for claim load balancing and assignment, comprising:

a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies, the data comprising a plurality of data elements for each of the insurance claims;

a computer storage unit for receiving, storing, and providing said data indicative of the plurality of insurance claims;

a segmentation platform processor configured for;

automatically, responsive to a new one of the insurance claims and dynamically responsive to a change in at least one of a subset of the plurality of data elements relating to one of the insurance claims previously segmented, executing segmentation logic, including;

determining a type of insurance associated with a first insurance claims of the plurality of insurance claims;

analyzing the received data associated with the first insurance claim, in accordance with first segmentation logic, to determine a first segment classification appropriate for the first insurance claim, the first segment classification being one of a plurality of sequential from least complex to most complex, ranked, complexity segment classifications, wherein at least the first segmentation logic comprises a rule mapping at least one parameter description value to a minimum complexity value of the plurality of sequential segment classifications;

analyzing the received data associated with the first insurance claim, in accordance with second segmentation logic different from the first segmentation logic, to determine a second segment classification appropriate for the second insurance claim, the second segment classification being another one of the plurality of sequential complexity segment classifications, and

transmitting an indication of the higher of the first and second segment classifications to a load balancing and assignment platform processor; and

a load balancing and assignment platform processor in communication with the storage unit, wherein the processor is configured for;

receiving from a separate human resources platform data indicative of availability of a plurality of claim handlers;

selecting a first claim handler for the first insurance claim based at least in part on;

(i) the higher of the first and second sequential segment classifications determined by the segmentation platform processor associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, (iii) load factors associated with claim handlers, (iv) the data indicative of availability of the plurality of claim handlers, and (v) expertise attributes associated with the claim handlers;

the selecting being performed at least in part by a predictive model trained with historical insurance claim information, the predictive model including at least one of;

(i) a neural network, and (ii) a support vector machine; and

transmitting an indication of the selected first claim handler.

2. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for:

indicating to the computer storage unit that the first claim handler is authorized to access the data indicative of the first insurance claim.

3. The system of claim 1, wherein the first claim handler is further selected based on requests to receive more insurance claims received from claim handlers.

4. The system of claim 1, wherein the first insurance claim is associated with at least one of:

(i) workers'"'"' compensation insurance, (ii) automobile insurance, (iii) homeowners insurance, (iv) property insurance, (v) general liability insurance, (vi) commercial insurance, and (vii) personal insurance.

5. The system of claim 1, wherein at least some of the received data indicative of a plurality of insurance claims are associated with at least one of:

(i) a newly received first notice of loss, or (ii) information determined after a first notice of loss was received.

6. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for:

automatically transmitting an indication of the first claim handler to at least one of;

(i) an email server, (ii) a workflow application, (iii) a report generator, (iv) a calendar application, and (v) a claim handler device.

7. The system of claim 1, wherein the data indicative of the plurality of insurance claims is received via at least one of:

(i) submitted paper claims, (ii) telephone call center operators, and (iii) an online claim submission web site.

8. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for:

automatically selecting a second claim handler for a second insurance claim based on an assignment preferences table.

9. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for:

automatically selecting a second claim handler for a second insurance claim based on a dedicated handler manager.

10. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for:

automatically selecting a second claim handler for a second insurance claim based on a catastrophe management table.

11. The system of claim 1, wherein claim handlers are associated with one of a plurality of claim handler offices, at least one of the claim handler offices being remote from other claim handler offices.

12. The system of claim 1, wherein, after said selection of the first claim handler for the first insurance claim, feedback performance data is evaluated and, as a result of the evaluation, the first insurance claim is re-assigned to a second claim handler.

13. A computer-implemented method associated with an insurance claim processing system, comprising:

receiving, by a communication device, data indicative of a plurality of insurance claims submitted in connection with insurance policies, the data comprising a plurality of data elements for each of the insurance claims;

storing, by a computer storage unit, said data indicative of the plurality of insurance claims;

automatically, responsive to a new one of the insurance claims and dynamically responsive to a change in at least one of a subset of the plurality of data elements relating to one of the insurance claims previously segmented, executing, by a segmentation platform processor, segmentation logic, including;

determining a type of insurance associated with a first insurance claim of the plurality of insurance claims;

