System and method for automating initial claim assignment

• US 8,046,281 B1
• Filed: 07/13/2006
• Issued: 10/25/2011
• Est. Priority Date: 07/13/2006
• Status: Active Grant

• Current Assignee: United Services Automobile Association
• Original Assignee: United Services Automobile Association
• Inventors: Urrutia, Roberta
• Primary Examiner(s): Merchant; Shahid R
• Application Number:
  US11/486,614
• Time in Patent Office: 1,930 Days
• Field of Search: 705/35, 705/1.1, 705/4, 705/7, 705/8, 705/9
• US Class Current: 705/35
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/06311 Scheduling, planning or task assignment for a person or group
• CPC Class Codes: G06Q 10/063112 Skill-based matching of a person or a group to a task
• CPC Class Codes: G06Q 10/063118 Staff planning in a project environment
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Various embodiments disclosed herein are directed to automatically making an initial claim assignment. The systems include information collection subsystems, skills assessment subsystems and assignment recommendation subsystems that provide a customer service representative with a recommendation for the best-suited available claim handler. The customer service representative may accept or override the recommendation in making the claim handler assignment. The determination of the best-suited available claim handler is made by correlating these skills required for handling a particular claim, the skills of the claim handlers, and an algorithm takes into account the claim handler'"'"'s current loss assignment count, number of hours spent, and future availability.

Claims

1. A system to process an insurance claim comprising at least one subsystem that:

includes a memory and one or more processors in a number of computing apparatuses, wherein the one or more processors execute program instructions stored in the memory such that the at least one subsystem;

collects information about losses to be covered by and data relevant to processing of the insurance claim;

classifies said information into a plurality of skill profiles including a work skill level profile;

determines a skill level required to handle the claim;

searches a data store having records of claim handlers, skill profiles associated with such claim handlers and at least one parameter from among the following group of parameters;

skill levels associated with said claim handlers, availability of said claim handlers, and workload of said claim handlers;

provides a recommendation to assign the insurance claim to an available claim handler with the requisite skill level;

provides the option to accept or override the recommendation; and

assigns a claim handler to process the insurance claim in real time wherein a customer service representative provides a customer with identification and contact information of the claim handler during an initial interaction,

wherein the subsystem that provides the recommendation to assign the insurance claim comprises at least one subsystem that;

determines a number of service requests currently assigned to the claim handler;

determines a number of hours that the claim handler spent on processing other claims;

determines a future availability of hours for the claim handler to process new claims;

calculates a total probability of assigning the claim by;

determining probable claims that could have been assigned to each claim handler at a given point in time by subtracting hours needed for service requests currently assigned from the number of hours that the claim handler spent on processing other claims to calculate a difference, and dividing the difference by a productivity factor;

determining a number of claims that each claim handler could potentially handle based on available hours at the given point in time by dividing the future availability of hours for the claim handler to process new claims by the productivity factor; and

calculating the total probability of handling the claim by adding the probable claims that could have been assigned to each claim handler at the given point in time to the number of claims that each claim handler could potentially handle based on available hours at the given point in time; and

recommends the claim handler with the highest total probability number.

2. The system of claim 1 further comprising at least one subsystem that:

selects a set of claim handlers with the skill level required to handle the claim; and

identifies the available claim handler from said set of claim handlers based on availability and workload.

3. The system of claim 1 wherein said subsystem that classifies said information into a plurality of skill profiles comprises at least one subsystem that:

classifies said information into a jurisdiction profile;

classifies said information into a line of business profile; and

classifies said information into a customer handling profile.

4. The system of claim 1 wherein said subsystem that determines the skill level required to handle the claim comprises at least one subsystem that:

accesses a table that correlates a subset of said plurality of skill profiles with a skill level required to process the claim; and

identifies a minimum skill level necessary to process the claim.

5. The system of claim 1 further comprising at least one subsystem that assigns the claim to the available claim handler.

