METHOD FOR AUTOMATING INSURANCE CLAIMS PROCESSING

• US 20090281841A1
• Filed: 05/12/2008
• Published: 11/12/2009
• Est. Priority Date: 05/12/2008
• Status: Abandoned Application

• Current Assignee: International Business Machines Corporation
• Original Assignee: International Business Machines Corporation
• Inventors: Lim, Desmond, Basak, Jayanta, Singh, Rashmi
• Application Number:
  US12/119,011
• Publication Number:
  US 20090281841A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Techniques for automating insurance claim processing are provided. The techniques include obtaining at least one rule from historical data, using the at least one rule to segment a dataset, wherein segmenting the dataset comprises using an iterative process, and wherein the iterative process comprises a decision tree, using the segmented dataset to determine if a claim can be automatically settled, and automatically settling a claim if it is determined that the claim can be automatically settled.

Claims

1. A method for automating insurance claim processing, comprising the steps of:

obtaining at least one rule from historical data;

using the at least one rule to segment a dataset, wherein segmenting the dataset comprises using an iterative process, and wherein the iterative process comprises a decision tree;

using the segmented dataset to determine if a claim can be automatically settled; and

automatically settling a claim if it is determined that the claim can be automatically settled.

2. The method of claim 1, further comprising enriching the historical data as additional data is gathered.

3. The method of claim 1, further comprising manually changing one of the at least one rule.

4. The method of claim 1, wherein the historical data is a set of one or more samples derived subject to an underlying claim processing model.

5. The method of claim 1, further comprising observing a correspondence between the at least one rule from the historical data and current knowledge of one or more claims experts.

6. The method of claim 1, further comprising labeling a claim based on at least one variable.

7. The method of claim 6, wherein the at least one variable comprises at least one of a type of loss, delay in a claim settlement and an indemnity paid in claim settlement.

8. The method of claim 6, further comprising applying a threshold to each variable, wherein the threshold corresponds to determining whether the claim can be automatically settled.

9. The method of claim 1, further comprising applying at least one additional classifier to the decision tree, wherein the at least additional classifier comprises at least one of a neural network, a k-nearest neighbor algorithm (k-NN), naï

ve Bayes, and a support vector machine (SVM).

10. A computer program product comprising a computer readable medium having computer readable program code for automating insurance claim processing, said computer program product including:

computer readable program code for obtaining at least one rule from historical data;

computer readable program code for using the at least one rule to segment a dataset, wherein segmenting the dataset comprises using an iterative process involving a pattern classification technique;

computer readable program code for using the segmented dataset to determine if a claim can be automatically settled; and

computer readable program code for automatically settling a claim if it is determined that the claim can be automatically settled.

11. The computer program product of claim 10, further comprising computer readable program code for enriching the historical data as additional data is gathered

12. The computer program product of claim 10, further comprising computer readable program code for manually changing one of the at least one rule.

13. The computer program product of claim 10, further comprising computer readable program code for observing a correspondence between the at least one rule from the historical data and current knowledge of one or more claims experts.

14. The computer program product of claim 10, further comprising computer readable program code for labeling a claim based on at least one variable.

15. The computer program product of claim 14, further comprising computer readable program code for applying a threshold to each variable, wherein the threshold corresponds to determining whether the claim can be automatically settled.

16. A system for automating insurance claim processing, comprising:

a memory; and

at least one processor coupled to said memory and operative to;

obtain at least one rule from historical data;

use the at least one rule to segment a dataset, wherein segmenting the dataset comprises using an iterative process involving a pattern classification technique;

use the segmented dataset to determine if a claim can be automatically settled; and

automatically settle a claim if it is determined that the claim can be automatically settled.

17. The system of claim 16, wherein the at least one processor coupled to said memory is further operative to enrich the historical data as additional data is gathered.

18. The system of claim 16, wherein the at least one processor coupled to said memory is further operative to manually change one of the at least one rule.

19. The system of claim 16, wherein the at least one processor coupled to said memory is further operative to observe a correspondence between the at least one rule from the historical data and current knowledge of one or more claims experts.

20. The system of claim 16, wherein the at least one processor coupled to said memory is further operative to label a claim based on at least one variable.