CLAIMS CATEGORIZATION IN A WORKFLOW

• US 20150278728A1
• Filed: 03/31/2015
• Published: 10/01/2015
• Est. Priority Date: 03/31/2014
• Status: Abandoned Application

• Current Assignee: Mitchell International Incorporated (Mitchell International Holding, Inc.)
• Original Assignee: Mitchell International Incorporated (Mitchell International Holding, Inc.)
• Inventors: Dinamani, Vidya, Bishop, Michael, Antley, Huey, Flagg, James, Ren, Iris, Renninger, Christian
• Application Number:
  US14/675,372
• Publication Number:
  US 20150278728A1
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: G06Q 10/0633 Workflow analysis
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A claim is processed and categorized prior to the assignment of a claims adjuster. The probability that the total amount of medical charges submitted for a claimant within a certain period of time following the date of loss will be below a certain threshold based on a small set of input variables. The input variables and prediction may be communicated to a claims management systems via web service. The claims management system that receives the prediction may be independent of the claims categorization system itself. That is, the user interface to gain access to the claims processing described herein may be independent of the claims processing itself. The prediction is achieved with analysis models that are configured to easily accommodate changes in the input parameters for the model.

Claims

1. A computer-implemented method for categorization of claims, the method comprising:

receiving a claim from a system user;

generating a predicted claim severity in response to user inputs of the received claim applied to a prediction model calculation;

determining further processing of the received claim in response to the predicted claim severity.

2. The computer-implemented method of claim 1, wherein the user inputs include data relating to claim information, collision information, and injury information.

3. A system comprising:

a user interface component that receives a claim from a system user;

a categorization engine that responds to user inputs of the received claim and performs calculation to perform operations comprising

generating a predicted claim severity in response to user inputs of the received claim applied to a prediction model calculation, and

determining further processing of the received claim in response to the predicted claim severity.

4. The system of claim 3, wherein the user inputs include data relating to claim information, collision information, and injury information.

5. A computer program product, tangibly embodied in a non transitory machine-readable storage medium, the medium including instructions configured to cause a data processing system to perform operations comprising:

receiving a claim from a system user;

generating a predicted claim severity in response to user inputs of the received claim applied to a prediction model calculation;

determining further processing of the received claim in response to the predicted claim severity.

6. The computer program product of claim 5, wherein the user inputs include data relating to claim information, collision information, and injury information.