Collaborative intelligent task processor for insurance claims

• US 8,180,668 B2
• Filed: 03/24/2011
• Issued: 05/15/2012
• 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:
  US13/071,347
• Publication Number:
  US 20110178825A1
• Time in Patent Office: 418 Days
• Field of Search: 705/14
• US Class Current: 705/14
• 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:

at least one computer including a processor and a memory device;

an insurance claims database operating on the at least one computer, the insurance claims database configured to store insurance claim data;

an action plan database operating on the at least one computer, the action plan database storing a plurality of action plans, wherein each of the action plans includes one or more automated procedures performed to complete a task related to processing an insurance claim; and

an automated task processor stored on the memory device and executable by the processor, the automated task processor configured to;

identify an insurance claim processing task performable by an automated performer;

obtain insurance claim data related to the identified insurance claim processing task from the insurance claims database;

for the identified insurance claim processing task, select an action plan from the action plan database based on the obtained insurance claim data;

for the selected action plan, identify a set of one or more automated procedures included in the action plan; and

cause execution of the identified set of automated procedures included in the action plan, wherein the selected action plan includes a first procedure that causes the automated task processor to acquire information related to an insurance claim, a second procedure that causes the automated task processor to trigger execution of an automated sub-process external to the selected action plan that provides additional data related to the insurance claim, and a third procedure that causes the automated task processor to process the acquired information and the provided additional data to yield a result responsive to the identified task, and wherein the provided additional data is stored in the insurance claims database.

2. The insurance claim processing system of claim 1, further comprising a pattern analysis component operating on the at least one computer, the pattern analysis component configured to identify patterns from the insurance claim data stored in the insurance claims database, wherein the automated task processor is further configured to identify the insurance claim processing task performable by the automated performer based on pattern matching performed by the pattern analysis component.

3. The insurance claim processing system of claim 1, wherein the second procedure triggers execution of the automated sub-process based on automated analysis by the automated task processor of information acquired by the first procedure.

4. The insurance claim processing system of claim 1, wherein the automated task processor is further configured to supply the information acquired by the first procedure to the automated sub-process, and wherein the automated sub-process uses the information acquired by the first procedure to provide the additional data related to the insurance claim.

5. The insurance claim processing system of claim 1, wherein the insurance claims database and the action plan database are included in a single database.

6. An insurance claim processing system, comprising:

at least one computer;

at least one database; and

an automated task processor executable with the at least one computer to analyze a task, the task comprising a description of a discrete activity performed to process a condition included in an insurance claim, the automated task processor further executable with the at least one computer to determine an action plan from information included in the at least one database, the action plan having a plurality of procedures responsive to the task,

wherein the action plan includes a first procedure that enables the automated task processor to acquire information related to the insurance claim, a second procedure that enables the automated task processor to trigger execution of an automated sub-process external to the action plan that provides additional data related to the insurance claim, and a third procedure to process the acquired information and the additional data to yield a result responsive to the task,

the automated task processor further executable with the at least one computer to store the additional data related to the insurance claim in the at least one database.

7. The insurance claim processing system of claim 6, wherein enablement of the automated sub-process is triggered based on automated analysis by the automated task processor of information acquired with the first procedure.

8. The insurance claim processing system of claim 6, wherein the automated task processor is further executable with the at least one computer to determine when modification of a procedure included in the action plan is needed.

9. The insurance claim processing system of claim 6, wherein the at least one database comprises an insurance claim database in which the acquired information is stored, and an action plan database in which the information used to determine the action plan is stored.

10. The insurance claim processing system of claim 6, wherein the automated task processor is further executable with the at least one computer to supply at least some of the information acquired in the first procedure to the automated sub-process, which is used by the automated sub-process to provide the additional data related to the insurance claim.

11. The insurance claim processing system of claim 6, wherein the automated task processor is further executable with the at least one computer to analyze at least one of the information related to the insurance claim acquired with the first procedure or the additional data related to the insurance claim provided by the automated sub-process, the automated task processor further executable with the at least one computer to generate additional data related to the insurance claim, the generated additional data stored in the at least one database by the automated task processor.

12. The insurance claim processing system of claim 6, wherein the automated task processor further executable with the at least one computer to determine the action plan comprises the automated task processor is further executable with the at least one computer to develop a group of procedures and combine the group of procedures with a pre-existing action plan stored in the at least one database.

13. The insurance claim processing system of claim 6, wherein the plurality of procedures are executable in at least one of a predetermined sequence or in parallel by the automated task processor.

