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Insurance Abstract
An insurance claim processing system may include an insurance claim
database, an event processor component, a task engine component
and a collaborative intelligent task processor. The insurance claim
database may be configured to store and provide access to data in
a data record that is related to an insurance claim. The event processor
component may be executable with a computer to iteratively monitor
the data in the data record and identify events. The task engine
component may be executable with a computer in response to one of
the identified events to generate tasks indicative of information
that needs to be acquired based on the contents of the data record.
The collaborative intelligent task processor may be executable with
a computer to analyze a task generated by the task engine component
and select an action plan that is responsive to the task. The action
plan may include a first procedure that enables the collaborative
intelligent task processor to acquire information related to the
insurance claim, and a second procedure that enables the collaborative
intelligent task processor to process the information to yield a
result responsive to the task.
Insurance Claims
1. An insurance claim processing system, comprising: an insurance
claim database configured to store and provide access to data in
a data record that is related to an insurance claim; an event processor
executable with a computer to iteratively monitor the data in the
data record and identify changes to the data as events; a task engine
component executable with a computer in response to one of the identified
events to generate tasks indicative of information related to the
event that is to be acquired based on the contents of the data record;
and a collaborative intelligent task processor executable with a
computer to analyze a task generated by the task engine component
and select an action plan that is responsive to the task, wherein
the action plan includes a first procedure that enables the collaborative
intelligent task processor to acquire information related to the
insurance claim, and a second procedure that enables the collaborative
intelligent task processor to process the acquired information to
yield a result responsive to the task.
2. The insurance claim processing system of claim 1, wherein the
collaborative intelligent task processor comprises a task handler
component executable to analyze and process the task to select the
action plan, and a data handler component executable based on procedures
in the selected action plan to request, receive, and analyze data
available from various sources.
3. The insurance claim processing system of claim 1, wherein the
collaborative intelligent task processor is also executable to store
the result responsive to the task in the insurance claim database.
4. The insurance claim processing system of claim 1, wherein the
collaborative intelligent task processor is executable to derive
a plurality of sub-results based on the acquired information, and
logically combine the sub-results to derive the result responsive
to the task.
5. The insurance claim processing system of claim 1, wherein the
collaborative intelligent task processor is executable to direct
deletion of another task generated by the task engine component
based on at least one of the result responsive to the task or the
information that is acquired based on the task.
6. The insurance claim processing system of claim 1, wherein the
collaborative intelligent task processor is executable to direct
the task engine component to allocate another task to the collaborative
intelligent task processor based on at least one of the result responsive
to the task or the information that is acquired based on the task.
7. The insurance claim processing system of claim 1, wherein the
collaborative intelligent task processor is executable to indicate
that the allocated task has been completed.
8. The insurance claim processing system of claim 1, wherein the
collaborative intelligent task processor is executable to store
data in the insurance claim database that is identifiable as an
event by the event processor and results in a new task generated
by the task engine component.
9. The insurance claim processing system of claim 8, wherein the
collaborative intelligent task processor is executable to monitor
for an update of the data in the insurance claim database in response
to the new task.
10. The insurance claim processing system of claim 9, wherein the
collaborative intelligent task processor is executable to retrieve
the updated data from the insurance claim database for use in further
processing to yield the result responsive to the task.
11. A method of processing insurance claims with instructions stored
in a computer, the method comprising: iteratively evaluating data
related to an insurance claim with a computer, wherein the evaluated
data is stored in an insurance claim database; generating an execution
task with the computer based on the content of the stored data;
analyzing the execution task with a collaborative intelligent task
processor executable with the computer, the collaborative intelligent
task processor selecting an action plan from among a plurality of
action plans to formulate a response to the execution task; the
collaborative intelligent task processor completing a first procedure
included in the action plan that results in acquisition of data
related to the insurance claim; and the collaborative intelligent
task processor completing a second procedure included in the action
plan to process the acquired data to obtain a result responsive
to the execution task.
12. The method of claim 11, further comprising the collaborative
intelligent task processor storing the result in the insurance claim
database in connection with the insurance claim so that the result
is available for subsequent iterative evaluation with the computer
to generate another execution task.
13. The method of claim 11, further comprising segmenting the insurance
claim with a pattern analyzer based on pattern matching of the data
related to the insurance claim.
14. The method of claim 13, further comprising the collaborative
intelligent task processor analyzing the pattern matching performed
by the pattern analyzer as a basis for selection of the action plan.
15. The method of claim 11, further comprising the collaborative
intelligent task processor comparing the data related to the insurance
claim to predetermined parameters associated with the execution
task to select the action plan.
16. The method of claim 15, wherein the predetermined parameters
specifically identify the action plan to be used.
17. The method of claim 15, wherein the predetermined parameters
comprises a task type identifier included with the execution task
that identifies the type of task to be performed.
18. The method of claim 11, further comprising the collaborative
intelligent task processor comparing the data related to the insurance
claim and pattern matching results provided by a pattern analyzer
to predetermined parameters associated with the execution task to
select the action plan.
19. The method of claim 11, further comprising the collaborative
intelligent task processor selecting the action plan based on a
data request that is identified within the execution task.
20. The method of claim 11, wherein generating an execution task
comprises allocating the execution task to the collaborative intelligent
task processor.
21. The method of claim 11, wherein analyzing the execution task
comprises the collaborative intelligent task processor reviewing
data associated with the insurance claim in view of predetermined
parameters; and the collaborative intelligent task processor electing
to complete the execution task when the task aligns with the predetermined
parameters.
