Automated task processor for insurance claims

• US 8,401,896 B2
• Filed: 03/21/2012
• Issued: 03/19/2013
• 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:
  US13/426,401
• Publication Number:
  US 20120179496A1
• Time in Patent Office: 363 Days
• Field of Search: 705/14, 705/4
• 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 and an automated 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 automated task processor may be executable with a computer to identify an insurance claim processing task from the insurance claim database, and obtain insurance claim data related to the identified insurance claim processing task. The automated task processor may also select an action plan from an action plan database based on the obtained insurance claim data. The automated task processor may also identify a set of one or more automated procedures included in the action plan, and cause execution of the identified set of procedures included in the action plan.

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;

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; 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 based on pattern matching performed by the pattern analysis component;

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.

2. The insurance claim processing system of claim 1, 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, wherein the provided additional data is stored in the insurance claims database.

3. The insurance claim processing system of claim 2, 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 2, 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. A method of processing insurance claims, comprising:

providing a computer;

the computer communicating with a database, the database configured to store insurance claim data and 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;

identifying patterns from insurance claim data stored in the insurance claims database with a pattern analysis component executed with the computer;

identifying an insurance claim processing task performable by an automated performer with an automated task processor, the insurance claim processing task identified based on pattern matching performed by the pattern analysis component;

obtaining insurance claim data related to the identified insurance claim processing task from the database with the automated task processor;

selecting, for the identified insurance claim processing task, an action plan from the database with the automated task processor based on the obtained insurance claim data;

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

causing execution of the identified set of automated procedures included in the action plan.

7. The method of claim 6, wherein the step of identifying, for the selected action plan, the set of one or more automated procedures included in the action plan comprises identifying a plurality of action plans, and ranking the action plans based on a degree of applicability of each of the action plans.

8. The method of claim 7, wherein the step of ranking the action plans comprises developing a score for each of the plurality of action plans based at least in part on the identified patterns.

9. The method of claim 6, wherein the step of selecting, for the identified insurance claim processing task, an action plan from the database comprises building an action plan from the one or more automated procedures included in the database.

10. The method of claim 9, wherein the step of building an action plan comprises selecting automated procedures based at least in part on the identified patterns.

11. The method of claim 9, wherein the step of building an action plan comprises selecting an existing action plan, and adding additional automated procedures to the action plan.

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

a memory storage device, instructions stored in the memory storage device that are executed by the processor to cause the processor to identify patterns from insurance claim data stored in an insurance claims database, the database configured to store insurance claim data and a plurality of action plans;

instructions stored in the memory storage device that are executed by the processor to cause the processor to execute a pattern analysis component to identify an insurance claim processing task performable by an automated performer, the insurance claim processing task identified based on the identified patterns;

instructions stored in the memory storage device that are executed by the processor to cause the processor to obtain insurance claim data related to the identified insurance claim processing task from the database;

instructions stored in the memory storage device that are executed by the processor to cause the processor to select, for the identified insurance claim processing task, an action plan from the database based on the obtained insurance claim data, wherein each of the action plans includes one or more automated procedures performed to complete a task related to processing an insurance claim;

instructions stored in the memory storage device that are executed by the processor to cause the processor to identify, for the selected action plan, a set of one or more automated procedures included in the action plan; and

instructions stored in the memory storage device that are executed by the processor to cause execution of the identified set of automated procedures included in the action plan.

13. The insurance claim processing system of claim 12, further comprising instructions stored in the memory storage device that are executed by the processor to cause comparison of the insurance related data to predetermined parameters associated with the identified insurance claim processing task to select the action plan.

14. The insurance claim processing system of claim 13, wherein the predetermined parameters specifically identify the action plan to be used.

15. The insurance claim processing system of claim 13, wherein the predetermined parameters comprises a task type identifier included with the identified insurance claim processing task that identifies the type of task to be performed.

16. The insurance claim processing system of claim 12, further comprising instructions stored in the memory storage device that are executed by the processor to cause the identified insurance claim processing task to be re-directed to a human organization entity based on at least one of predetermined triggers, thresholds, or scenarios.

17. The insurance claim processing system of claim 12, further comprising instructions stored in the memory storage device that are executed by the processor to cause the action plan to be selected based at least partially on the identified patterns.

18. The insurance claim processing system of claim 12, further comprising instructions stored in the memory storage device that are executed by the processor to cause modification of the selected action plan.

19. The insurance claim processing system of claim 12, wherein the automated procedures comprise procedures to acquire data and procedures to process data to obtain a result responsive to the insurance claim processing task.

20. The insurance claim processing system of claim 12, wherein the selected action plans comprise a plurality of selected action plans, and the insurance claim processing system further comprises instructions stored in the memory storage device that are executed by the processor to cause hierarchical ranking of the selected action plans in accordance with the identified patterns.