Collaborative intelligent task processor for insurance claims

• US 7,933,786 B2
• Filed: 11/01/2005
• Issued: 04/26/2011
• Est. Priority Date: 11/01/2005
• Status: Active Grant

• Current Assignee: DUCK Creek Technologies Incorporated
• Original Assignee: Accenture Global Services Limited (Accenture PLC)
• Inventors: Wargin, Jeffrey Michael, Dahle, David R., Weiss, Jeffrey G.
• Primary Examiner(s): Shrestha; Bijendra K.
• Application Number:
  US11/264,115
• Publication Number:
  US 20070100669A1
• Time in Patent Office: 2,002 Days
• Field of Search: 705/4
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/06316 Sequencing of tasks or work
• CPC Class Codes: G06Q 30/0225 Avoiding frauds
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

An insurance claim processing system may include an insurance claim database, an event processor component, a task engine component and a collaborative intelligent task processor. The insurance claim database may be configured to store and provide access to data in a data record that is related to an insurance claim. The event processor component may be executable with a computer to iteratively monitor the data in the data record and identify events. The task engine component may be executable with a computer in response to one of the identified events to generate tasks indicative of information that needs to be acquired based on the contents of the data record. The collaborative intelligent task processor may be executable with a computer to analyze a task generated by the task engine component and select an action plan that is responsive to the task. The action plan may include a first procedure that enables the collaborative intelligent task processor to acquire information related to the insurance claim, and a second procedure that enables the collaborative intelligent task processor to process the information to yield a result responsive to the task.

Claims

1. An insurance claim processing system, comprising:

a computer comprising a processor and a memory;

an insurance claim database configured to store and provide access to data in a data record that is related to an insurance claim;

an event processor executable with the computer and configured to iteratively monitor the data in the data record and identify changes to the data as events;

a task engine component executable with the computer in response to one of the identified events and configured to generate tasks indicative of information related to the event that is to be acquired based on the contents of the data record; and

a collaborative intelligent task processor executable with the computer and configured to analyze a task generated by the task engine component and select an action plan that is responsive to the task,

wherein the action plan includes a plurality of computer executable procedures performed automatically by the collaborative intelligent task processor in series or in parallel, or in a combination of series and parallel, the action plan including a first procedure configured to enable automated execution of the collaborative intelligent task processor by the computer to acquire information related to the insurance claim, and a second procedure configured to enable automated execution of the collaborative intelligent task processor by the computer to process the acquired information to yield a result responsive to the task; and

wherein the collaborative intelligent task processor is further executable by the computer and configured to modify a procedure, or a group of procedures included in the action plan subsequent to selection of the action plan, modification of the procedure, or group of procedures by the collaborative intelligent task processor based on the task generated by the task engine component and the contents of the data record.

2. The insurance claim processing system of claim 1, wherein the collaborative intelligent task processor comprises a task handler component executable by the computer and configured to analyze and process the task to select the action plan, and a data handler component executable by the computer and configured to perform the procedures in the selected action plan to request, receive, and analyze data available from various sources.

3. The insurance claim processing system of claim 1, wherein the collaborative intelligent task processor is also executable by the computer and configured to store the result responsive to the task in the insurance claim database.

4. The insurance claim processing system of claim 1, wherein the collaborative intelligent task processor is executable by the computer and configured to derive a plurality of sub-results based on the acquired information, and logically combine the sub-results to derive the result responsive to the task.

5. The insurance claim processing system of claim 1, wherein the collaborative intelligent task processor is executable by the computer and configured to direct deletion of another task generated by the task engine component based on at least one of the result responsive to the task or the information that is acquired based on the task.

6. The insurance claim processing system of claim 1, wherein the collaborative intelligent task processor is executable by the computer and configured to direct the task engine component to allocate another task to the collaborative intelligent task processor based on at least one of the result responsive to the task or the information that is acquired based on the task.

7. The insurance claim processing system of claim 1, wherein the collaborative intelligent task processor is executable by the computer and configured to indicate that the allocated task has been completed.

8. The insurance claim processing system of claim 1, wherein the collaborative intelligent task processor is executable by the computer and configured to store data in the insurance claim database that is identifiable as an event by the event processor and results in a new task generated by the task engine component.

9. The insurance claim processing system of claim 8, wherein the collaborative intelligent task processor is executable by the computer and configured to monitor for an update of the data in the insurance claim database in response to the new task.

10. The insurance claim processing system of claim 9, wherein the collaborative intelligent task processor is executable by the computer and configured to retrieve the updated data from the insurance claim database for use in further processing to yield the result responsive to the task.

42. The insurance claim processing system of claim 1, wherein the intelligent collaborative intelligent task processor is further executable by the computer and configured to enable execution of a computer executable sub-routine, the computer executable sub-routine being independent of and unassociated with the action plan.