14. An insurance claim processing system, comprising:

a processor;

a database in communication with the processor;

a tangible computer readable medium in communication with the processor, the tangible computer readable medium having stored therein a plurality of instructions for an automated task processor that are executable by the processor, the plurality of instructions comprising;

instructions for the automated task processor to analyze a task representing at least one step in a process to administer at least part of an insurance claim;

instructions for the automated task processor to determine action plans that fulfill the at least one step in the process, each of the action plans comprising a plurality of executable procedures in the form of computer executable instructions to at least one of request, receive, analyze or transmit data to complete the at least one step in the process;

instructions for the automated task processor to initiate a first procedure included in an action plan to acquire data from the database related to the insurance claim;

instructions for the automated task processor to initiate a second procedure included in the action plan to trigger an automated sub-process having executable instructions external to the action plan, the automated sub-process executable based on the data acquired in the first procedure to return additional insurance claim related data; and

instructions for the automated task processor to store the additional insurance claim related data in the database.

15. The insurance claim processing system of claim 14, wherein the instructions for the automated task processor to determine action plans that fulfill the at least one step in the process comprises instructions for the automated task processor to assemble the action plan based on data stored in the database that is associated with the insurance claim, and instructions to store the assembled action plan in the database, wherein the action plan is assembled from procedures or groups of procedures included in the database.

16. The insurance claim processing system of claim 15, wherein the instructions for the automated task processor to assemble the action plan comprises instructions for the automated task processor to build the action plan based on data requests included in the task and insurance claim data stored in the database that is associated with the insurance claim.

17. The insurance claim processing system of claim 14, wherein the instructions for the automated task processor to determine action plans that fulfill the at least one step in the process comprises instructions for the automated task processor to hierarchally rank and score action plans when a plurality of action plans are identified that fulfill the at least one step in the process, a score developed for each of the identified action plans based on a degree of applicability of each of the identified action plans to specific circumstances present in insurance claim data stored in the database, the insurance claim data associated with the insurance claim.

18. The insurance claim processing system of claim 14, wherein the instructions for the automated task processor to determine action plans that fulfill the at least one step in the process comprises instructions for the automated task processor to compare insurance claim data stored in the database in association with the insurance claim to predetermined parameters associated with the task to select an action plan stored in the database.

19. The insurance claim processing system of claim 18, wherein the predetermine parameters associated with the task include an identifier identifying one or more corresponding action plans.

20. The insurance claim processing system of claim 14, wherein the instructions for the automated task processor to determine action plans that fulfill the at least one step in the process comprises instructions for the automated task processor to analyze insurance claim data stored in the database that is associated with the insurance claim, and pattern match segments of the insurance claim data to produce pattern results used to determine the action plans that fulfill the at least one step in the process.

21. The insurance claim processing system of claim 14, wherein the plurality of procedures included in the action plan are selectively executed sequentially or in parallel by the processor.

22. A method of processing insurance claims, the method comprising:

receiving, with an automated task processor executing on a computer, a task comprising a description of a discrete activity performed to process an aspect of an insurance claim;

analyzing the task and data related to the insurance claim with the automated task processor, the data related to the insurance claim stored in a database in association with the task;

determining an action plan corresponding to the task with the automated task processor, the action plan including a plurality of computer readable instructions providing automated execution of a plurality of procedures by the automated task processor to complete the task;

executing a first procedure included in the action plan with the automated task processor to retrieve information from the data related to the insurance claim stored in the database;

executing a second procedure included in the action plan with the automated task processor to trigger an automated sub-process comprising activities to provide additional data related to the insurance claim, the sub-process independent from and unassociated with the action plan;

the automated task processor supplying the automated sub-process with the information retrieved using the first procedure for use by the automated sub-process to generate additional data related to the insurance claim; and

the automated task processor receiving and storing in the database the additional data received from the sub-process.

23. The method of claim 22, further comprising analyzing with the automated task processor the data related to the insurance claim stored in the database and the additional data related to the insurance claim received from the automated sub-process, and the automated task processor automatically terminating automated processing of the action plan and re-assigning the task for completion by a human performer in response to the analysis of data related to the insurance claim stored in the database and the additional data related to the insurance claim received from the automated sub-process.

24. The method of claim 22, further comprising automatically generating a form letter with the automated task processor using the data related to the insurance claim and the additional data provided by the sub-process.

25. The method of claim 22, wherein the plurality of computer readable instructions included in the action plan are selectively executed sequentially or in parallel by the automated task processor in an automated fashion.

26. The method of claim 22, wherein the sub-process is a first sub-process, and the method further comprises:

executing a third procedure included in the action plan with the automated task processor to trigger a second automated sub-process comprising activities to provide additional data related to the insurance claim, the second sub-process independent from and unassociated with the action plan and the first sub-process;

supplying the second sub-process with the information retrieved using the first procedure and the additional data related to the insurance claim received from the first sub-process; and

receiving and storing data received from the second sub-process in the database as part of the data related to the insurance claim.

27. The method of claim 22, wherein the computer is a first computer, the automated sub-process is performed with a second computer, and supplying the automated sub-process with the information retrieved using the first procedure comprises transmitting the information retrieved using the first procedure over a network to the second computer.