Multiple policy claims processing
First Claim
1. A method of processing insurance claims relating to one or more policies, comprising:
- receiving, by a computer system, at least one notice of an event or a condition that gives rise to a claim for payment under a first policy;
creating, by the computer system, a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating, by the computer system, at a policy level, two or more policies with the claim management case;
simultaneously displaying, by the computer system, the two or more policies associated with the claim management case in a claim policy portfolio table, wherein each of at least two rows in the displayed claim policy portfolio table corresponds to a different one of the policies;
automatically generating and queuing, by the computer system, for each of at least two of the policies associated with the claim management case and simultaneously displayed in the claim policy portfolio table, one or more work items to be processed in a policy-level workflow for the policy, wherein, for at least one of the policies, automatically generating and queuing the one or more work items to be processed in the policy-level workflow comprises automatically generating and queuing one or more information requirements for the adjudicating the policy;
performing, by the computer system, at least one process relating to the claim management case in a claim management case workflow established at a claim management case level, wherein the at least one process performed at the claim management case level applies to all of the policies associated with the claim management case;
performing, by the computer system, at least one process relating to the claim management case in at least one policy workflow established at a policy level, wherein the at least one process performed at the policy level applies to only one of the policies associated with the claim management case and does not apply to the other policies associated with the claim management case;
determining, by the computer system, whether at least one predetermined requirement for the claim management case has been met at the case management level and whether at least one predetermined requirement for the claim management case has been met at the policy level;
the computer system performing at least one rendezvous, wherein at least one rendezvous comprises;
a queued item waiting for a response from a policy administration system;
the queued item receiving response data from the policy administration system;
the computer system comparing the response data from the policy administration system to expected data; and
the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and
adjudicating at least one claim under one or more of the policies.
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Accused Products
Abstract
Methods and systems are provided for processing claims. A claim management case is created for an insured in response to a notice of a claim. One or more insurance policies covering the insured are associated with the claim management case. In some embodiments, all of the insurance policies covering the insured are associated with the claim management case. At least one process relating to the claim management case is performed at a claim management case level. The process performed at the claim management case level applies to at least one of the insurance policies associated with the claim management case. The processes performed at the claim management case level may apply to all the insurance policies associated with the claim management case. One or more processes relating to the claim management case are performed at a policy level.
153 Citations
23 Claims
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1. A method of processing insurance claims relating to one or more policies, comprising:
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receiving, by a computer system, at least one notice of an event or a condition that gives rise to a claim for payment under a first policy; creating, by the computer system, a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating, by the computer system, at a policy level, two or more policies with the claim management case; simultaneously displaying, by the computer system, the two or more policies associated with the claim management case in a claim policy portfolio table, wherein each of at least two rows in the displayed claim policy portfolio table corresponds to a different one of the policies; automatically generating and queuing, by the computer system, for each of at least two of the policies associated with the claim management case and simultaneously displayed in the claim policy portfolio table, one or more work items to be processed in a policy-level workflow for the policy, wherein, for at least one of the policies, automatically generating and queuing the one or more work items to be processed in the policy-level workflow comprises automatically generating and queuing one or more information requirements for the adjudicating the policy; performing, by the computer system, at least one process relating to the claim management case in a claim management case workflow established at a claim management case level, wherein the at least one process performed at the claim management case level applies to all of the policies associated with the claim management case; performing, by the computer system, at least one process relating to the claim management case in at least one policy workflow established at a policy level, wherein the at least one process performed at the policy level applies to only one of the policies associated with the claim management case and does not apply to the other policies associated with the claim management case; determining, by the computer system, whether at least one predetermined requirement for the claim management case has been met at the case management level and whether at least one predetermined requirement for the claim management case has been met at the policy level; the computer system performing at least one rendezvous, wherein at least one rendezvous comprises; a queued item waiting for a response from a policy administration system; the queued item receiving response data from the policy administration system; the computer system comparing the response data from the policy administration system to expected data; and the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and adjudicating at least one claim under one or more of the policies. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 18, 19, 20, 21, 22, 23)
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16. A system, comprising:
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a processor; a memory coupled to the processor and configured to store program instructions executable by the processor to; receiving at least one notice of an event or a condition that gives rise to a claim for payment under a first policy; creating a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating two or more policies with the claim management case; simultaneously displaying the two or more policies associated with the claim management case in a claim policy portfolio table, wherein each of at least two rows in the displayed claim policy portfolio table corresponds to a different one of the policies; automatically generating and queuing, for each of at least two of the policies associated with the claim management case and simultaneously displayed in the claim policy portfolio table, one or more work items to be processed in a policy-level workflow for the policy, wherein, for at least one of the policies, automatically generating and queuing the one or more work items to be processed in the policy-level workflow comprises automatically generating and queuing one or more information requirements for the adjudicating the policy; performing at least one process relating to the claim management case in a claim management case workflow established at a claim management case level, wherein the at least one process performed at the claim management case level applies to all of the policies associated with the claim management case; performing at least one process relating to the claim management case in at least one policy workflow established at a policy level, wherein the at least one process performed at the policy level applies to only one of the policies associated with the claim management case and does not apply to the other policies associated with the claim management case; determining, by the computer system, whether at least one predetermined requirement for the claim management case has been met at the case management level and whether at least one predetermined requirement for the claim management case has been met at the policy level; the computer system performing at least one rendezvous, wherein at least one rendezvous comprises; a queued item waiting for a response from a policy administration system; the queued item receiving response data from the policy administration system; the computer system comparing the response data from the policy administration system to expected data; and the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and adjudicating at least one claim under one or more of the policies.
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17. A tangible, computer readable physical storage medium comprising program instructions stored thereon, wherein the program instructions are computer-executable to:
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receiving at least one notice of an event or a condition that gives rise to a claim for payment under a first policy; creating a claim management case in response to the at least one notice of the event or condition that gives rise to the claim for payment under the first policy, wherein creating the claim management case comprises associating two or more policies with the claim management case; simultaneously displaying the two or more policies associated with the claim management case in a claim policy portfolio table, wherein each of at least two rows in the displayed claim policy portfolio table corresponds to a different one of the policies; automatically generating and queuing, for each of at least two of the policies associated with the claim management case and simultaneously displayed in the claim policy portfolio table, one or more work items to be processed in a policy-level workflow for the policy, wherein, for at least one of the policies, automatically generating and queuing the one or more work items to be processed in the policy-level workflow comprises automatically generating and queuing one or more information requirements for the adjudicating the policy; performing at least one process relating to the claim management case in a claim management case workflow established at a claim management case level, wherein the at least one process performed at the claim management case level applies to all of the policies associated with the claim management case; performing at least one process relating to the claim management case in at least one policy workflow established at a policy level, wherein the at least one process performed at the policy level applies to only one of the policies associated with the claim management case and does not apply to the other policies associated with the claim management case; determining, by the computer system, whether at least one predetermined requirement for the claim management case has been met at the case management level and whether at least one predetermined requirement for the claim management case has been met at the policy level; the computer system performing at least one rendezvous, wherein at least one rendezvous comprises; a queued item waiting for a response from a policy administration system; the queued item receiving response data from the policy administration system; the computer system comparing the response data from the policy administration system to expected data; and the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and adjudicating at least one claim under one or more of the policies.
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Specification