43. The insurance claim processing system of claim 1, wherein the action plan that is responsive to the task selected by the collaborative intelligent task processor comprises a plurality of action plans, and the collaborative intelligent task processor is further executable with the computer and configured to develop a hierarchal ranking of the plurality of action plans, and select the action plan having the highest hierarchal rank, the hierarchal ranking of the action plans generated by the collaborative intelligent task processor based on the contents of the data record.

44. The insurance claim processing system of claim 43, wherein the hierarchal ranking is developed based on a score established for each of the plurality of action plans, the score based on a degree of applicability of the procedures in a respective one of the action plans to specific circumstances indicated in the contents of the data record.

45. The insurance claim processing system of claim 1, wherein modification of the procedure, or group of procedures by the collaborative intelligent task processor comprises performing automated evaluation of the action plan with the collaborative intelligent task processor in view of the task, the acquired information related to the insurance claim, and the contents of the data record.

46. The insurance claim processing system of claim 1, wherein the task includes a type identifier indicating a type of task to be performed and a subset of action plans capable of performing the task, and the collaborative intelligent task processor is executable with the computer and configured to select from among the subset of action plans based on the type identifier and the contents of the data record.

11. A method of processing insurance claims with instructions stored in a computer memory, the method comprising:

iteratively evaluating data related to an insurance claim with a computer, wherein the evaluated data is stored in an insurance claim database;

generating an execution task with the computer based on the content of the stored data;

analyzing the execution task with a collaborative intelligent task processor executable with the computer,

the collaborative intelligent task processor selecting an action plan from among a plurality of action plans to formulate a response to the execution task, wherein the action plan includes a plurality of computer executable procedures performed automatically by the collaborative intelligent task processor in series or in parallel, or in a combination of series and parallel;

the collaborative intelligent task processor completing automated execution of a first procedure included in the action plan that results in acquisition of data related to the insurance claim;

the collaborative intelligent task processor completing automated execution of a second procedure included in the action plan to process the acquired data to obtain a result responsive to the execution task;

the collaborative intelligent task processor determining when modification of the action plan is required to obtain the result responsive to the execution task; and

the collaborative intelligent task processor modifying the action plan in response to a determination that modification of the action plan is required to obtain the result responsive to the execution task.

12. The method of claim 11, further comprising the collaborative intelligent task processor storing the result in the insurance claim database in connection with the insurance claim so that the result is available for subsequent iterative evaluation with the computer to generate another execution task.

13. The method of claim 11, further comprising segmenting the insurance claim with a pattern analyzer based on pattern matching of the data related to the insurance claim.

14. The method of claim 13, further comprising the collaborative intelligent task processor analyzing the pattern matching performed by the pattern analyzer as a basis for selection of the action plan.

15. The method of claim 11, further comprising the collaborative intelligent task processor comparing the data related to the insurance claim to predetermined parameters associated with the execution task to select the action plan.

16. The method of claim 15, wherein the predetermined parameters specifically identify the action plan to be used.

17. The method of claim 15, wherein the predetermined parameters comprises a task type identifier included with the execution task that identifies the type of task to be performed.

18. The method of claim 11, further comprising the collaborative intelligent task processor comparing the data related to the insurance claim and pattern matching results provided by a pattern analyzer to predetermined parameters associated with the execution task to select the action plan.

19. The method of claim 11, further comprising the collaborative intelligent task processor selecting the action plan based on a data request that is identified within the execution task.

20. The method of claim 11, wherein generating an execution task comprises allocating the execution task to the collaborative intelligent task processor.

21. The method of claim 11, wherein analyzing the execution task comprises the collaborative intelligent task processor reviewing data associated with the insurance claim in view of predetermined parameters;

and the collaborative intelligent task processor electing to complete the execution task when the task aligns with the predetermined parameters.

22. The method of claim 11, wherein selecting an action plan comprises the collaborative intelligent task processor selectively associating a subset of procedures from among a plurality of procedures to build the action plan that is responsive to the execution task.

23. The method of claim 22, wherein selectively associating a subset of procedures comprises identifying procedures from among the plurality of procedures capable of providing logical steps to complete the execution task.

24. The method of claim 23, wherein identifying procedures comprises ranking the procedures that are applicable to the execution task based on the data related to the insurance claim.

25. An insurance claim processing system embodied in instructions stored on a memory device, the instructions executable by a computer with a processor, comprising:

a memory device,

instructions stored in the memory device that are executed by the computer and configured to iteratively analyze data associated with an insurance claim and identify investigations to be performed to process the insurance claim;

instructions stored in the memory device that are executed by the computer and are configured to generate an assignable task related to one of the identified investigations;

instructions stored in the memory device that are executed by the computer after allocation of the task to a collaborative intelligent task processor, and are configured to select an action plan responsive to the assignable task, wherein the action plan includes a plurality of computer executable procedures performed automatically by the collaborative intelligent task processor in series or in parallel, or in a combination of series and parallel;

instructions stored in the memory device that are executed by the computer to enable automated execution of the collaborative intelligent task processor and are configured to modify a procedure, or a group of procedures included in the action plan subsequent to selection of the action plan based on the assignable task generated by the computer and the data associated with the insurance claim;

instructions stored in the memory device that are executed by the computer and are configure to enable automated execution of the collaborative intelligent task processor configured to complete a first procedure included in the action plan, wherein the first procedure enables acquisition of information related to the insurance claim;

instructions stored in the memory device that are executed by the computer and configured to enable automated execution of the collaborative intelligent task processor configured to complete a second procedure included in the action plan, to process the acquired information; and

instructions stored in the memory device that are executed by the computer and configured to store results in association with the insurance claim.

