Methods and Systems for Automated, Predictive Modeling of the Outcome of Benefits Claims

• US 20090222290A1
• Filed: 02/27/2009
• Published: 09/03/2009
• Est. Priority Date: 02/29/2008
• Status: Abandoned Application

• Current Assignee: The Advocator Group LLC (Brown & Brown Inc.)
• Original Assignee: The Advocator Group LLC (Brown & Brown Inc.)
• Inventors: Crowe, Michael K.
• Application Number:
  US12/394,161
• Publication Number:
  US 20090222290A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A system for automated, predictive modeling of the outcome of a benefits claim includes a profile generator, an evaluation component, and a case management application. The profile generator executes on a computing device and retrieves a claimant profile associated with an adjudicated claim. The evaluation component executes on the computing device and generates a prediction of an outcome of a claim brought by a potential claimant of a government benefit, responsive to the retrieved claimant profile. The evaluation component generates a recommendation to file the claim for the government benefit, responsive to the generated prediction. The case management application executes on the computing device, receives the generated prediction of the outcome of the claim and the generated recommendation and displays at least one of the generated prediction and the generated recommendation.

Claims

1. A method for automated, predictive modeling of the outcome of a benefits claim, the method comprising:

receiving, by a profile generator executing on a computing device, from a case management application, information associated with a potential claimant of a government benefit;

retrieving, by the profile generator, a claimant profile associated with an adjudicated claim;

generating, by an evaluation component executing on the computing device, a prediction of an outcome of a claim brought by the potential claimant for the government benefit, responsive to the retrieved claimant profile;

generating, by the evaluation component, a recommendation to file the claim for the government benefit, responsive to the generated prediction; and

displaying, by the case management application, at least one of the generated prediction and the generated recommendation.

2. The method of claim 1 further comprising retrieving, by the profile generator, a claimant profile associated with a pending claim.

3. The method of claim 1 further comprising generating, by the profile generator, a claimant profile for the potential claimant, responsive to the received information.

4. The method of claim 1 further comprising comparing, by the evaluation component, at least one data point associated with the potential claimant with at least one data point associated with an existing claimant.

5. The method of claim 1 further comprising applying, by the evaluation component, an algorithm to information associated with the potential claimant to predict a level of benefit for which the potential claimant will be eligible.

6. The method of claim 1, wherein generating, by an evaluation component, a prediction of an outcome of a claim further comprises generating, by the evaluation component, a prediction of a length of time needed to adjudicate the claim.

7. The method of claim 1, wherein generating, by the evaluation component, the recommendation to file the claim comprises generating, by the evaluation component, a recommendation to defer filing of the claim for the government benefit, responsive to the generated prediction.

8. The method of claim 1, wherein generating, by the evaluation component, the recommendation to file the claim comprises generating, by the evaluation component, a recommendation not to file the claim for the government benefit, responsive to the generated prediction.

9. A system for automated, predictive modeling of the outcome of a benefits claim comprising:

a profile generator executing on a computing device and retrieving a claimant profile associated with an adjudicated claim;

an evaluation component executing on the computing device, generating a prediction of an outcome of a claim brought by a potential claimant of a government benefit, responsive to the retrieved claimant profile, and generating a recommendation to file the claim for the government benefit, responsive to the generated prediction; and

a case management application executing on the computing device, receiving the generated prediction of the outcome of the claim and the generated recommendation and displaying at least one of the generated recommendation and the generated prediction.

10. The system of claim 9, wherein the profile generator further comprises means for receiving, from the case management application, information associated with the potential claimant.

11. The system of claim 9, wherein the profile generator further comprises means for generating a claimant profile associated with the potential claimant.

12. The system of claim 9, wherein the evaluation component further comprises means for generating a prediction of a length of time needed to adjudicate the claim.

13. The system of claim 9, wherein the evaluation component further comprises means for generating a recommendation to defer filing of the claim for the government benefit, responsive to the generated prediction.

14. The system of claim 9, wherein the evaluation component further comprises means for generating a recommendation not to file the claim for the government benefit, responsive to the generated prediction.

15. The system of claim 9 further comprising a second computing device executing the case management application.

16. The system of claim 9 further comprising a case management user interface, provided by the case management application, displayed to a user of the case management application and receiving information associated with the potential claimant.

17. A computer readable medium having instructions thereon that when executed provide a method for automated, predictive modeling of the outcome of a benefits claim, the computer readable media comprising:

instructions to receive, by a profile generator executing on a computing device, from a case management application, information associated with a potential claimant of a government benefit;

instructions to retrieve, by the profile generator, a claimant profile associated with an adjudicated claim;

instructions to generate, by an evaluation component executing on the computing device, a prediction of an outcome of a claim brought by the potential claimant for the government benefit, responsive to the retrieved claimant profile;

instructions to generate, by the evaluation component, a recommendation to file the claim for the government benefit, responsive to the generated prediction; and

instructions to display, by the case management application, the recommendation.

18. The computer readable medium of claim 17 further comprising instructions to retrieve, by the profile generator, a claimant profile associated with a pending claim.

19. The computer readable medium of claim 17 further comprising instructions to generate, by the profile generator, a claimant profile for the potential claimant, responsive to the received information.

20. The computer readable medium of claim 17 further comprising instructions to compare, by the evaluation component, at least one data point associated with a potential claimant with at least one data point associated with an existing claimant.

21. The computer readable medium of claim 17 further comprising instructions to apply, by the evaluation component, an algorithm to information associated with the potential claimant to predict a level of benefit for which the potential claimant will be eligible.

22. The computer readable medium of claim 17 further comprising instructions to generate, by the evaluation component, a prediction of a length of time needed to adjudicate the claim.

23. The computer readable medium of claim 17 further comprising instructions to generate, by the evaluation component, a recommendation to defer filing of the claim for the government benefit, responsive to the generated prediction.

24. The computer readable medium of claim 17 further comprising instructions to generate, by the evaluation component, a recommendation not to file the claim for the government benefit, responsive to the generated prediction.