Patent Issued for System and method for data driven risk relationship review tool (USPTO 11978001): Hartford Fire Insurance Company
2024 MAY 24 (NewsRx) -- By a
The assignee for this patent, patent number 11978001, is
Reporters obtained the following quote from the background information supplied by the inventors: “It may be advantageous to analyze the risks and resource allocations associated with multiple systems and/or entities. For example, it might be advantageous to understand particular amounts of risk and allocations and the impact that such risks and allocations may have had on past (and, potentially, future) performance. Moreover, an enterprise might want to facilitate understanding and reaction to requests for allocations of resources-and a manual review of such requests may be an important part of this process.
“In some cases, a report may be manually created and given to an insurance agent/broker and/or customer to help them understand the risk situation. For example, FIGS. 1A and 1B show an example of a typical report that may be used to review claim information with an insurance agent/broker or customer. In particular, FIG. 1A shows a first page 110 of typical claim status report that might be used to explain and/or review a workers’ compensation claim. The report might be generated, for example, using a spreadsheet application such as the EXCEL® spreadsheet application available from MICROSOFT®. The first page 110 might include, for example, insured information 112 (e.g., of a business that purchased workers’ compensation insurance from an insurer). The first page 110 might further include claim information 114, such as an employee name, claim number, date of hire, date of loss, occupation, location of loss, employment status, wage data, demographic information, attorney information, etc. The first page 110 might also include financial information 116, such as paid, outstanding, and/incurred monetary values for indemnity, medial, and expense costs. The first page 110 could also include claim professional information 118 (e.g., a name and contact information) and additional data (e.g., text notes describing the loss, providing a current medical status, a disability status, and mitigating factors). FIG. 1B shows a second page 120 of typical claim status report that might be used to explain and/or review a workers’ compensation claim, including a reserve rationale 122 and a resolution plan 124.
“Similarly, FIGS. 2A and 2B show another example of a typical report that may be used to review claim information with an insurance agent/broker or customer. As before, FIG. 2A shows a first page 210 of typical claim status report that might be used to explain and/or review a workers’ compensation claim. The first page 210 again includes insured information 212, claim information 214, financial information 216, claim professional information 218, and additional data. FIG. 2B shows a second page 220 of typical claim status report that might be used to explain and/or review a workers’ compensation claim, including a reserve rationale 222 and a resolution plan 224.
“The breadth and depth of information associated with resource requests, often over an extended period of time, can overwhelm such a review process. That is, manually collecting, formatting, examining, and understanding these types of risks and allocations associated with risk relationships can be a complicated, time consuming, and error-prone task, especially when there are a substantial number of inter-related systems, entities, characteristics impacting resource allocations, and/or other factors involved in the analysis. Moreover, manually determining who should receive the report (and how and when they need to receive them) can be a difficult task for a claim handler, claim account executive, workforce manager, team leader, etc.
“It would be desirable to provide systems and methods to display an automated data driven risk relationship review tool in a way that provides more accurate results, which are easier to communicate in a timely fashion as compared to traditional approaches.”
In addition to obtaining background information on this patent, NewsRx editors also obtained the inventors’ summary information for this patent: “According to some embodiments, systems, methods, apparatus, and computer program code display an automated data driven risk relationship review tool in a way that provides more accurate results, which are easier to communicate in a timely fashion as compared to traditional approaches and that allow for flexibility and effectiveness when providing those results. In some embodiments, a system may provide an automated data driven risk relationship review tool via a back-end application computer server of an enterprise. The system may include a resource allocation data store that contains electronic records representing requested resource allocations between the enterprise and a plurality of entities. The server may receive an indication of a selected requested resource allocation and retrieve, from the resource allocation data store, the electronic record associated with the selected requested resource allocation. The server may automatically calculate a first and second review date for the selected requested resource allocation and automatically establish a communication link based on the first review date for the selected requested resource allocation. The system may then support a graphical interactive user interface display via a distributed communication network, the interactive user interface display providing resource allocation data in connection with the second review date.
“Some embodiments comprise: means for receiving, by a computer processor of a back-end application computer server from a resource allocation data store, an indication of a selected requested resource allocation between an enterprise and an entity, wherein the resource allocation data store contains electronic records that represent a plurality of requested resource allocations between the enterprise and a plurality of entities, and further wherein each electronic record includes an electronic record identifier and a set of resource allocation values associated with risk attributes; means for retrieving, from the resource allocation data store, the electronic record associated with the selected requested resource allocation, including the set of resource allocation values associated with risk attributes; means for automatically calculating a first and second review date for the selected requested resource allocation; and means for automatically establishing a communication link based on the first review date for the selected requested resource allocation, wherein the back-end application computer server supports a graphical interactive user interface display via a distributed communication network, the interactive user interface display providing resource allocation data in connection with the second review date.
“In some embodiments, a communication device associated with a back-end application computer server exchanges information with remote devices in connection with an interactive graphical user interface. The information may be exchanged, for example, via public and/or proprietary communication networks.
“A technical effect of some embodiments of the invention is an improved and computerized way to display an automated data driven risk relationship review tool in a way that provides more accurate results, which are easier to communicate in a timely fashion as compared to traditional approaches. With these and other advantages and features that will become hereinafter apparent, a more complete understanding of the nature of the invention can be obtained by referring to the following detailed description and to the drawings appended hereto.”