6. A method processing an insurance claim comprising:

utilizing a memory and one or more processors in a number of computing apparatuses, wherein the one or more processors execute program instructions stored in the memory to perform the method for;

collecting information about losses to be covered by and data relevant to processing of the insurance claim;

classifying said information into a plurality of skill profiles including a work skill level profile;

determining a skill level required to handle the claim;

searching a data store having records of claim handlers, skill profiles associated with such claim handlers, and at least one parameter from among the following group of parameters;

skill levels associated with said claim handlers, availability of said claim handlers, and workload of said claim handlers;

providing a recommendation to assign the insurance claim to an available claim handler with the requisite skill level;

providing the option to accept or override the recommendation; and

assigning, through execution of the instructions by the one or more processors, a claim handler to process the insurance claim in real time wherein a customer service representative provides a customer with identification and contact information of the claim handler during an initial interaction,

wherein providing a recommendation to assign the insurance claim to an available claim handler comprises;

determining a number of service requests currently assigned to the claim handler;

determining a number of hours that the claim handler spent on processing other claims;

determining future availability of hours for the claim handler to process new claims;

calculating a total probability of assigning the claim, wherein calculating the total probability comprises;

determining probable claims that could have been assigned to each claim handler at a given point in time by subtracting hours needed for service requests currently assigned from the number of hours that the claim handler spent on processing other claims to calculate a difference, and dividing the difference by a productivity factor;

determining a number of claims that each claim handler could potentially handle based on available hours at the given point in time by dividing the future availability of hours for the claim handler to process new claims by the productivity factor; and

calculating the total probability of handling the claim by adding the probable claims that could have been assigned to each claim handler at the given point in time to the number of claims that each claim handler could potentially handle based on available hours at the given point in time; and

recommending the claim handler with the highest total probability number.

7. The method of claim 6 further comprising:

selecting a set of claim handlers with the skill level required to handle the claim; and

identifying the available claim handler from said set of claim handlers based on availability and workload.

8. The method of claim 6 wherein said method element of classifying said information into a plurality of skill profiles comprises:

classifying said information into a jurisdiction profile;

classifying said information into a line of business profile; and

classifying said information into a customer handling profile.

9. The method of claim 6 wherein said method element of determining the skill level required to handle the claim comprises:

accessing a table that correlates a subset of said plurality of skill profiles with a skill level required to process the claim; and

identifying a minimum skill level necessary to process the claim.

10. The method of claim 6 further comprising assigning the claim to the available claim handler.

11. A tangible computer-readable medium comprising instructions, which when executed by a computer, cause the computer to:

collect information about losses to be covered by and data relevant to processing of the insurance claim;

classify said information into a plurality of skill profiles including a work skill level profile;

determine a skill level required to handle the claim;

search a data store having records of claim handlers, skill profiles associated with such claim handlers and at least one parameter from among the following group of parameters;

skill levels associated with said claim handlers, availability of said claim handlers, and workload of said claim handlers;

provide a recommendation to assign the insurance claim to an available claim handler with the requisite skill level;

provide the option to accept or override the recommendation; and

assign a claim handler to process the insurance claim in real time wherein a customer service representative provides a customer with identification and contact information of the claim handler during an initial interaction,

wherein the instructions to provide a recommendation to assign the insurance claim further comprise instructions to;

determine a number of service requests currently assigned to the claim handler;

determine a number of hours that the claim handler spent on processing other claims;

determine a future availability of hours for the claim handler to process new claims; and

calculate a total probability of assigning the claim by;

determining probable claims that could have been assigned to each claim handler at a given point in time by subtracting hours needed for service requests currently assigned from the number of hours that the claim handler spent on processing other claims to calculate a difference, and dividing the difference by a productivity factor;

determining a number of claims that each claim handler could potentially handle based on available hours at the given point in time by dividing the future availability of hours for the claim handler to process new claims by the productivity factor; and

calculating the total probability of handling the claim by adding the probable claims that could have been assigned to each claim handler at the given point in time to the number of claims that each claim handler could potentially handle based on available hours at the given point in time; and

recommend the claim handler with the highest total probability number.

12. The computer-readable medium of claim 11 further comprising instructions to:

select a set of claim handlers with the skill level required to handle the claim; and

identify the available claim handler from said set of claim handlers based on availability and workload.

13. The computer-readable medium of claim 11 wherein said instructions to classify said information into a plurality of skill profiles comprises instructions to:

classify said information into a jurisdiction profile;

classify said information into a line of business profile; and

classify said information into a customer handling profile.

14. The computer-readable medium of claim 11 wherein said instructions to determine the skill level required to handle the claim comprises instructions to:

access a table that correlates a subset of said plurality of skill profiles with a skill level required to process the claim; and

identify a minimum skill level necessary to process the claim.

15. The computer-readable medium of claim 11 further comprising instructions to assign the claim to the available claim handler.