System and method for automating initial claim assignment
First Claim
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.
1 Assignment
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Accused Products
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.
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Citations
15 Claims
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1. A system to process an insurance claim comprising at least one subsystem that:
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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. - View Dependent Claims (2, 3, 4, 5)
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6. A method processing an insurance claim comprising:
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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. - View Dependent Claims (7, 8, 9, 10)
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11. A tangible computer-readable medium comprising instructions, which when executed by a computer, cause the computer to:
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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. - View Dependent Claims (12, 13, 14, 15)
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Specification