Multiple policy claims processing

• US 8,010,389 B2
• Filed: 06/29/2007
• Issued: 08/30/2011
• Est. Priority Date: 06/04/2007
• Status: Active Grant

• Current Assignee: Computer Sciences Corporation (DXC Technology Company)
• Original Assignee: Computer Sciences Corporation (DXC Technology Company)
• Inventors: Wait, Julian F., Knifton, Jess V.
• Primary Examiner(s): Abdi; Kambiz
• Assistant Examiner(s): Ziegle; Stephanie
• Application Number:
  US11/824,543
• Publication Number:
  US 20090006138A1
• Time in Patent Office: 1,523 Days
• Field of Search: 705 2- 4, 705 35- 45
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Methods and systems are provided for processing claims. A claim management case is created for an insured in response to a notice of a claim. One or more insurance policies covering the insured are associated with the claim management case. In some embodiments, all of the insurance policies covering the insured are associated with the claim management case. At least one process relating to the claim management case is performed at a claim management case level. The process performed at the claim management case level applies to at least one of the insurance policies associated with the claim management case. The processes performed at the claim management case level may apply to all the insurance policies associated with the claim management case. One or more processes relating to the claim management case are performed at a policy level.

Claims

1. A method of processing insurance claims relating to one or more policies, comprising:

receiving, by a computer system, at least one notice of an event or a condition that gives rise to a claim for payment under a first policy;

creating, by the computer system, a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating, by the computer system, at a policy level, two or more policies with the claim management case;

simultaneously displaying, by the computer system, the two or more policies associated with the claim management case in a claim policy portfolio table, wherein each of at least two rows in the displayed claim policy portfolio table corresponds to a different one of the policies;

automatically generating and queuing, by the computer system, for each of at least two of the policies associated with the claim management case and simultaneously displayed in the claim policy portfolio table, one or more work items to be processed in a policy-level workflow for the policy, wherein, for at least one of the policies, automatically generating and queuing the one or more work items to be processed in the policy-level workflow comprises automatically generating and queuing one or more information requirements for the adjudicating the policy;

performing, by the computer system, at least one process relating to the claim management case in a claim management case workflow established at a claim management case level, wherein the at least one process performed at the claim management case level applies to all of the policies associated with the claim management case;

performing, by the computer system, at least one process relating to the claim management case in at least one policy workflow established at a policy level, wherein the at least one process performed at the policy level applies to only one of the policies associated with the claim management case and does not apply to the other policies associated with the claim management case;

determining, by the computer system, whether at least one predetermined requirement for the claim management case has been met at the case management level and whether at least one predetermined requirement for the claim management case has been met at the policy level;

the computer system performing at least one rendezvous, wherein at least one rendezvous comprises;

a queued item waiting for a response from a policy administration system;

the queued item receiving response data from the policy administration system;

the computer system comparing the response data from the policy administration system to expected data; and

the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and

adjudicating at least one claim under one or more of the policies.

2. The method of claim 1, wherein all of the policies covering the insured carried by a particular carrier are associated with the claim management case.

3. The method of claim 1, wherein the policies comprise one or more life insurance policies, wherein the event or condition comprises the death of the insured.

4. The method of claim 1, wherein performing the at least one process at the claim management case level comprises determining that an information requirement applicable to two or more of the policies has been satisfied.

5. The method of claim 1, further comprising inhibiting adjudication of any claim under the policies until the at least one predetermined information requirement is satisfied at the claim management case level and the at least one predetermined information requirement is satisfied at the policy level.

6. The method of claim 1, further comprising performing at least one process relating to a second policy in response to receiving the notice relating to the first policy.

7. The method of claim 6, wherein the event or condition comprises the death of an insured under at least one of the policies, wherein the at least one process relating to the second policy comprises suspending a premium on the second policy.

8. The method of claim 1, further comprising performing a first process relating to the first policy covering the insured in response to receiving the notice and performing a second process relating to a second policy in response to receiving the notice, wherein the first process is different from the second process.

9. The method of claim 1, further comprising proceeding with processing of one or more of the policies and suspending processing of one or more other policies in response to receiving the at least one notice.

10. The method of claim 1, further comprising suspending activity for the claim management case at the policy level until one or more predetermined conditions are satisfied at the claim management case level.

11. The method of claim 1, further comprising suspending activity for the claim management case at the claim management case level until one or more predetermined conditions are satisfied at the policy level.

12. The method of claim 1, further comprising associating one or more insurance coverages with one of the policies, and performing at least one process relating to the claim management case at a coverage level, wherein the at least one process performed at the coverage level applies to only one of the coverages associated with the policy.

13. The method of claim 12, further comprising suspending activity for the claim management case at the claim management case level until one or more predetermined conditions are satisfied at the policy level and the coverage level.

14. The method of claim 12, further comprising inhibiting adjudication of any the policies in the claim management case or adjudication of any of the coverages in the claim management case until one or more predetermined requirements are satisfied for the claim management case.

15. The method of claim 1, wherein performing the at least one process at the claim management case level comprises determining whether a single payment can be issued to a designee for two or more of the policies.

