System and method for identifying potential future interaction risks between a client and a provider

• US 10,366,360 B2
• Filed: 10/29/2014
• Issued: 07/30/2019
• Est. Priority Date: 11/16/2012
• Status: Active Grant

• Current Assignee: SPF, Inc.
• Original Assignee: SPF, Inc.
• Inventors: Lawless, Jennifer S., Lawless, Charles B., Hader, Michael William
• Primary Examiner(s): Stamber, Eric W
• Assistant Examiner(s): Young, Ashley Y
• Application Number:
  US14/527,467
• Publication Number:
  US 20150051945A1
• Time in Patent Office: 1,735 Days
• Field of Search: None
• CPC Class Codes: G06Q 10/0635 Risk analysis of enterprise or organisation activities

Abstract

A method for identifying potential future interaction risks between a client and a provider using a computer server is disclosed. Transactions between the client and the provider are conducted in association with one or more communication platforms and the method includes storing client data on the computer server received from a variety of data sources including client claims data, and storing agent data on the computer server received from a variety of data sources. The method further includes obtaining feedback data related to at least one of the client, the agent, and one of the transactions and analyzing the data to identify potential future transactional problems.

Claims

1. A method for actively monitoring interaction risks via a computer server potentially associated with transactions between a client and a provider, wherein the transactions between the client and provider are conducted in association with two or more communication platforms associated with the provider, the two or more communication platforms selected from the group comprising voice handlers, email servers, short message service servers, instant message servers and fax servers, the method comprising:

receiving client claims data on the computer server from a first data source, the client claims data having at least some portion of data related to the client;

storing client claims data in a database operably associated with the computer server, the client claims data stored in the database being inaccessible to the provider;

storing risk guidelines in the database operably associated with the computer server, at least one of the risk guidelines associated with the provider;

receiving client identifying information on the computer server from the provider;

selecting client claims data from the database based on the client identifying information from the provider;

categorizing, by the computer server, the client into a client risk category based on a computer analysis of the risk guidelines associated with the provider and the selected client claims data, the risk category of the client being inaccessible to the provider;

delivering functionality to the provider that automatically, without user intervention, captures communications involving the client and the provider on at least one of the two or more communication platforms and automatically reports on the captured communications via at least one of the two or more communication platforms, a frequency of capturing, reporting, or both being based on the provider-inaccessible client risk category associated with the client; and

preventing, by an employee of the provider, an agent of the provider from completing at least one of the transactions between the client and provider based at least in part on the automatic reports of the captured communications.

2. The method of claim 1, further comprising:

storing agent data regarding at least one agent of the provider on the computer server, the agent data received from a variety of data sources;

obtaining feedback data related to at least one of the client, the agent, and a transaction between the client and the provider; and

analyzing the agent data, the client claims data, and the feedback data to identify potential future transactional problems.

3. The method of claim 2, wherein the variety of data sources includes a database managed by the Financial Industry Regulatory Agency.

4. The method of claim 2, wherein the step of analyzing the agent data, the client claims data, and the feedback data to identify potential future transactional problems includes drawing data from a risk guideline database.

5. The method of claim 1, wherein the computer server includes a selection module including one or more processors configured to select client claims data based on at least a portion of client identifying information and a categorization module including one or more processors configured to receive the selected client claims data from the selection module and generate the provider-inaccessible client risk category.

6. The method of claim 1, wherein client claims data is received by the computer server from two or more servers associated with two or more providers and risk guidelines are associated with each of the two or more providers, and wherein risk guidelines are unique to each of the two or more providers.

7. The method of claim 1, wherein the database storing the client claims data is a set of virtual storage areas and system operably connected to the computer server.

8. The method of claim 1, wherein the provider is an institution having a plurality of institutional agents, the method further comprising:

storing, for each of the plurality of institutional agents, an agent risk category for each of the plurality of institutional agents in the database, wherein the frequency of the capturing, reporting, or both is further based on the agent risk category associated with each communication.

9. The method of claim 8, further comprising:

receiving agent claims data on the computer server from a second data source, wherein at least some portion of the agent claims data is related to one of the plurality of institutional agents;

storing agent claims data in the database operably associated with the computer server;

selecting agent claims data from the database based on the agent identifying information;

determining an agent risk category based on a computer analysis of the risk guidelines for the provider and the selected agent claims data; and

writing over the stored agent risk category for each of the plurality of institutional agents in the database when the determined agent risk category is riskier than the stored agent risk category.

10. The method of claim 9, wherein the agent claims data is received from a plurality of data sources, further comprising normalizing the agent claims data between the plurality of data sources.

