System and method for processing data relating to insurance claim stability indicator

• US 8,571,900 B2
• Filed: 12/14/2012
• Issued: 10/29/2013
• Est. Priority Date: 12/19/2006
• Status: Active Grant

• Current Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Original Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Inventors: Belhe, Upendra D., Goddu, Gregory P., McLaughlin, Kelly J., Mohanty, Natalie, Mauer, Kathleen F.
• Primary Examiner(s): Oyebisi, Ojo O
• Application Number:
  US13/715,426
• Publication Number:
  US 20130144659A1
• Time in Patent Office: 319 Days
• Field of Search: 705/4, 705/2
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

The invention relates generally to data analysis, and to systems and methods for the computation of the volatility of a loss. The system comprises a module for receiving a data parameter, a database for storing the parameter, a computerized predictive model, and a business logic processor for executing the predictive model. The volatility is used to, among other things, determine an appropriate work flow for handling the loss.

Claims

1. A system for processing insurance claim data comprising:

an input device for receiving data indicative of at least one parameter corresponding to a characteristic of an insurance claim;

a data storage device for storing the data indicative of the at least one parameter received by the input device;

a computerized model for determining a stability indicator for the insurance claim based on the data indicative of the at least one parameter, wherein the stability indicator is indicative of a likelihood of a non-linear increase in expenditures in relation to the insurance claim; and

one or more business logic processors configured to;

execute the computerized model; and

process the insurance claim based upon the stability indicator determined by the computerized model.

2. The system of claim 1, wherein the computerized model comprises one or more of a linear regression model, a decision tree model, or a collection of decision trees.

3. The system of claim 1, wherein the stability indicator is indicative of the likelihood of the non-linear increase in expenditures in one or more of medical payments, medical review and management, third party investigation expenses, and claim oversight.

4. The system of claim 1, wherein the non-linear increase in expenditures comprises one or more of spikes in expenditures, exponential growth of expenditures, and stepwise increases in expenditures.

5. The system of claim 1, wherein the one or more business logic processors are further configured to:

detect a change in the stability indicator associated with the claim, wherein a value of the stability indicator is inversely related to the likelihood of the non-linear increase in expenditures, and

recommend a course of treatment for a claimant of the claim based on the detected change.

6. The system of claim 1, wherein the one or more business logic processors being configured to process the insurance claim comprises the one or more business logic processors being configured to make a workflow determination for the insurance claim based upon the stability indicator, and

wherein the workflow determination comprises one of an assignment of the insurance claim to an employee from a plurality of employees to handle the claim based upon the stability indicator and a selection of an investigation level for the insurance claim based upon the stability indicator.

7. The system of claim 1, wherein:

the data storage device is configured such that the data indicative of the at least one parameter may be updated;

the at least one of the one or more business logic processors is configured to re-execute the computerized model in response to the data indicative of the at least one parameter being updated to determine a new instability indicator; and

the at least one of the one or more business logic processors is configured to process the insurance claim based upon the new instability indicator.

8. The system of claim 1, wherein:

the data storage device is configured such that the data indicative of the at least one parameter may be updated; and

at least one of the one or more business logic processors is configured to retrain the computerized model in response to the data indicative of the at least one parameter being updated.

9. A method for processing insurance claim data comprising:

receiving by an input device data indicative of at least one parameter corresponding to a characteristic of an insurance claim;

storing by a processor the data indicative of the at least one parameter in a data storage device;

executing by the processor a computerized model based at least in part on the data indicative of the at least one parameter to determine a stability indicator for the insurance claim, wherein the stability indicator is indicative of a likelihood of a non-linear increase in expenditures in relation to the insurance claim; and

processing by the processor the insurance claim based upon the stability indicator determined by the computerized model.

10. The method of claim 9, wherein the computerized model comprises one or more of a linear regression model, a decision tree model, or a collection of decision trees.

11. The method of claim 9, wherein the stability indicator is indicative of the likelihood of the non-linear increase in expenditures in one or more of medical payments, medical review and management, third party investigation expenses, and claim oversight.

12. The method of claim 9, wherein the non-linear increase in expenditures comprises one or more of spikes in expenditures, exponential growth of expenditures, and stepwise increases in expenditures.

13. The method of claim 9, further comprising:

detecting by the processor a change in the stability indicator associated with the claim, wherein a value of the stability indicator is inversely related to the likelihood of the non-linear increase in expenditures, and

recommending by the processor a course of treatment for a claimant of the claim based on the detected change.

14. The method of claim 9, wherein processing by the processor the insurance claim comprises the processor making a workflow determination for the insurance claim based upon the stability indicator, and

wherein the workflow determination comprises one of an assignment of the insurance claim to an employee from a plurality of employees to handle the claim based upon the stability indicator and a selection of an investigation level for the insurance claim based upon the stability indicator.

15. The method of claim 9, further comprising:

receiving by the input device an update to the data indicative of the at least one parameter;

re-executing by the processor the computerized model in response to the update to the data indicative of the at least one parameter to determine a new instability indicator; and

processing by the processor the insurance claim based upon the new instability indicator.

16. The method of claim 9, further comprising:

receiving by the input device an update to the data indicative of the at least one parameter; and

retraining by the processor the computerized model in response to the data indicative of the at least one parameter being updated.

17. A non-transitory computer-readable medium encoded with machine-readable instructions for processing insurance claim data, the machine-readable instructions being configured to cause a computer to:

receive data indicative of at least one parameter corresponding to a characteristic of an insurance claim;

store the data indicative of the at least one parameter in a data storage device;

execute a computerized model based at least in part on the data indicative of the at least one parameter to determine a stability indicator for the insurance claim, wherein the stability indicator is indicative of a likelihood of a non-linear increase in expenditures in relation to the insurance claim; and

process the insurance claim based upon the stability indicator determined by the computerized model.

18. The computer-readable medium of claim 17, wherein the machine-readable instructions are further configured to cause the computer to:

detect a change in the stability indicator associated with the claim, wherein a value of the stability indicator is inversely related to the likelihood of the non-linear increase in expenditures, and

recommend a course of treatment for a claimant of the claim based on the detected change.

19. The computer-readable medium of claim 17, wherein the instructions configured to cause the computer to process the insurance claim comprise instructions for configuring the computer to make a workflow determination for the insurance claim based upon the stability indicator,

wherein the workflow determination comprises one of an assignment of the insurance claim to an employee from a plurality of employees to handle the claim based upon the stability indicator and a selection of an investigation level for the insurance claim based upon the stability indicator.

20. The computer-readable medium of claim 17, wherein the machine-readable instructions are further configured to cause the computer to:

receive by the input device an update to the data indicative of the at least one parameter;

re-execute by the processor the computerized model in response to the update to the data indicative of the at least one parameter to determine a new instability indicator; and

process by the processor the insurance claim based upon the new instability indicator.