Patent Issued for System For Claim Load Balancing (USPTO 10,217,170)

2019 MAR 11 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Hartford Fire Insurance Company (Hartford, Connecticut, United States) has been issued patent number 10,217,170, according to news reporting originating out of Alexandria, Virginia, by NewsRx editors.

The patent’s inventors are Edwards, Paul J. (West Hartford, CT); Shemesh, Keren (West Hartford, CT).

This patent was filed on October 31, 2014 and was published online on March 11, 2019.

From the background information supplied by the inventors, news correspondents obtained the following quote: “An insurer may provide payments when claims are made in connection with an insurance policy. For example, an employee who is injured while working might receive payments associated with a workers’ compensation insurance policy purchased by his or her employer. Similarly, a person involved in an automobile accident may receive a payment in connection with an automobile insurance policy. The insurer may assign a claim handler to communicate with a claimant, an employer, another insurer, and/or medical service providers to help determine the appropriate amount of payment. Note that submitted claims may involve various amounts of work by a claim handler. For example, one type or segment of insurance claim might be relatively straightforward while another segment of claims involve complex determinations of liability and/or injury issues.

“In one approach, a received insurance claim is simply assigned to a claim handler in a random or round robin manner. This, however, might lead to one claim handler having a significantly more complex workload as compared to another claim handler. Moreover, manually determining the complexity of an insurance claim, and/or which claim handler it should be assigned, can be a time consuming and error prone task, especially when there are a substantial number of claims, of many different types, to be analyzed. For example, an insurer might receive tens of thousands of new insurance claims each year (which might represent a billion dollars of potential liability). It would therefore be desirable to provide systems and methods to facilitate the assignment of insurance claims to appropriate segments and/or to claim handlers in an automated, efficient, and accurate manner.”

Supplementing the background information on this patent, NewsRx reporters also obtained the inventors’ summary information for this patent: “According to some embodiments, systems, methods, apparatus, computer program code and means may facilitate the assignment of insurance claims to appropriate segments and/or claim handlers. In some embodiments, a communication device may receive data indicative of a plurality of insurance claims along with an indication of an appropriate claim segment classification for each insurance claim. A first claim handler may then be automatically selected for a first insurance claim based at least in part on: (i) a first segment classification associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, and (iii) load factors associated with claim handlers. An indication of the selected first claim handler may then be transmitted.

“A technical effect of some embodiments of the invention is an improved and computerized method to facilitate the assignment of insurance claims to appropriate segments and/or claim handlers. 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:

“What is claimed is:

“1. A system for claim load balancing and assignment, comprising: a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies, the data comprising a plurality of data elements for each of the insurance claims; a computer storage unit for receiving, storing, and providing said data indicative of the plurality of insurance claims; a segmentation platform processor configured for: automatically, responsive to a new one of the insurance claims and dynamically responsive to a change in at least one of a subset of the plurality of data elements relating to one of the insurance claims previously segmented, executing segmentation logic, including: determining a type of insurance associated with a first insurance claims of the plurality of insurance claims; analyzing the received data associated with the first insurance claim, in accordance with first segmentation logic, to determine a first segment classification appropriate for the first insurance claim, the first segment classification being one of a plurality of sequential from least complex to most complex, ranked, complexity segment classifications, wherein at least the first segmentation logic comprises a rule mapping at least one parameter description value to a minimum complexity value of the plurality of sequential segment classifications; analyzing the received data associated with the first insurance claim, in accordance with second segmentation logic different from the first segmentation logic, to determine a second segment classification appropriate for the second insurance claim, the second segment classification being another one of the plurality of sequential complexity segment classifications, and transmitting an indication of the higher of the first and second segment classifications to a load balancing and assignment platform processor; and a load balancing and assignment platform processor in communication with the storage unit, wherein the processor is configured for: receiving from a separate human resources platform data indicative of availability of a plurality of claim handlers; selecting a first claim handler for the first insurance claim based at least in part on: (i) the higher of the first and second sequential segment classifications determined by the segmentation platform processor associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, (iii) load factors associated with claim handlers, (iv) the data indicative of availability of the plurality of claim handlers, and (v) expertise attributes associated with the claim handlers; the selecting being performed at least in part by a predictive model trained with historical insurance claim information, the predictive model including at least one of: (i) a neural network, and (ii) a support vector machine; and transmitting an indication of the selected first claim handler.