26. The insurance claim processing system of claim 25, wherein the first procedure includes instructions to request information from at least one of a proprietary data source or a public data source, or combinations thereof, and the second procedure includes instructions to enable a sub-routine outside the action plan to process the requested information.

27. The insurance claim processing system of claim 25, wherein the assignable task includes indication of data to be acquired and processed, and the action plan is selected to obtain the data indicated by the assignable task, and process the acquired data.

28. The insurance claim processing system of claim 25, further comprising instructions stored in the memory device to perform pattern matching of the data associated with the insurance claim and provide a pattern matching result that is useable to process the insurance claim.

29. The insurance claim processing system of claim 28, further comprising instructions stored in the memory device to analyze the pattern matching result and the data associated with the insurance claim to select an action plan.

30. An insurance claim processing system, comprising:

a computer having a processor and a memory, wherein the processor is configured to execute a collaborative intelligent task processor, the collaborative intelligent task processor comprising;

a task analysis component executable with the processor and configured to receive an assigned task related to processing of an insurance claim, wherein the task analysis component is configured to select an action plan responsive to the assigned task that includes at least two procedures, wherein the action plan includes a plurality of computer executable procedures performed automatically by the collaborative intelligent task processor in series or in parallel, or in a combination of series and parallel;

a data retrieval component included in the collaborative intelligent task processor, automated execution of the data retrieval component enabled by the processor and configured to complete a procedure included in the selected action plan to access and retrieve information;

an enable actions component included in the collaborative intelligent task processor, automated execution of the enable actions component enabled by the processor and configured to complete a procedure included in the selected action plan by initiation of a sub-process that is not part of the selected action plan, by selective supply of retrieved information to the sub-process and by receipt of resulting information from the sub-process; and

a data analysis component included in the collaborative intelligent task processor, automated execution of the data analysis component enabled by the processor and configured to complete a procedure included in the selected action plan to apply processing rules to at least one of the retrieved information or the resulting information, or combinations thereof, to generate a task result responsive to the assigned task;

wherein the task analysis component is further executable with the processor and configured to modify a procedure, or a group of procedures included in the action plan, subsequent to selection of the action plan, based on the assigned task and data associated with the insurance claim.

31. The insurance claim processing system of claim 30, further comprising an action plan database stored in the memory, the action plan database comprising a plurality of predetermined action plans stored therein that are selectable by the task analysis component based on the content of the assigned task.

32. The insurance claim processing system of claim 31, wherein the assigned task identifies at least one of the predetermined action plans to be selected by the task analysis component.

33. The insurance claim processing system of claim 31, wherein the assigned task is evaluated by the task analysis component to select at least one of the predetermined action plans.

34. The insurance claim processing system of claim 30, wherein the task analysis component is further executable by the processor and configured to select a plurality of action plans and generate a hierarchal ranking of the action plans so that a highest ranking action plan may be selected.

35. The insurance claim processing system of claim 30, wherein the enable actions component is further executable by the processor and configured to initiate execution of the sub-process by the storage of data with predetermined parameters that trigger said execution.

36. The insurance claim processing system of claim 30, wherein the enable actions component is further executable by the processor and configured to monitor for the results of a sub-process and direct the data retrieval component to retrieve the results for use in further processing to complete the assigned task.

37. The insurance claim processing system of claim 30, wherein the processor is further configured to execute a forms component executable to populate portions of a form with data and provide the form to the data retrieval component to further populate the form with at least one of retrieved information or resulting information, or the combination thereof.

38. The insurance claim processing system of claim 30, wherein the task analysis component is further executable by the processor and configured to modify the action plan based on at least one of the task, a task type descriptive of the type of task that is included in the task, information requested in the task, one or more parameters associated with the task or the action plan, or combinations thereof.

39. The insurance claim processing system of claim 31, wherein the task analysis component is further executable by the processor and configured to develop an action plan and select the developed action plan when the action plan responsive to the assigned task does not exist to be selected from the action plan database.

40. The insurance claim processing system of claim 39, wherein the task analysis component is further executable by the processor and configured to develop the action plan from one or more procedures included in the action plan database.

41. The insurance claim processing system of claim 39, wherein the task analysis component is further executable by the processor and configured to develop the action plan based on at least one of the task, a task type included in the task, information requested in the task, one or more parameters associated with the task or the action plan, or combinations thereof.