System and method for automated processing of claims

• US 20090037250A1
• Filed: 07/31/2007
• Published: 02/05/2009
• Est. Priority Date: 07/31/2007
• Status: Active Grant

• Current Assignee: Caterpillar Incorporated
• Original Assignee: Caterpillar Incorporated
• Inventors: Green, Joshua Willis, Kaag, Matthew Steven, Meyer, Douglas Clifford, Vogel, Donna Louise, Haynes, Darrel Wayne
• Granted Patent: US 8,150,722 B2
• Time in Patent Office: Days
• US Class Current: 705/10
• CPC Class Codes: G06Q 10/0639 Performance analysis of employees; Performance analysis of enterprise or organisation operations
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 30/0201 Market modelling; Market analysis; Collecting market data
• CPC Class Codes: G06Q 30/0204 Market segmentation

Abstract

A system and method are disclosed that provide for processing claims. The system and method include receiving a claim from a customer and determining if a customer average value associated with the customer is greater than or equal to a threshold value. The system and method also include processing the claim when the customer average value is less than the threshold value and determining if the claim meets one or more predetermined parameters when the customer average value is greater than or equal to the threshold value. In addition, the system and method include processing the claim when the claim meets the one or more predetermined parameters and forwarding the claim for further investigation when the claim fails to meet the one or more predetermined parameters and the customer average value is greater than or equal to the threshold value.

Claims

1. A method for processing claims, comprising:

receiving a claim from a customer;

determining if a customer average value associated with the customer is greater than or equal to a threshold value;

processing the claim when the customer average value is less than the threshold value;

determining if the claim meets one or more predetermined parameters when the customer average value is greater than or equal to the threshold value;

processing the claim when the claim meets the one or more predetermined parameters; and

forwarding the claim for further investigation when the claim fails to meet the one or more predetermined parameters and the customer average value is greater than or equal to the threshold value.

2. The method as in claim 1, wherein determining if the customer average value is greater than the threshold value further includes:

calculating a group average value associated with a group of customers, wherein the customer is included in the group of customers;

calculating the customer average value;

calculating a plurality of values based on the group average value;

identifying one of the plurality of values as the threshold value; and

determining if the customer average value is greater than or equal to the threshold value.

3. The method as in claim 2, further including:

calculating a standard deviation based on the group average value.

4. The method as in claim 3, wherein the threshold value is based on the standard deviation.

5. The method as in claim 1, wherein forwarding the claim further includes:

denying the claim.

6. The method as in claim 2, wherein forwarding the claim further includes:

reviewing one or more processes associated with the customer;

determining an improvement plan associated with the customer; and

monitoring the improvement plan.

7. The method as in claim 6, further including:

calculating a new group average value associated with the group of customers;

calculating a new customer average value associated with the customer; and

calculating a new standard deviation based on the new group average value.

8. The method as in claim 2, wherein the group average value is a mean average value.

9. A computer-readable medium including instructions for performing a method, when executed by a processor, for processing dealer returns, comprising:

receiving a claim from a customer;

determining if a customer average value associated with the customer is greater than or equal to a threshold value;

processing the claim when the customer average value is less than the threshold value;

determining if the claim meets one or more predetermined parameters when the customer average value is greater than or equal to the threshold value;

processing the claim when the claim meets the one or more predetermined parameters; and

forwarding the claim for further investigation when the claim fails to meet the one or more predetermined parameters and the customer average value is greater than or equal to the threshold value.

10. The computer-readable medium of claim 9, wherein determining if the customer average value is greater than the threshold value further includes:

calculating a group average value associated with a group of customers, wherein the customer is included in the group of customers;

calculating the customer average value;

calculating a plurality of values based on the group average value;

identifying one of the plurality of values as the threshold value; and

determining if the customer average value is greater than or equal to the threshold value.

11. The computer-readable medium of claim 10, further including:

calculating a standard deviation based on the group average value.

12. The computer-readable medium of claim 11, wherein the threshold value is based on the standard deviation.

13. The computer-readable medium of claim 9, wherein forwarding the claim further includes:

denying the claim.

14. The computer-readable medium of claim 10, wherein forwarding the claim further includes:

reviewing one or more processes associated with the customer;

determining an improvement plan associated with the customer; and

monitoring the improvement plan.

15. The computer-readable medium of claim 14, further including:

calculating a new group average value associated with the group of customers;

calculating a new customer average value associated with the customer; and

calculating a new standard deviation based on the new group average value.

16. The computer-readable medium of claim 12, wherein the group average value is a mean average value.

17. A method for processing claims, comprising:

receiving a claim from a customer, wherein the customer has an associated customer average value;

determining if the customer average value is greater than or equal to a threshold value, wherein the threshold value is based on a group average value associated with a group of customers, and wherein the customer is included in the group of customers; and

processing the claim when the customer average value is less than the threshold value.

18. The method as in claim 17, wherein determining if the customer average value is greater than the threshold value further includes:

calculating the group average value;

calculating the customer average value;

calculating a plurality of values based on the group average value;

identifying one of the plurality of values as the threshold value; and

determining if the customer average value is greater than or equal to the threshold value.

19. The method as in claim 18, further including:

calculating a standard deviation based on the group average value, wherein the threshold value is based on the standard deviation.

20. The method as in claim 17, further including:

determining if the claim meets one or more predetermined parameters when the customer average value is greater than or equal to the threshold value;

processing the claim when the claim meets the one or more predetermined parameters; and

forwarding the claim for further investigation when the claim fails to meet the one or more predetermined parameters and the customer average value is greater than or equal to the threshold value.