SYSTEM AND METHOD FOR IMPROVED INSURANCE CALL ROUTING AND PROCESSING

• US 20150181037A1
• Filed: 12/23/2013
• Published: 06/25/2015
• Est. Priority Date: 12/23/2013
• Status: Active Grant

• Current Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Original Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Inventors: Lancaster, Christopher W., Bailey, Sarah Elizabeth, Collins-Mashkovich, Elizabeth Monique
• Granted Patent: US 10,115,163 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: H04M 3/4211 where the identifier is used to access a profile
• CPC Class Codes: H04M 3/493 Interactive information services, e.g. directory enquiries ; Arrangements therefor, e.g. interactive voice response [IVR] systems or voice portals
• CPC Class Codes: H04M 3/5166 in combination with interactive voice response systems or voice portals, e.g. as front-ends

Abstract

An insurance policy management system for administering and managing insurance inquiries related to disability and leave management via an interactive voice response platform that communicates with combined short term disability/leave management resources and clinical intake nurse resources.

Claims

1. An interactive voice response processing system for insurance based applications comprising:

one or more data storage devices storing a database having a plurality of selected options for different option sets for prompting to different entities in the interactive voice response processing system;

an interactive voice response server in communication with the database, the server having at least one processor configured for communication over a network and one or more memories; and

an interactive voice response application, stored in the one or more memories, having processor executable instructions, which instructions, when executed by the at least one processor, cause the at least one processor to;

receive an initial communication from an entity;

provide an initial set of interactive voice response options to be prompted by the interactive voice response data processing system;

receive an option selection from the entity from the initial set of interactive voice response options;

and

dependent on the received option selection, either provide a subsequent set of interactive voice response options to be prompted by the interactive voice response data processing system, wherein the subsequent interactive voice response options include access to at least one combined short term disability and leave management resource and at least one clinical intake nurse resource, the short term disability and leave management resource and the clinical intake nurse resource in communication with at least one insurance claims based subsystem, or route the entity to one of the at least one combined short term disability and leave management resource and at least one clinical intake nurse resource.

2. The system of claim 1, wherein the one insurance claims based subsystem is an adjudication system for adjudicating between various disability/leave determinations.

3. The system of claim 1, wherein the initial set of interactive voice response options include an option related to inquiries from a physician'"'"'s office, an option related to a new claim and an overflow option.

4. The system of claim 1, wherein the initial set of interactive voice response options include an option related to inquiries from a physician'"'"'s office and an option related to a new claim.

5. The system of claim 4, wherein the option related to inquiries from the physician'"'"'s office is routed to the combined short term disability and leave management resource for initiating a claim based workflow.

6. The system of claim 4, wherein the option related to a new claim is routed to the combined short term disability and leave management resource if based on a pregnancy.

7. The system of claim 4, wherein the option related to a new claim is routed to the combined short term disability and leave management resource if based on an illness or injury of the entity.

8. The system of claim 1, wherein the initial set of interactive voice response options include an overflow option that is routed to the combined short term disability and leave management resource.

9. The system of claim 1, wherein the initial set of interactive voice response options include an option related to inquiries from a physician'"'"'s office that is subsequently routed to the combined short term disability and leave management resource.

10. The system of claim 1, wherein the initial set of interactive voice response options are provided on a mobile phone app configured to establish an internet protocol based communication with a combined short term disability and leave management resource.

11. An interactive voice response processing method for insurance based applications comprising:

receiving via an interactive voice response communication network an insurance inquiry from a subscriber entity;

accessing subscriber entity data in a database to determine preliminary characteristics of the entity;

providing by, an interactive voice response processor, an initial set of interactive voice response options based on preliminary characteristics of the entity;

receiving by, the interactive voice response processor, an option selection from the entity from the initial set of interactive voice response options;

and

providing by, the interactive voice response processor, a subsequent set of interactive voice response options, wherein the subsequent interactive voice response options include access to at least one combined short term disability and leave management resource and at least one clinical intake nurse resource, the short term disability and leave management resource and the clinical intake nurse resource in communication with at least one insurance claims based subsystem.

12. The method of claim 11, wherein the initial set of interactive voice response options include an option related to inquiries from a physician'"'"'s office, an option related to a new claim, an overflow option and a language option.

13. The method of claim 11, wherein the initial set of interactive voice response options include an option related to inquiries from a physician'"'"'s office and an option related to a new claim.

14. The method of claim 13, wherein the option related to inquiries from the physician'"'"'s office is routed to the combined short term disability and leave management resource for initiating a claim based workflow.

15. The method of claim 14, wherein the option related to a new claim is routed to the combined short term disability and leave management resource if based on a pregnancy of the entity.

16. The method of claim 14, wherein the option related to a new claim is routed to the combined short term disability and leave management resource if based on an illness or injury of the entity.

17. The method of claim 11, wherein the initial set of interactive voice response options include an overflow option that is routed to the combined short term disability and leave management resource.

18. A computer program product comprising a computer usable non-transitory storage medium storing computer usable program code for interactive voice response prompting, the computer usable program code, when executed by one or more computer processors, causing the one or more computer processors to perform the steps of:

receiving a call in an interactive voice response processing system from a caller;

retrieving an initial set of insurance related options to be prompted by the interactive voice response data processing system;

providing the initial set of insurance related options to the caller;

receiving a selection from the initial set of insurance related options from the caller; and

responsive to the received selection, either providing a subsequent set of insurance related option to the caller based on the selection from the initial set of insurance related options, or routing the caller to at least one of a combined short term disability and leave management resource and a clinical intake nurse, the combined short term disability and leave management resource and a clinical intake nurse in communication with one or more insurance claims subsystems.

19. The computer program product of claim 18, wherein a caller initiating a new claim for their own pregnancy will be routed to the combined short term disability and leave management resource.

20. The computer program product of claim 18, wherein the one or more insurance claim subsystems comprises a short term disability claim initiation subsystem.