analyzing the received data associated with the first insurance claim, in accordance with first segmentation logic, to determine a first segment classification appropriate for the first insurance claim, the first segment classification being one of a plurality of sequential from least complex to most complex, ranked, complexity segment classifications, wherein at least the first segmentation logic comprises a rule mapping at least one parameter description value to a minimum complexity value of the plurality of sequential segment classifications;

analyzing the received data associated with the first insurance claim, in accordance with second segmentation logic different from the first segmentation logic, to determine a second segment classification appropriate for the first insurance claim, the second segment classification being another one of the plurality of sequential complexity segment classifications, and

transmitting, by the segmentation platform processor, an indication of the higher of the first and second segment classifications to a load balancing and assignment platform processor;

receiving, by the load balancing and assignment platform processor, from a separate human resources platform, data indicative of availability of a plurality of claim handlers;

automatically selecting, by the load balancing and assignment platform processor, a first claim handler for the first insurance claim based at least in part on;

(i) the higher of the sequential first and second segment classifications determined by the segmentation platform processor associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, (iii) load factors associated with claim handlers;

(iv) the data indicative of availability of the plurality of claim handlers, and (v) expertise attributes associated with the claim handlers;

the selecting being performed at least in part by a predictive model trained with historical insurance claim information, the predictive model including at least one of;

(i) a neural network, and (ii) a support vector machine; and

transmitting, by the load balancing and assignment platform processor, an indication of the selected claim handler.

14. The method of claim 13, wherein the first claim handler is further selected based on paid time off information associated with claim handlers.

15. The method of claim 13, wherein the first claim handler is further selected based on requests to receive more insurance claims received from claim handlers.

16. The method of claim 13, wherein at least some of the received data indicative of a plurality of insurance claims are associated with at least one of:

(i) a newly received first notice of loss, or (ii) information determined after a first notice of loss was received.

17. The method of claim 13, further comprising:

automatically selecting, by the load balancing and assignment platform processor, a second claim handler for a second insurance claim based on at least one of;

(i) an assignment preferences table, (ii) a dedicated handler manager, and (iii) a catastrophe management table.

18. A system for claim load balancing and assignment, comprising:

a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies along with an indication of an appropriate claim segment classification for each insurance claim, including insurance policies associated with workers'"'"' compensation insurance and automobile insurance, the data comprising a plurality of data elements for each of the insurance claims;

a computer storage unit for receiving, storing, and providing said data indicative of the plurality of insurance claims; and

a segmentation platform processor configured for;

automatically, responsive to a new one of the insurance claims and dynamically responsive to a change in at least one of a subset of the plurality of data elements relating to one of the insurance claims previously segmented, executing segmentation logic, including;

determining a type of insurance associated with a first insurance claims of the plurality of insurance claims;

analyzing the received data associated with the first insurance claim, in accordance with first segmentation logic, to determine a first segment classification appropriate for the first insurance claim, the first segment classification being one of a plurality of sequential from least complex to most complex, ranked, complexity segment classifications, wherein at least the first segmentation logic comprises a rule mapping at least one parameter description value to a minimum complexity value of the plurality of sequential segment classifications;

analyzing the received data associated with the first insurance claim, in accordance with second segmentation logic different from the first segmentation logic, to determine a second segment classification appropriate for the second insurance claim, the second segment classification being another one of the plurality of sequential complexity segment classifications, and

transmitting an indication of the higher of the first and second segment classifications to a load balancing and assignment platform processor;

a load balancing and assignment platform processor in communication with the storage unit, wherein the processor is configured for;

receiving from a separate human resources platform data indicative of availability of a plurality of claim handlers;

selecting a first claim handler for the first insurance claim based at least in part on;

(i) the higher of the first and second sequential segment classifications associated with the first insurance claim determined by the segmentation platform processor associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, (iii) load factors associated with claim handlers, (iv) the data indicative of availability of the plurality of claim handlers, and (v) expertise attributes associated with the claim handlers;

the selecting being performed at least in part by a predictive model trained with historical insurance claim information, the predictive model including at least one of;

(i) a neural network, and (ii) a support vector machine; and

transmitting an indication of the selected first claim handler.

19. The system of claim 18, wherein the first claim handler is further selected based on at least one of:

(i) paid time off information associated with claim handlers, and (ii) requests to receive more insurance claims received from claim handlers.

20. The system of claim 18, wherein a second claim handler is further selected based on at least one of:

(i) an assignment preferences table, (ii) a dedicated handler manager, and (iii) a catastrophe management table.