GUI FOR RISK PROFILES
First Claim
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1. A memory device storing machine-readable instructions, the instructions executable by a processor to cause the processor to:
- retrieve a first set of data from a database, the data including information about a plurality of insurance claims;
perform an analysis of the first set of data to determine a first result associated with a first key performance indicator;
obtain a first set of benchmark values corresponding to the first key performance indicator;
compare the first result to the first set of benchmark values to determine the relationship of the first result to the set of benchmark values; and
generate a risk profile report for output to the user that includes the relationship between the first result and the first set of benchmark valueswherein the key performance indicator is one of the group consisting of;
a percentage of workers compensation claims that include temporary total disability payments;
an average number of days per temporary total disability claim;
an average value of indemnity claims;
a medical-to-indemnity conversion rate;
a claim closure, rate for workers compensation claims;
an average time between a date of loss, and a date reported to a third party;
a percentage of total claim payments attributable to medical costs;
a percentage of medical costs attributable to pharmacy costs;
a PPO penetration rate;
a percentage of claims litigated;
a percentage of total claim payments attributable to expenses;
a percentage of total claim payments attributable to legal expenses;
a trend relationship related to an actuarially based claim frequency rate;
a variance related to an incidence rate of Occupational Safety &
Health Administration (OSHA) claims;
a variance related to a lost work date rate; and
a loss rate calculated based on claim frequency and claim severity.
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Abstract
A memory device stores machine-readable instructions executable by a processor to cause the processor to graphically depict on a display device a first category of risk analysis data related to a plurality of insurance claims. The processor also causes the display to graphically depict a relationship between a first analysis result and a first benchmark value corresponding to the first analysis result, and graphically depict one or more user controls for selecting a second category of risk analysis data.
10 Citations
18 Claims
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1. A memory device storing machine-readable instructions, the instructions executable by a processor to cause the processor to:
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retrieve a first set of data from a database, the data including information about a plurality of insurance claims; perform an analysis of the first set of data to determine a first result associated with a first key performance indicator; obtain a first set of benchmark values corresponding to the first key performance indicator; compare the first result to the first set of benchmark values to determine the relationship of the first result to the set of benchmark values; and generate a risk profile report for output to the user that includes the relationship between the first result and the first set of benchmark values wherein the key performance indicator is one of the group consisting of;
a percentage of workers compensation claims that include temporary total disability payments;
an average number of days per temporary total disability claim;
an average value of indemnity claims;
a medical-to-indemnity conversion rate;
a claim closure, rate for workers compensation claims;
an average time between a date of loss, and a date reported to a third party;
a percentage of total claim payments attributable to medical costs;
a percentage of medical costs attributable to pharmacy costs;
a PPO penetration rate;
a percentage of claims litigated;
a percentage of total claim payments attributable to expenses;
a percentage of total claim payments attributable to legal expenses;
a trend relationship related to an actuarially based claim frequency rate;
a variance related to an incidence rate of Occupational Safety &
Health Administration (OSHA) claims;
a variance related to a lost work date rate; and
a loss rate calculated based on claim frequency and claim severity. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A memory device storing machine-readable instructions, the instructions executable by a processor to cause the processor to
retrieve one or more sets of data from a database, the data including information about a plurality of insurance claims; -
perform an analysis on each of the one or more sets of data to determine a result for each set of data, the result being associated with a key performance indicator for each set of data; obtain one or more sets of benchmark values, each of the one or more sets of benchmark values corresponding to a respective one of the one or more key performance indicators; compare each of the one or more results to the respective one or more sets of benchmark values; associate a respective risk indication, according to the respective comparison of the one or more results to the one or more benchmark values, with the key performance indicator for each set of data; and generate a risk profile report for output to the user that includes the risk indication associated with the key performance indicator for each sot of data; wherein at least one key performance indicator is selected form the group consisting of;
a percentage of workers compensation claims that include temporary total disability payments;
an average number of days per temporary total disability claim;
an average value of indemnity claims a medical-to-indemnity conversion rate;
a claim closure rate for workers compensation claims;
an average time between a date of loss and a date reported to a third party;
a percentage of total claim payments attributable to medical costs;
a percentage of medical costs attributable to pharmacy costs;
a PPO penetration rate;
a percentage of claims litigated;
a percentage of total claim payments attributable to expenses;
a percentage of total claim payments attributable to legal expenses;
a trend relationship related to an actuarially based claim frequency rate;
a variance related to an incidence rate of Occupational Safety &
Health Administration (OSHA) claims;
a variance related to a lost work date rate; and
a loss rate calculated based on claim frequency and claim severity. - View Dependent Claims (14, 15, 16, 17, 18)
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Specification