SYSTEM FOR CLAIM LOAD BALANCING

• US 20160071217A1
• Filed: 10/31/2014
• Published: 03/10/2016
• Est. Priority Date: 09/05/2014
• 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: Edwards, Paul J., Shemesh, Keren
• Granted Patent: US 10,217,170 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: G06Q 10/063116 Schedule adjustment for a person or group
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

According to some embodiments, data may be received indicative of a plurality of insurance claims along with an indication of an appropriate claim segment classification for each insurance claim. A first claim handler may then be automatically selected for a first insurance claim based at least in part on: (i) a first segment classification associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, and (iii) load factors associated with claim handlers. An indication of the selected first claim handler may then be transmitted.

Claims

1. A system for claim load balancing and assignment, comprising:

a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies along with an indication of an appropriate claim segment classification for each insurance claim;

a computer storage unit for receiving, storing, and providing said data indicative of the plurality of insurance claims; and

a load balancing and assignment platform processor in communication with the storage unit, wherein the processor is configured for;

selecting a first claim handler for a first insurance claim based at least in part on;

(i) a first segment classification associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, and (iii) load factors associated with claim handlers, and

transmitting an indication of the selected first claim handler.

2. The system of claim 1, wherein the load balancing and assignment platform process is further configured for:

indicating to the computer storage unit that the first claim handler is authorized to access the data indicative of the first insurance claim.

3. The system of claim 1, wherein said selecting comprises, for each of a plurality claim handlers:

determining, for each claim handler, a current number of claims being handled,

calculating an adjusted load L_ADJUSTED for each claim handler;

4. The system of claim 1, wherein the first claim handler is further selected based on employee availability information, associated with claim handlers, received from a human resources platform.

5. The system of claim 1, wherein the first claim handler is further selected based on requests to receive more insurance claims received from claim handlers.

6. The system of claim 1, wherein the load balancing and assignment engine is associated with a predictive model trained with historical insurance claim information.

7. The system of claim 6, wherein the predictive model is associated with at least one of:

(i) a neural network, (ii) a Bayesian network, (iii) a Hidden Markov model, (iv) an expert system, (v) a decision tree, (vii) a collection of decision trees, (viii) a support vector machine, and (ix) weighted factors.

8. The system of claim 1, wherein the first insurance claim is associated with at least one of:

(i) workers'"'"' compensation insurance, (ii) automobile insurance, (iii) homeowners insurance, (iv) property insurance, (v) general liability insurance, (vi) commercial insurance, and (vii) personal insurance.

9. The system of claim 1, wherein at least some of the received data indicative of a plurality of insurance claims are associated with at least one of:

(i) a newly received first notice of loss, or (ii) information determined after a first notice of loss was received.

10. The system of claim 1, wherein the processor is further configured for:

automatically transmitting an indication of the first claim handler to at least one of;

(i) an email server, (ii) a workflow application, (iii) a report generator, (iv) a calendar application, and (v) a claim handler device.

11. The system of claim 1, wherein the data indicative of the plurality of insurance claims is received via at least one of:

(i) submitted paper claims, (ii) telephone call center operators, and (iii) an online claim submission web site.

12. The system of claim 1, wherein the processor is further configured for:

automatically selecting a second claim handler for a second insurance claim based on an assignment preferences table.

13. The system of claim 1, wherein the processor is further configured for:

automatically selecting a second claim handler for a second insurance claim based on a dedicated handler manager.

14. The system of claim 1, wherein the processor is further configured for:

automatically selecting a second claim handler for a second insurance claim based on a catastrophe management table.

15. The system of claim 1, further comprising:

a segmentation platform processor configured for;

automatically determining that the first insurance claim is associated with a first type of insurance and that a second insurance claim is associated with a second type of insurance different from the first type of insurance,

analyzing the received data associated with the first insurance claim, in accordance with first segmentation logic, to determine the first segment classification appropriate for the first insurance claim,

analyzing the received data associated with the second insurance claim, in accordance with second segmentation logic different from the first segmentation logic, to determine a second segment classification appropriate for the second insurance claim, and

transmitting an indication of the first segment classification to the load balancing and assignment platform processor.

16. The system of claim 1, wherein claim handlers are associated with one of a plurality of claim handler offices, at least one of the claim handler offices being remote from other claim handler offices.

17. The system of claim 1, wherein, after said selection of the first claim handler for the first insurance claim, feedback performance data is evaluated and, as a result of the evaluation, the first insurance claim is re-assigned to a second claim handler.

18. A computer-implemented method associated with an insurance claim processing system, comprising:

receiving, by a communication device, data indicative of a plurality of insurance claims submitted in connection with insurance policies;

storing, by a computer storage unit, said data indicative of the plurality of insurance claims;

automatically selecting, by a load balancing and assignment platform processor, a first claim handler for a first insurance claim based at least in part on;

(i) a first segment classification associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, and (iii) load factors associated with claim handlers; and

transmitting an indication of the selected claim handler.

19. The method of claim 18, wherein said selecting comprises, for each of a plurality claim handlers:

determining, by the load balancing and assignment platform processor for each claim handler, a current number of claims being handled;

dividing, by the load balancing and assignment platform processor, the current number of claims by a load factor associated with that claim handler to determine an adjusted current number of claims being handled; and

selecting, by the load balancing and assignment platform processor, the first claim handler as having the fewest adjusted current number of claims being handled.

20. The method of claim 18, wherein the first claim handler is further selected based on paid time off information associated with claim handlers.

21. The method of claim 18, wherein the first claim handler is further selected based on requests to receive more insurance claims received from claim handlers.

22. The method of claim 18, wherein at least some of the received data indicative of a plurality of insurance claims are associated with at least one of:

(i) a newly received first notice of loss, or (ii) information determined after a first notice of loss was received.

23. The method of claim 18, further comprising:

automatically selecting, by the load balancing and assignment platform processor, a second claim handler for a second insurance claim based on at least one of;

(i) an assignment preferences table, (ii) a dedicated handler manager, and (iii) a catastrophe management table.

24. A system for claim load balancing and assignment, comprising:

a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies along with an indication of an appropriate claim segment classification for each insurance claim, including insurance policies associated with workers'"'"' compensation insurance and automobile insurance;

a computer storage unit for receiving, storing, and providing said data indicative of the plurality of insurance claims; and

a load balancing and assignment platform processor in communication with the storage unit, wherein the processor is configured for;

determining, for each of a plurality of claim handlers, a current number of claims being handled,

dividing the current number of claims by a load factor associated with each claim handler to determine an adjusted current number of claims being handled,

selecting a first claim handler as having the fewest adjusted current number of claims being handled, and

transmitting an indication of the selected first claim handler.

25. The system of claim 24, wherein the first claim handler is further selected based on at least one of:

(i) paid time off information associated with claim handlers, and (ii) requests to receive more insurance claims received from claim handlers.

26. The system of claim 24, wherein the first claim handler is further selected based on at least one of:

(i) an assignment preferences table, (ii) a dedicated handler manager, and (iii) a catastrophe management table.