The claims supplied by the inventors are:
“1. A system to provide a data driven risk relationship review tool via a back-end application computer server of an enterprise, comprising: (a) a plurality of remote devices; (b) an email server, workflow application, and calendar application to automatically schedule meetings and establish communication links; © the back-end application computer server, coupled to the plurality of remote devices, the email server, workflow application, calendar application, and resource allocation data store, including: a computer processor, and a computer memory, coupled to the computer processor, storing instructions that, when executed by the computer processor, cause the back-end application computer server to: (i) receive, from a first remote device of the plurality of remote devices, a request for a resource allocation between the enterprise and an entity, the request including data from a third-party data source; (ii) automatically calculate a first and second review date for the requested resource allocation, and (iv) automatically establish a communication link as one of an audio link, a text chat link, and a video link and schedule a meeting for the first review date, via the email server, workflow application, and calendar application, based on the calculation of the first review date for the requested resource allocation, wherein the communication link is established between at least two parties; and (d) a communication port coupled to the back-end application computer server to transmit data to the first remote device to support a graphical interactive user interface display via a distributed communication network, the interactive user interface display providing resource allocation data in connection with the second review date.
“2. The system of claim 1, wherein calculation of the first and second review dates are associated with at least one of: a predictive model created using data fields and text flags identified in electronic records of the resource allocation data store, claim data, and bill data from a bill review system.
“3. The system of claim 1, wherein the communication link is further associated with at least one of: (i) a calendar application, and (ii) an email message.
“4. The system of claim 1, wherein the user interface further provides a view of claim factors that draw attention to the request if there is a potential of increasing severity.
“5. The system of claim 1, wherein the user interface further provides at least one of: (i) demographic information, (ii) graphical indications of body locations, (iii) resource allocation reserve information, (iv) a resource allocation reserve rationale, (v) time information, and (vi) a resource allocation resolution plan.
“6. The system of claim 1, wherein the user interface leverages insights from multiple machine learning assets and claim metrics.
“7. The system of claim 1, wherein risks of certain aspects of a claim are calculated by the system and used to provide a next best action to a claim handler.
“8. A computerized method to provide a data driven risk relationship review tool via a back-end application computer server of an enterprise, comprising: receiving, by a computer processor of the back-end application computer server from a first remote device of a plurality of remote devices, a request for a resource allocation between the enterprise and an entity, the request including data from a third-party data source; automatically calculating a first and second review date for the requested resource allocation; and automatically establishing a communication link as one of an audio link, a text chat link, and a video link and schedule a meeting for the first review date, via an email server, workflow application, and calendar application, based on the calculation of the first review data for the requested resource allocation, wherein the communication link is established between at least two parties and wherein the back-end application computer server transmits data to the first remote device in support of a graphical interactive user interface display via a distributed communication network, the interactive user interface display providing resource allocation data in connection with the second review date.
“9. The method of claim 8, wherein calculation of the first and second review dates are associated with at least one of: a predictive model created using data fields and text flags identified in electronic records of a resource allocation data store, claim data, and bill data from a bill review system.
“10. The method of claim 8, wherein the communication link is further associated with at least one of: (i) a calendar application, and (ii) an email message, (iii) an audio link.
“11. The method of claim 8, wherein the user interface further provides a view of claim factors that draw attention to the request if there is a potential of increasing severity.
“12. The method of claim 8, wherein the user interface further provides at least one of: (i) demographic information, (ii) graphical indications of body locations, (iii) resource allocation reserve information, (iv) a resource allocation reserve rationale, (v) time information, and (vi) a resource allocation resolution plan.
“13. The method of claim 8, wherein the user interface leverages insights from multiple machine learning assets and claim metrics.
“14. The method of claim 8, wherein risks of certain aspects of a claim are calculated and used to provide a next best action to a claim handler.
“15. A non-transitory, computer-readable medium storing instructions, that, when executed by a processor, cause the processor to perform a method to provide a data driven risk relationship review tool via a back-end application computer server of an enterprise, the method comprising: receiving, by the computer processor of the back-end application computer server from a first remote device of a plurality of remote devices, a request for a resource allocation between the enterprise and an entity, the request including data from a third-party; automatically calculating a first and second review date for the requested resource allocation; and automatically establishing a communication link as one of an audio link, a text chat link, and a video link and scheduling a meeting for the first review date, via an email server, workflow application, and calendar application, based on the calculation of the first review date for the requested resource allocation, wherein the communication link is established between at least two parties, and wherein the back-end application computer server transmits data to the first remote device in support of a graphical interactive user interface display via a distributed communication network, the interactive user interface display providing resource allocation data in connection with the second review date.
“16. The medium of claim 15, wherein calculation of the first and second review dates are associated with at least one of: a predictive model created using data fields and text flags identified in electronic records of the resource allocation data store, claim data, and bill data from a bill review system.
“17. The method of claim 15, wherein the user interface further provides a view of claim factors that draw attention to the request if there is a potential of increasing severity.
“18. The medium of claim 15, wherein the user interface further provides at least one of: (i) demographic information, (ii) graphical indications of body locations, (iii) resource allocation reserve information, (iv) a resource allocation reserve rationale, (v) time information, and (vi) a resource allocation resolution plan.
“19. The medium of claim 15, wherein the user interface leverages insights from multiple machine learning assets and claim metrics.
“20. The medium of claim 15, wherein risks of certain aspects of a claim are calculated and used to provide a next best action to a claim handler.”
For more information, see this patent: Boliou,
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