“2. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for: indicating to the computer storage unit that the first claim handler is authorized to access the data indicative of the first insurance claim.

“3. The system of claim 1, wherein the first claim handler is further selected based on requests to receive more insurance claims received from claim handlers.

“4. The system of claim 1, wherein the first insurance claim is associated with at least one of: (i) workers’ compensation insurance, (ii) automobile insurance, (iii) homeowners insurance, (iv) property insurance, (v) general liability insurance, (vi) commercial insurance, and (vii) personal insurance.

“5. The system of claim 1, wherein at least some of the received data indicative of a plurality of insurance claims are associated with at least one of: (i) a newly received first notice of loss, or (ii) information determined after a first notice of loss was received.

“6. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for: automatically transmitting an indication of the first claim handler to at least one of: (i) an email server, (ii) a workflow application, (iii) a report generator, (iv) a calendar application, and (v) a claim handler device.

“7. The system of claim 1, wherein the data indicative of the plurality of insurance claims is received via at least one of: (i) submitted paper claims, (ii) telephone call center operators, and (iii) an online claim submission web site.

“8. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for: automatically selecting a second claim handler for a second insurance claim based on an assignment preferences table.

“9. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for: automatically selecting a second claim handler for a second insurance claim based on a dedicated handler manager.

“10. The system of claim 1, wherein the load balancing and assignment platform processor is further configured for: automatically selecting a second claim handler for a second insurance claim based on a catastrophe management table.

“11. The system of claim 1, wherein claim handlers are associated with one of a plurality of claim handler offices, at least one of the claim handler offices being remote from other claim handler offices.

“12. The system of claim 1, wherein, after said selection of the first claim handler for the first insurance claim, feedback performance data is evaluated and, as a result of the evaluation, the first insurance claim is re-assigned to a second claim handler.

“13. A computer-implemented method associated with an insurance claim processing system, comprising: receiving, by a communication device, data indicative of a plurality of insurance claims submitted in connection with insurance policies, the data comprising a plurality of data elements for each of the insurance claims; storing, by a computer storage unit, said data indicative of the plurality of insurance claims; automatically, responsive to a new one of the insurance claims and dynamically responsive to a change in at least one of a subset of the plurality of data elements relating to one of the insurance claims previously segmented, executing, by a segmentation platform processor, segmentation logic, including: determining a type of insurance associated with a first insurance claim of the plurality of insurance claims; analyzing the received data associated with the first insurance claim, in accordance with first segmentation logic, to determine a first segment classification appropriate for the first insurance claim, the first segment classification being one of a plurality of sequential from least complex to most complex, ranked, complexity segment classifications, wherein at least the first segmentation logic comprises a rule mapping at least one parameter description value to a minimum complexity value of the plurality of sequential segment classifications; analyzing the received data associated with the first insurance claim, in accordance with second segmentation logic different from the first segmentation logic, to determine a second segment classification appropriate for the first insurance claim, the second segment classification being another one of the plurality of sequential complexity segment classifications, and transmitting, by the segmentation platform processor, an indication of the higher of the first and second segment classifications to a load balancing and assignment platform processor; receiving, by the load balancing and assignment platform processor, from a separate human resources platform, data indicative of availability of a plurality of claim handlers; automatically selecting, by the load balancing and assignment platform processor, a first claim handler for the first insurance claim based at least in part on: (i) the higher of the sequential first and second segment classifications determined by the segmentation platform processor associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, (iii) load factors associated with claim handlers; (iv) the data indicative of availability of the plurality of claim handlers, and (v) expertise attributes associated with the claim handlers; the selecting being performed at least in part by a predictive model trained with historical insurance claim information, the predictive model including at least one of: (i) a neural network, and (ii) a support vector machine; and transmitting, by the load balancing and assignment platform processor, an indication of the selected claim handler.

