SYSTEM FOR CLAIM DATA SEGMENTATION

• US 20160071218A1
• 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: Blakeman, Cory R., Edwards, Paul J., Shemesh, Keren
• Granted Patent: US 9,984,421 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 is received indicative of a plurality of insurance claims. It may then be automatically determined that a 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. The received data associated with the first insurance claim may be analyzed in accordance with first segmentation logic to determine a first segment classification appropriate for the first insurance claim. Similarly, the received data associated with the second insurance claim may be automatically analyzed in accordance with second segmentation logic to determine a second segment classification appropriate for the second insurance claim. Indications of the first and second segment classifications may then be transmitted (e.g., to a load balancing and assignment engine that automatically selects claim handlers for insurance claims).

Claims

1. A system for claim data segmentation, comprising:

a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies;

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

a segmentation platform processor in communication with the storage unit, wherein the processor is configured for;

automatically determining that a 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 a 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 indications of the first and second segment classifications.

2. The system of claim 1, wherein at least one of the first and second types of insurance are 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.

3. The system of claim 1, wherein at least one of the first and second segmentation logic is associated with at least one of:

(i) a potential claim liability, (ii) an injury classification, (iii) an injury severity, (iv) a hospitalization, and (v) an admission to intensive care.

4. The system of claim 1, wherein at least one of the first and second segmentation logic is associated with at least one of:

(i) a claimant age, (ii) co-morbidity information, (iii) an amount of work absence, (iv) jurisdiction information, and (v) an indication of potential litigation.

5. The system of claim 1, wherein at least one of the first and second segmentation logic is associated with a configurable segment ranking table.

6. The system of claim 5, wherein said analyzing the received data associated with the first insurance claim, in accordance with first segmentation logic, comprises:

determining an injury driven foundation segment;

applying non-injury driven rules to determine a non-injury driven segment; and

selecting one of the injury driven foundation segment and non-injury driven segment based on the configurable segment ranking table.

7. 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.

8. The system of claim 1, wherein the received data indicative of a plurality of insurance claims include at least five of:

(i) a date and time, (ii) a claim number, (iii) a claim type, (iv) a loss date, (v) a benefit state, (vi) a claimant name, (vii) a claimant date of birth, (viii) a cause of injury, (ix) a claim description, (x) a body part, (xi) an injury, (xii) a return to work date, (xiii) an indication of whether the claimant was injured doing normal job duties, (xiv) an employment status, (xv) an indication of whether an injury resulted in death, (xvi) an indication of whether the injury requires surgery, (xvii) an indication of whether claim involves equipment or machinery, (xviii) an indication of whether safety equipment was provided, (xix) an indication of whether the claim is questionable, (xx) an indication of whether and injured worker is represented by an attorney, (xxi) a claim description, (xxii) a type of loss, (xxiii) a body part, (xxiv) an injury, (xxv) a geographic location, and (xxvi) forms and policy endorsements.

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

automatically transmitting indications of the first and second segment classifications to at least one of;

(i) an email server, (ii) a workflow application, (iii) a report generator, (iv) a calendar application, and (v) a load balancing and assignment engine.

10. 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.

11. The system of claim 1, further comprising:

a load balancing and assignment engine to receive the indications of the first and second segment classifications and to select a first claim handler for the first insurance claim based at least in part on the first segment classification.

12. The system of claim 11, wherein the first claim handler is further selected based on numbers of other insurance claims currently assigned to claim handlers.

13. The system of claim 12, wherein the first claim handler is further selected based on load factors associated with claim handlers.

14. The system of claim 13, wherein the first claim handler is further selected based on paid time off information associated with claim handlers.

15. The system of claim 14, wherein the first claim handler is further selected based on requests to receive more insurance claims received from claim handlers.

16. The system of claim 11, wherein at least one of the segmentation platform processor and load balancing and assignment engine are associated with a predictive model trained with historical insurance claim information.

17. The system of claim 16, 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.

18. A 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 determining, by a segmentation platform processor, that a 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, by the segmentation platform processor in accordance with first segmentation logic, to determine a first segment classification appropriate for the first insurance claim;

analyzing the received data associated with the second insurance claim, by the segmentation platform processor 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 indications of the first and second segment classifications from the segmentation platform processor.

19. The method of claim 18, wherein at least one of the first and second types of insurance are 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.

20. The method of claim 18, wherein at least one of the first and second segmentation logic is associated with at least one of:

(i) a potential claim liability, (ii) an injury classification, (iii) an injury severity, (iv) a hospitalization, and (v) an admission to intensive care.

21. The method of claim 18, wherein at least one of the first and second segmentation logic is associated with at least one of:

(i) a claimant age, (ii) co-morbidity information, (iii) an amount of work absence, (iv) jurisdiction information, and (v) an indication of potential litigation.

22. The method of claim 18, wherein at least one of the first and second segmentation logic is associated with a configurable segment ranking table.

23. A system for claim data segmentation, comprising:

a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies, 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 segmentation platform processor in communication with the storage unit, wherein the processor is configured for;

automatically determining that a first insurance claim is associated with workers'"'"' compensation insurance and that a second insurance claim is associated with automobile insurance,

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

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

transmitting indications of the first and second segment classifications.

24. The system of claim 23, wherein at least one of the workers'"'"' compensation and automobile segmentation logic is associated with at least one of:

(i) a potential claim liability, (ii) an injury classification, (iii) an injury severity, (iv) a hospitalization, and (v) an admission to intensive care.

25. The system of claim 23, wherein at least one of the workers'"'"' compensation and automobile segmentation logic is associated with at least one of:

(i) a claimant age, (ii) co-morbidity information, (iii) an amount of work absence, (iv) jurisdiction information, and (v) an indication of potential litigation.

26. The system of claim 23, wherein at least one of the workers'"'"' compensation and automobile segmentation logic is associated with a configurable segment ranking table.

27. The system of claim 23, 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.