11. The method of claim 9, wherein the delivered functionality further includes functionality for comparing words in the communication with stop words, the frequency of capturing, reporting, or both is further based on presence of keywords in the communication.

12. The method of claim 11, wherein one of the communication platforms is a telephone system and the delivered functionality automatically captures audio from telephone calls on the telephone system, the delivered functionality further includes functionality that automatically converts the captured audio into text.

13. The method of claim 9, wherein the client identifying information includes a telephone number associated with the client, the delivered functionality further includes functionality that identities the client associated with the telephone call on the telephone system based on the telephone numbers associated with the telephone call.

14. A system for actively monitoring interaction risks potentially associated with transactions between a client and a provider, wherein the transactions between the client and provider are conducted in association with two or more communication platforms associated with the provider, the two or more communication platforms selected from the group comprising voice handlers, email servers, short message service servers, instant message servers and fax servers, the system comprising:

on a computer server, means for receiving client claims data from a first data source, the client claims data having at least some portion of data related to the client, means for receiving client identifying information from the provider, electronic storage for the client claims data, provider risk guidelines, and client identifying information, means for categorizing the client into a provider-inaccessible client risk category based on the provider risk guidelines and the client claims data stored on the computer server; and

means for automatically capturing communications involving the client and the provider on at least one of the two or more communication platforms based on the provider-inaccessible risk category of the client;

means for automatically, without user invention, reporting on the captured communications via at least one of the two or more communication platforms, a frequency of capturing, reporting, or both being based on the provider-inaccessible client risk category associated with the client; and

a user interface for preventing, by an employee of the provider, an agent of the provider from completing at least one of the transactions between the client and provider based at least in part on the automatic reports of the captured communications.

15. The system of claim 14, wherein the provider is an institution having a plurality of agent identifying information from the provider wherein the electronic storage further stores the agent identifying information and an agent risk category for each of the plurality of institutional agents, wherein the frequency of the capturing, reporting, or both is further based on the agent risk category associated with each communication.

16. The system of claim 14, further comprising:

means for receiving agent claims data on the computer server from a second data source, wherein at least some portion of the agent claims data is related to one of the plurality of institutional agents, wherein the agents claims data is saved in the electronic storage; and

means for selecting agent claims data from the saved agents claim data based on the agent identifying information; and

means for determining an agent risk category based on the risk guidelines for the provider and the selected agent claims data, wherein the means for determining the agent risk category writes over the stored agent risk category for each of the plurality of institutional agents in the electronic storage when the determined agent risk category is riskier than the stored agent risk category.

17. The system of claim 16, further comprising means for comparing words in the communication with keywords such that the frequency of capturing, reporting, or both is further determined by presence of keywords in the communication.

18. The system of claim 17, wherein one of the communication platforms is a telephone system, the system further comprising:

means for automatically capturing audio from telephone calls on a telephone system;

and means for automatically converting the captures audio into text.

19. The system of claim 18, wherein the client identifying information includes a telephone number associated with the client, the system further comprising means for identifying the client associated with a telephone call on the telephone system based on the telephone numbers associated with the telephone call.

20. A method for actively monitoring interaction risks associated with transactions between a client and one or more providers, wherein the transactions between the client and the one or more providers are conducted in association with two or more communication platforms associated with the one or more providers, the two or more communication platforms selected from the group consisting of voice handlers, email servers, short message service servers, instant message servers and fax servers, the method comprising:

receiving client claims data on a computer server from one or more data sources, the client claims data having at least a portion of data related to the client;

storing client claims data in at least one database operably associated with the computer server;

storing risk guidelines in at least one database operably associated with the computer server, at least one of the risk guidelines associated with the provider;

receiving client identifying information on the computer server from the one or more providers;

selecting client claims data from the database based on the client identifying information from the provider;

categorizing, by the computer server, the client into a provider-inaccessible client risk category based on a computer analysis of the risk guidelines associated with the provider and the selected client claims data;

delivering functionality to the one or more providers that automatically captures communications involving the client and the provider on at least one of the one or more communication platforms, a frequency of capturing being based on the provider-inaccessible client risk category associated with the client;

delivering additional functionality to the one or more providers that automatically captures at least one random communication, in addition to capturing communication based on the risk category;

delivering additional functionality to the one or more providers that automatically reports on the captured communications based on the client risk category and random captured communications via at least one of the two or more communication platforms; and

preventing, by an employee of the provider, an agent of the provider from completing at least one of the transactions between the client and provider based at least in part on the automatic reports of the captured communications;

wherein automation of capturing and reporting is without user intervention.