Segmentation platform system
First Claim
1. A system, comprising:
- a communication device to receive claim data for a plurality of claims submitted in connection with policies of a first coverage type and a second coverage type;
a computer storage unit for receiving, storing, and providing the claims data for the plurality of claims;
a claim intake computer system configured for receiving the claim data corresponding to the plurality of claims of the first coverage type and the second coverage type; and
a claims processing computer system coupled to the computer storage unit and the claim intake computer system, the claims processing computer system including;
first segmentation logic applicable to claims of the first coverage type and second segmentation logic applicable to claims of the second coverage type;
a segmentation platform processor in communication with the computer storage unit, wherein the segmentation platform processor is configured for;
automatically determining, for each claim of the plurality of claims, a segment classification based on application of the one of the first segmentation logic and the second segmentation logic applicable to the claim; and
transmitting a segment classification indication for each of the plurality of claims comprising one of a first segment classification indication and a second segment classification indication; and
a load balancing and assignment engine configured for;
receiving the one of the first segment classification indication or the second segment classification indication for each of the plurality of claims from the segmentation platform processor;
accessing a claim handler database to identify eligible claim handlers for each of the plurality of claims based on the one of the first segment classification indication or the second segment classification indication for each of the plurality of claims;
determine a load for each of the eligible claim handlers for each of the plurality of claims;
automatically selecting, for each of the plurality of claims based on the determined load for each of the corresponding eligible claim handlers for the claim, assignment of each claim to one of the eligible claim handlers and a case manager; and
transmitting an electronic file for each of the plurality of claims to the assigned one of the claim handler and the case manager.
1 Assignment
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Accused Products
Abstract
According to some embodiments, data is received indicative of a plurality of insurance claims. It may then be automatically determined that a first insurance claim is associated with a first type of insurance and that a second insurance claim is associated with a second type of insurance. The received data associated with the first insurance claim may be analyzed in accordance with first segmentation logic to determine a first segment classification appropriate for the first insurance claim. Similarly, the received data associated with the second insurance claim may be automatically analyzed in accordance with second segmentation logic to determine a second segment classification appropriate for the second insurance claim. Indications of the first and second segment classifications may then be transmitted (e.g., to a load balancing and assignment engine that automatically selects claim handlers for insurance claims).
29 Citations
16 Claims
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1. A system, comprising:
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a communication device to receive claim data for a plurality of claims submitted in connection with policies of a first coverage type and a second coverage type; a computer storage unit for receiving, storing, and providing the claims data for the plurality of claims; a claim intake computer system configured for receiving the claim data corresponding to the plurality of claims of the first coverage type and the second coverage type; and a claims processing computer system coupled to the computer storage unit and the claim intake computer system, the claims processing computer system including; first segmentation logic applicable to claims of the first coverage type and second segmentation logic applicable to claims of the second coverage type; a segmentation platform processor in communication with the computer storage unit, wherein the segmentation platform processor is configured for; automatically determining, for each claim of the plurality of claims, a segment classification based on application of the one of the first segmentation logic and the second segmentation logic applicable to the claim; and transmitting a segment classification indication for each of the plurality of claims comprising one of a first segment classification indication and a second segment classification indication; and a load balancing and assignment engine configured for; receiving the one of the first segment classification indication or the second segment classification indication for each of the plurality of claims from the segmentation platform processor; accessing a claim handler database to identify eligible claim handlers for each of the plurality of claims based on the one of the first segment classification indication or the second segment classification indication for each of the plurality of claims; determine a load for each of the eligible claim handlers for each of the plurality of claims; automatically selecting, for each of the plurality of claims based on the determined load for each of the corresponding eligible claim handlers for the claim, assignment of each claim to one of the eligible claim handlers and a case manager; and transmitting an electronic file for each of the plurality of claims to the assigned one of the claim handler and the case manager. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A computer-implemented method comprising:
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receiving, by a communication device of a claim intake computer system, data indicative of a plurality of claims submitted in connection with policies providing at least a first coverage type and a second coverage type different from the first coverage type; storing, by a computer storage unit, the data indicative of the plurality of claims; automatically determining, by a segmentation platform processor of a claims processing computer system, for each claim of the plurality of claims, a segment classification based on application of one of first segmentation logic applicable to claims of the first coverage type and second segmentation logic applicable to claims of the second coverage type; transmitting, from the segmentation platform processor to a load balancing and assignment engine, a segment classification indication for each of the plurality of claims comprising one of a first segment classification indication and a second segment classification indication; receiving, by the load balancing and assignment engine from the segmentation platform processor, the segment classification indication for each of the plurality of claims; accessing, by the load balancing and assignment engine, a claim handler database to identify eligible claim handlers for each of the plurality of claims based on the one of the first segment classification indication or the second segment classification indication for each of the plurality of claims; determining, by the load balancing and assignment engine, a load for each of the eligible claim handlers for each of the plurality of claims; automatically selecting, by the load balancing and assignment engine for each of the plurality of claims based on the adjusted load for each of the corresponding eligible claim handlers for the claim, assignment of each claim to one of the eligible claim handlers and a case manager; and transmitting, by the load balancing and assignment engine, an electronic file for each of the plurality of claims to the assigned one of the eligible claim handlers and the case manager. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16)
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Specification