System and method of administering, tracking and managing of claims processing

• US 7,953,615 B2
• Filed: 04/03/2001
• Issued: 05/31/2011
• Est. Priority Date: 04/03/2000
• Status: Active Grant

• Current Assignee: Mitchell International Incorporated (Mitchell International Holding, Inc.)
• Original Assignee: Mitchell International Incorporated (Mitchell International Holding, Inc.)
• Inventors: Fisher, Frederick C, Griffin, David, Lyons, Thomas, Aquila, Anthony, Schrenk, Edward L, Marsh, Mike, Portal, Carlos, Cole, Patrick, Christian, Hassold
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): ALTSCHUL, AMBER L
• Application Number:
  US09/825,604
• Publication Number:
  US 20020035488A1
• Time in Patent Office: 3,710 Days
• Field of Search: 705/4, 705/7, 705/10, 705/2, 705/3
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A system and method of administering, tracking and managing of claims processing.

Claims

1. A computer comprising:

a processor; and

a memory, coupled to the processor and having computer program code embodied therein for enabling the processor to;

receiving data related to the insurance claim, the data comprising a plurality of data elements, a data element serving as an assignment criterion;

assign a score to first and second data elements of the plurality of data elements based on scoring rules, wherein each data element includes one or more data from the group consisting of policy information, vehicle information, number of vehicles involved, repair cost, number of parties involved, time of incident, and location of incident;

determine an overall score of the insurance claim based on the assigned scores;

determine a class of the insurance claim according to classing rules;

and

determine a type of assignee to whom to assign the insurance claim according to the application of business rules to the overall score of the insurance claim and the class of the insurance claim, wherein the business rules weight the class more highly than the score.

2. A computer comprising:

a processor, and

a memory, coupled to the processor and having computer program code embodied therein for enabling the processor to;

determine, based on data elements of the insurance claim, a claim score for first and second data elements, wherein each data element includes one or more data from the group consisting of policy information, vehicle information, number of vehicle involved, repair cost, number of party involved, time of incident, and location of incident;

determine an overall score for the insurance claim using each of the claim scores;

determine, based on the insurance claim, a class of the insurance claim;

determine, based on the overall claim score and the class, the type of assignee; and

assign the insurance claim to the determined assignee.

3. The computer of claim 2, wherein an effect of the class on the type of assignee is weighted greater than an effect of the claim score on the type of assignee.

4. The computer of claim 2, wherein the claim score reflects a severity of the insurance claim.

5. The computer of claim 2, wherein the claim score is determined based on an element of a group comprising information regarding an insurance policy, information regarding a party involved in a loss, and information regarding how a loss was reported.

6. The computer of claim 2, further comprising determining, based on the claim score, a priority of the insurance claim.

7. The computer of claim 2, wherein an assignee comprises an element of a group comprising an insurance adjuster, a repair facility, an appraiser, and a rental provider.

8. The computer of claim 2, wherein an effect of the first data element on the claim score is greater than an effect of the second data element on the claim score.

9. The computer of claim 2, wherein each data element includes an element score, and wherein the claim score is based on the element scores of the data elements.

10. The computer of claim 2, further comprising:

determining a first set of profiles, wherein each profile in the first set represents a potential assignee of the determined type, and wherein each profile in the first set includes a profile score;

determining a second set of profiles, wherein the second set contains profiles in the first set that have the highest profile scores, and wherein each profile in the second set includes a measure of capacity to complete the insurance claim; and

determining, from the second set of profiles, a profile with the largest measure of capacity.

11. A computer program product comprising a computer useable medium having computer program logic embodied therein for enabling a computer system to select a type of assignee from a plurality of types of assignees, said computer program logic comprising:

computer readable program code for determining, based on data elements of the insurance claim, a claim score for first and second data elements, wherein each data element includes one or more data from the group consisting of policy information, vehicle information, number of vehicles involved, repair cost, number of parties involved, time of incident, and location of incident;

a second computer readable program code for determining an overall score for the insurance claim using the claim scores;

a third computer readable program code for determining, based on the insurance claim, a class of the insurance claim; and

a fourth computer readable program code for determining, based on the claim score and the class, the type of assignee.

12. The computer program product of claim 11, further comprising:

computer readable program code for determining a first set of profiles, wherein each profile in the first set represents a potential assignee of the determined type, and wherein each profile in the first set includes a profile score;

computer readable program code for determining a second set of profiles, wherein the second set contains profiles in the first set that have the highest profile scores, and wherein each profile in the second set includes a measure of capacity to complete the insurance claim; and

computer readable program code for determining, from the second set of profiles, a profile with the largest measure of capacity.

13. The computer program product of claim 12, wherein the fourth computer readable program code is configured to weight an effect of the class greater than an effect of the claim score in determining the type of assignee.

14. The computer program product of claim 12, wherein the claim score reflects a severity of the insurance claim.

15. The computer program product of claim 12, wherein the first computer readable program code determines claim score based on insurance policy information, information regarding a party involved in a loss, or information regarding how a loss was reported.

16. The computer program product of claim 12, further comprising computer readable program code for determining, based on the claim score, a priority of the insurance claim.

17. The computer program product of claim 12, wherein an assignee comprises an insurance adjuster, a repair facility, an appraiser, or a rental provider.

18. The computer program product of claim 12, wherein the first computer readable program code weights an effect of the first data element on the claim score greater than an effect of the second data element on the claim score.

19. The computer program product of claim 18, wherein a data element includes an element score, and wherein the first computer readable program code determines claim score based on the element scores of the data elements.