Systems, Methods, and Computer Program Products for Processing Insurance Claims

• US 20120143634A1
• Filed: 12/02/2011
• Published: 06/07/2012
• Est. Priority Date: 12/02/2010
• Status: Abandoned Application

• Current Assignee: American International Group Incorporated
• Original Assignee: American International Group Incorporated
• Inventors: Beyda, Peter, Seth, Archana, Apsel, Ira, Gitter, Michael
• Application Number:
  US13/310,528
• Publication Number:
  US 20120143634A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Systems, methods, and computer program products for processing a claimant'"'"'s insurance claim provide the architectural components to facilitate a common philosophy and infrastructure for processing claims in a consistent manner. A highly cohesive infrastructure can be provided that allows for legacy systems to participate in a service-oriented manner.

Claims

1. A method for processing insurance claims, the method comprising employing a process server to deploy and execute services of a service-oriented architecture comprising computer executable instructions stored on a tangible computer-readable medium to perform the steps of:

using a user interface layer of a global claims online application to enter data about an insurance claim into the global claims online application;

processing service requests via an enterprise service bus (ESB);

invoking business data services using the global claims online application user interface layer to store the entered insurance claim data in a claim transactional database;

invoking business orchestration using a workflow management module of the global claims online application and the ESB to perform a sequence of work objects to be completed for processing the insurance claim.

2. The method for processing insurance claims of claim 1, wherein the process server is at a first geographical site, and the computer executable instructions stored on the tangible computer-readable medium perform a further step of:

associating a user interface channel including a user interface browser and a web server with the global claims online application to display the user interface layer at a second geographical site.

3. The method for processing insurance claims of claim 2, wherein the computer executable instructions stored on the tangible computer-readable medium perform a step of:

deploying claims services of the service-oriented architecture in response to an invocation received from the user interface layer.

4. The method for processing insurance claims of claim 2, wherein the computer executable instructions stored on the tangible computer-readable medium perform a step of:

deploying data services of the service-oriented architecture in response to an invocation received from the user interface layer.

5. The method for processing insurance claims of claim 4, wherein the computer executable instructions stored on the tangible computer-readable medium perform a step of:

accessing a data integration hub and invoking a data transformation service of the service-oriented architecture to integrate claims data.

6. The method for processing insurance claims of claim 2, wherein the computer executable instructions stored on the tangible computer-readable medium perform a step of:

using a web services cluster to call CRUD stored procedures from a global claims data repository.

7. The method for processing insurance claims of claim 1, wherein the computer executable instructions stored on the tangible computer-readable medium perform a step of:

writing messages to a global claims message queue server using the ESB;

consuming messages from the queue server using the ESB;

using a business event monitoring module of the global claims online application and the ESB to monitor for messages in the message queue server.

8. The method for processing insurance claims of claim 1, wherein the process server is at a first geographical site, and an in-country server is at a second geographical site, the computer executable instructions stored on the tangible computer-readable medium perform a further step of:

invoking a delegated service from the in-country server using the ESB.

9. The method for processing insurance claims of claim 8, wherein the computer executable instructions stored on the tangible computer-readable medium perform a step of:

replicating send and receive queues of a global claims message queue server in corresponding send and receive queues of an in-country queue server.

10. A non-transitory, tangible computer-readable storage medium bearing instructions for processing insurance claims, the instructions, when executing on one or more computing devices, perform the steps of:

using a web server to display a user interface layer of a global claims online application on a user interface browser to receive data about an insurance claim;

processing service requests via an enterprise service bus (ESB);

invoking business data services in response to input from the global claims online application user interface layer to store the entered insurance claim data in a claim transactional database;

invoking business orchestration using a workflow management module of the global claims online application and the ESB to perform a sequence of work objects to be completed for processing the insurance claim.

11. A system for processing insurance claims comprising:

a physical computer-readable medium including a global claims online application, the global claims online application including;

a user interface layer adapted to allow a user to interface with the global claims online application,

a workflow management module adapted to determine a sequence of work objects to be completed for the insurance claim and to determine which user of a set of users works on each of the work objects relating to the insurance claim, and

a business rules management module adapted to manage logical rules for segmenting the insurance claim or a feature thereof to follow a predetermined workflow;

a physical computer-readable medium housing an enterprise messaging system having an enterprise service bus (ESB) adapted to route messages for processing service requests;

a processor adapted to execute the global claims online application contained on the physical computer-readable medium and to deploy and execute services of a service-oriented architecture through the ESB.

12. The system of claim 11, wherein the business rules management module of the global claims online application is adapted to manage logical rules for determining whether an insurance claim can be adjudicated automatically.

13. The system of claim 11, wherein the global claims online application includes a business event monitoring module adapted to provide real-time tracking of claim processing.

14. The system of claim 13, wherein the global claims online application includes an alerts and notifications module adapted to provide users operational information.

15. The system of claim 13, wherein the global claims online application includes a logging and audit trail module adapted to monitor the activities of the global claims online application and provide a log thereof.

16. The system of claim 11, further comprising:

a global claims data repository operably arranged with the processor through the ESB, the global claims data repository adapted to store integrated information related to an insurance claim.

17. The system of claim 16, further comprising:

a data integration hub operably arranged with the processor through the ESB, the data integration hub adapted to invoke a data transformation service of the service-oriented architecture to integrate claims data.

18. The system of claim 11, further comprising:

a web server operably arranged with the global claims online application, the web server adapted to display the user interface layer of the global claims online application on a user interface browser to receive requests from a user and send responses to the user.

19. The system of claim 18, further comprising:

a global claims queue module operably arranged with the processor through the ESB;

a physical computer-readable medium housing a web services cluster adapted to invoke services of the service-oriented architecture, process orchestration, and read/write to queues of the global claims queue module.

20. The system of claim 18, further comprising:

a physical computer-readable medium housing a perimeter security application adapted to provide a web access management system with different access permissions;

wherein the processor is adapted to execute the perimeter security application.