18. The method of claim 1, wherein at least one of the policies covers an insured, wherein creating the claim management case comprises associating, by the computer system, at a coverage level separate from and below the policy level, one or more coverages on the insured with one of the policies, the method further comprising:

performing, by the computer system, at least one process relating to the claim management case at a coverage level, wherein the at least one process performed at the coverage level applies to only one of the coverages associated with one of the policies;

determining, by the computer system, whether at least one predetermined requirement for the claim management case has been met at the coverage level; and

inhibiting, by the computer system, adjudication of any the policies in the claim management case or adjudication of any of the coverages in the claim management case until the predetermined requirements for the claim management case are satisfied at the case management level, the policy level, and the coverage level.

19. The method of claim 1, wherein creating the claim management case comprises:

performing a search for policies against one or more policy administrative host systems; and

associating at least two policies found in the search with the claim management case; and

wherein displaying the two or more policies associated with the claim management case in the claim policy portfolio table comprises displaying, in the claim policy portfolio table, at least two policies found in the search against the one or more policy administrative host systems.

20. The method of claim 1, further comprising associating at least one policy with the claim management case by adding the policy to the claim policy portfolio table.

21. The method of claim 1, further comprising:

automatically generating a requirements workflow for at least one of the policies in the claim management case, wherein generating the requirements workflow comprises generating one or more requirement work items and queuing the requirements work items in a requirements queue; and

automatically generating a correspondence workflow for the at least one policy in the claim management case, wherein generating the correspondence workflow comprises generating one or more correspondence work items and queuing the correspondence work items in a correspondence queue, wherein the correspondence workflow for the at least one policy is separate from the requirements workflow for the at least one policy.

22. The method of claim 1, wherein performing the at least one process relating to the claim management case in the at least one policy workflow at the policy level comprises synchronizing at least one information requirement between a first policy administration system associated with a first one of the policies associated with the claim management case and a second policy administration system associated with a second one of the policies associated with the claim management case.

23. The method of claim 18, wherein creating the claim management case comprises:

creating a node hierarchy comprising a claim management case node for the claim management case, a policy node for each of at least two of the policies, and a coverage node for each of at least one coverage associated with one of the policies,

wherein creating the node hierarchy comprises;

attaching at least two of the policy nodes to the claim management case node; and

attaching at least one coverage node to one of the policy nodes,

wherein the node hierarchy comprises two or more procedures and two or more data structures in a service-oriented architecture.

16. A system, comprising:

a processor;

a memory coupled to the processor and configured to store program instructions executable by the processor to;

receiving at least one notice of an event or a condition that gives rise to a claim for payment under a first policy;

creating a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating two or more policies with the claim management case;

simultaneously displaying the two or more policies associated with the claim management case in a claim policy portfolio table, wherein each of at least two rows in the displayed claim policy portfolio table corresponds to a different one of the policies;

automatically generating and queuing, for each of at least two of the policies associated with the claim management case and simultaneously displayed in the claim policy portfolio table, one or more work items to be processed in a policy-level workflow for the policy, wherein, for at least one of the policies, automatically generating and queuing the one or more work items to be processed in the policy-level workflow comprises automatically generating and queuing one or more information requirements for the adjudicating the policy;

performing at least one process relating to the claim management case in a claim management case workflow established at a claim management case level, wherein the at least one process performed at the claim management case level applies to all of the policies associated with the claim management case;

performing at least one process relating to the claim management case in at least one policy workflow established at a policy level, wherein the at least one process performed at the policy level applies to only one of the policies associated with the claim management case and does not apply to the other policies associated with the claim management case;

determining, by the computer system, whether at least one predetermined requirement for the claim management case has been met at the case management level and whether at least one predetermined requirement for the claim management case has been met at the policy level;

the computer system performing at least one rendezvous, wherein at least one rendezvous comprises;

a queued item waiting for a response from a policy administration system;

the queued item receiving response data from the policy administration system;

the computer system comparing the response data from the policy administration system to expected data; and

the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and

adjudicating at least one claim under one or more of the policies.

17. A tangible, computer readable physical storage medium comprising program instructions stored thereon, wherein the program instructions are computer-executable to:

receiving at least one notice of an event or a condition that gives rise to a claim for payment under a first policy;

creating a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating two or more policies with the claim management case;

simultaneously displaying the two or more policies associated with the claim management case in a claim policy portfolio table, wherein each of at least two rows in the displayed claim policy portfolio table corresponds to a different one of the policies;

automatically generating and queuing, for each of at least two of the policies associated with the claim management case and simultaneously displayed in the claim policy portfolio table, one or more work items to be processed in a policy-level workflow for the policy, wherein, for at least one of the policies, automatically generating and queuing the one or more work items to be processed in the policy-level workflow comprises automatically generating and queuing one or more information requirements for the adjudicating the policy;

performing at least one process relating to the claim management case in a claim management case workflow established at a claim management case level, wherein the at least one process performed at the claim management case level applies to all of the policies associated with the claim management case;

performing at least one process relating to the claim management case in at least one policy workflow established at a policy level, wherein the at least one process performed at the policy level applies to only one of the policies associated with the claim management case and does not apply to the other policies associated with the claim management case;

determining, by the computer system, whether at least one predetermined requirement for the claim management case has been met at the case management level and whether at least one predetermined requirement for the claim management case has been met at the policy level;

the computer system performing at least one rendezvous, wherein at least one rendezvous comprises;

a queued item waiting for a response from a policy administration system;

the queued item receiving response data from the policy administration system;

the computer system comparing the response data from the policy administration system to expected data; and

the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and

adjudicating at least one claim under one or more of the policies.