System for evaluating potential claim outcomes using related historical data
First Claim
1. A computer system comprising:
- a data storage device for receiving, storing, and providing access to historical claim data;
a computer processor for executing program instructions and for retrieving the historical claim data from the data storage device;
a memory, coupled to the computer processor, for storing program instructions for execution by the computer processor;
a categorical aggregation component comprising program instructions stored in the memory for providing categorized and aggregated historical claim data by determining a first set of claim characteristics, identifying first claims of the historical claim data which exhibit the first set of claim characteristics, determining whether a number of the first claims exceeds a statistical significance threshold, in response to a determination that the number of the first claims exceeds a statistical significance threshold, determining a total severity statistical profile based on a total severity of each of the first claims, determining whether the total severity statistical profile meets predefined profile criteria, and, in response to determining that the total severity statistical profile meets the predefined profile criteria, associating the first set of claim characteristics with a first claim category, identifying claims of the historical claim data associated with the first claim category, assigning each identified claim associated with the first claim category to one of a plurality of total severity ranges based on the total severity of the identified claim, and determining an average cost per claim year divided amongst a plurality of expense categories for claims of each total severity range when executed by the computer processor; and
a communication device, coupled to the computer processor, to output categorized and aggregated historical claim data including the average cost per claim year for claims of each total severity range.
0 Assignments
0 Petitions
Accused Products
Abstract
A computer system includes a data storage device. The data storage module receives, stores, and provides access to historical claim data. A categorical aggregation component comprising program instructions stored in a program memory provides categorized and aggregated historical claim data by identifying claim categories based on the historical claim data, each of the one or more claim categories associated with a respective set of claim characteristics, identifying claims of the historical claim data associated with one of the claim categories, assigning each identified claim to one of a plurality of total severity ranges based on the total severity of the identified claim, and determining an average cost per claim year for claims of each total severity range when executed by a computer processor.
-
Citations
17 Claims
-
1. A computer system comprising:
-
a data storage device for receiving, storing, and providing access to historical claim data; a computer processor for executing program instructions and for retrieving the historical claim data from the data storage device; a memory, coupled to the computer processor, for storing program instructions for execution by the computer processor; a categorical aggregation component comprising program instructions stored in the memory for providing categorized and aggregated historical claim data by determining a first set of claim characteristics, identifying first claims of the historical claim data which exhibit the first set of claim characteristics, determining whether a number of the first claims exceeds a statistical significance threshold, in response to a determination that the number of the first claims exceeds a statistical significance threshold, determining a total severity statistical profile based on a total severity of each of the first claims, determining whether the total severity statistical profile meets predefined profile criteria, and, in response to determining that the total severity statistical profile meets the predefined profile criteria, associating the first set of claim characteristics with a first claim category, identifying claims of the historical claim data associated with the first claim category, assigning each identified claim associated with the first claim category to one of a plurality of total severity ranges based on the total severity of the identified claim, and determining an average cost per claim year divided amongst a plurality of expense categories for claims of each total severity range when executed by the computer processor; and a communication device, coupled to the computer processor, to output categorized and aggregated historical claim data including the average cost per claim year for claims of each total severity range. - View Dependent Claims (2, 3, 4, 5, 6, 11)
-
-
7. A method of operating a categorical aggregation component, the method comprising:
-
receiving historical claim data from a data warehouse; determining a first set of claim characteristics; identifying, via a processor, first claims of the historical claim data which exhibit the first set of claim characteristics; determining, via the processor, whether a number of the first claims exceeds a statistical significance threshold; in response to a determination that the number of the first claims exceeds a statistical significance threshold, determining, via the processor, a total severity statistical profile based on a total severity of each of the first claims; determining, via the processor, whether the total severity statistical profile meets predefined profile criteria; and in response to a determination that the total severity statistical profile meets the predefined profile criteria, associating, via the processor, the first set of claim characteristics with a first claim category; identifying, via the processor, claims of the historical claim data associated with the first claim category; assigning, via the processor, each identified claim associated with the first claim category to one of a plurality of total severity ranges based on the total severity of the identified claim; determining, via the processor, an average cost per claim year divided amongst a plurality of expense categories for claims of each total severity range; and outputting, to a file server, categorized and aggregated historical claim data including the average cost per claim year for claims of each total severity range. - View Dependent Claims (8, 9, 10)
-
-
12. A non-transitory medium storing processor-executable program code, the program code executable by a device to:
-
receive historical claim data from a data warehouse; determine a first set of claim characteristics; identify first claims of the historical claim data which exhibit the first set of claim characteristics; determine whether a number of the first claims exceeds a statistical significance threshold; in response to a determination that the number of the first claims exceeds a statistical significance threshold, determine a total severity statistical profile based on a total severity of each of the first claims; determine whether the total severity statistical profile meets predefined profile criteria; and in response to a determination that the total severity statistical profile meets the predefined profile criteria, associate the first set of claim characteristics with a first claim category; identify claims of the historical claim data associated with the first claim category; assign each identified claim associated with the first claim category to one of a plurality of total severity ranges based on the total severity of the identified claim; determine an average cost per claim year divided amongst a plurality of expense categories for claims of each total severity range; and output, to a file server, categorized and aggregated historical claim data including the average cost per claim year for claims of each total severity range. - View Dependent Claims (13, 14, 15, 16, 17)
-
Specification