“14. The method of claim 13, wherein the first claim handler is further selected based on paid time off information associated with claim handlers.

“15. The method of claim 13, wherein the first claim handler is further selected based on requests to receive more insurance claims received from claim handlers.

“16. The method of claim 13, wherein at least some of the received data indicative of a plurality of insurance claims are associated with at least one of: (i) a newly received first notice of loss, or (ii) information determined after a first notice of loss was received.

“17. The method of claim 13, further comprising: automatically selecting, by the load balancing and assignment platform processor, a second claim handler for a second insurance claim based on at least one of: (i) an assignment preferences table, (ii) a dedicated handler manager, and (iii) a catastrophe management table.

“18. A system for claim load balancing and assignment, comprising: a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies along with an indication of an appropriate claim segment classification for each insurance claim, including insurance policies associated with workers’ compensation insurance and automobile insurance, the data comprising a plurality of data elements for each of the insurance claims; a computer storage unit for receiving, storing, and providing said data indicative of the plurality of insurance claims; and a segmentation platform processor configured for: automatically, responsive to a new one of the insurance claims and dynamically responsive to a change in at least one of a subset of the plurality of data elements relating to one of the insurance claims previously segmented, executing segmentation logic, including: determining a type of insurance associated with a first insurance claims of the plurality of insurance claims; analyzing the received data associated with the first insurance claim, in accordance with first segmentation logic, to determine a first segment classification appropriate for the first insurance claim, the first segment classification being one of a plurality of sequential from least complex to most complex, ranked, complexity segment classifications, wherein at least the first segmentation logic comprises a rule mapping at least one parameter description value to a minimum complexity value of the plurality of sequential segment classifications; analyzing the received data associated with the first insurance claim, in accordance with second segmentation logic different from the first segmentation logic, to determine a second segment classification appropriate for the second insurance claim, the second segment classification being another one of the plurality of sequential complexity segment classifications, and transmitting an indication of the higher of the first and second segment classifications to a load balancing and assignment platform processor; a load balancing and assignment platform processor in communication with the storage unit, wherein the processor is configured for: receiving from a separate human resources platform data indicative of availability of a plurality of claim handlers; selecting a first claim handler for the first insurance claim based at least in part on: (i) the higher of the first and second sequential segment classifications associated with the first insurance claim determined by the segmentation platform processor associated with the first insurance claim, (ii) numbers of other insurance claims currently assigned to claim handlers, (iii) load factors associated with claim handlers, (iv) the data indicative of availability of the plurality of claim handlers, and (v) expertise attributes associated with the claim handlers; the selecting being performed at least in part by a predictive model trained with historical insurance claim information, the predictive model including at least one of: (i) a neural network, and (ii) a support vector machine; and transmitting an indication of the selected first claim handler.

“19. The system of claim 18, wherein the first claim handler is further selected based on at least one of: (i) paid time off information associated with claim handlers, and (ii) requests to receive more insurance claims received from claim handlers.

“20. The system of claim 18, wherein a second claim handler is further selected based on at least one of: (i) an assignment preferences table, (ii) a dedicated handler manager, and (iii) a catastrophe management table.”

For the URL and additional information on this patent, see: Edwards, Paul J.; Shemesh, Keren. System For Claim Load Balancing. U.S. Patent Number 10,217,170, filed October 31, 2014, and published online on March 11, 2019. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=10,217,170.PN.&OS=PN/10,217,170RS=PN/10,217,170

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