22. The method of claim 11, wherein selecting an action plan comprises
the collaborative intelligent task processor selectively associating
a subset of procedures from among a plurality of procedures to build
the action plan that is responsive to the execution task.
23. The method of claim 22, wherein selectively associating a subset
of procedures comprises identifying procedures from among the plurality
of procedures capable of providing logical steps to complete the
execution task.
24. The method of claim 23, wherein identifying procedures comprises
ranking the procedures that are applicable to the execution task
based on the data related to the insurance claim.
25. An insurance claim processing system embodied in instructions
stored on a memory device, comprising: a memory device, instructions
stored in the memory device to iteratively analyze data associated
with an insurance claim and identify investigations to be performed
to process the insurance claim; instructions stored in the memory
device to generate an assignable task related to one of the identified
investigations; instructions stored in the memory device executable
after allocation of the task to a collaborative intelligent task
processor to select an action plan responsive to the assignable
task; instructions stored in the memory device to complete a first
procedure included in the action plan, wherein the first procedure
enables acquisition of information related to the insurance claim;
instructions stored in the memory device to complete a second procedure
included in the action plan, to process the acquired information;
and instructions stored in the memory device to store the results
in association with the insurance claim.
26. The insurance claim processing system of claim 25, wherein
the first procedure includes instructions to request information
from at least one of a proprietary data source or a public data
source, or combinations thereof, and the second procedure includes
instructions to enable a sub-routine outside the action plan to
process the requested information.
27. The insurance claim processing system of claim 25, wherein
the assignable task includes indication of data to be acquired and
processed, and the action plan is selected to obtain the data indicated
by the assignable task, and process the acquired data.
28. The insurance claim processing system of claim 25, further
comprising instructions stored in the memory device to perform pattern
matching of the data associated with the insurance claim and provide
a pattern matching result that is unable to process the insurance
claim.
29. The insurance claim processing system of claim 28, further
comprising instructions stored in the memory device to analyze the
pattern matching result and the data associated with the insurance
claim to select an action plan.
30. An insurance claim processing system, comprising: a task analysis
component executable by a computer to receive an assigned task related
to processing of an insurance claim, wherein the task analysis component
is configured to select an action plan responsive to the assigned
task that includes at least two procedures; a data retrieval component
executable by a computer to complete a procedure included in the
selected action plan to access and retrieve information; an enable
actions component executable by a computer to complete a procedure
included in the selected action plan by initiation of a sub-process
that is not part of the selected action plan, by selective supply
of retrieved information to the sub-process and by receipt of resulting
information from the sub-process; and a data analysis component
executable by a computer to complete a procedure included in the
selected action plan to apply processing rules to at least one of
the retrieved information or the resulting information, or combinations
thereof, to generate a task result responsive to the assigned task.
31. The insurance claim processing system of claim 30, further
comprising an action plan database, the action plan database comprising
a plurality of predetermined action plans stored therein that are
selectable by the task analysis component based on the content of
the assigned task.
32. The insurance claim processing system of claim 31, wherein
the assigned task identifies at least one of the predetermined action
plans to be selected by the task analysis component.
33. The insurance claim processing system of claim 31, wherein
the assigned task is evaluated by the task analysis component to
select at least one of the predetermined action plans.
34. The insurance claim processing system of claim 30, wherein
the task analysis component is configured to select a plurality
of action plans and generate a hierarchal ranking of the action
plans so that a highest ranking action plan may be selected.
35. The insurance claim processing system of claim 30, wherein
the enable actions component is executable to initiate execution
of the sub-process by the storage of data with predetermined parameters
that trigger said execution.
36. The insurance claim processing system of claim 30, wherein
the enable actions component is executable to monitor for the results
of a sub-process and direct the data retrieval component to retrieve
the results for use in further processing to complete the assigned
task.
37. The insurance claim processing system of claim 30, further
comprising a forms component configured to populate portions of
a form with data and provide the form to the data retrieval component
to further populate the form with at least one of retrieved information
or resulting information, or the combination thereof.
38. The insurance claim processing system of claim 30, wherein
the task analysis component is further executable to modify the
action plan.
39. The insurance claim processing system of claim 38, wherein
the task analysis component is executable to modify the action plan
based on at least one of the task, a task type descriptive of the
type of task that is included in the task, information requested
in the task, one or more parameters associated with the task or
the action plan, or combinations thereof.
40. The insurance claim processing system of claim 31, wherein
the task analysis component is further executable to develop an
action plan and select the developed action plan when the action
plan responsive to the assigned task does not exist to be selected
from the action plan database.
41. The insurance claim processing system of claim 40, wherein
the task analysis component is executable to develop the action
plan from one or more procedures included in the action plan database.
42. The insurance claim processing system of claim 40, wherein
the task analysis component is executable to develop the action
plan based on at least one of the task, a task type included in
the task, information requested in the task, one or more parameters
associated with the task or the action plan, or combinations thereof.
Insurance Description
FIELD OF THE INVENTION
[0001] The present invention relates generally to insurance, and
more particularly, to a collaborative intelligent task processor
configured to collaboratively operate to complete one or more tasks
associated with an insurance claim.
BACKGROUND
[0002] Processing insurance claims is a significant part of the
business activities of insurance companies. Efficient processing
of insurance claims provides benefits not only in retaining and
attracting customers, but also in minimizing costs. In the past,
insurance companies have serviced insurance claims the same, regardless
of complexity. Recently, however, there has been more focus on handling
insurance claims differently based on the complexity of the individual
insurance claim.
[0003] In general, insurance claims may be grouped into three segments,
namely, 1) Core Claims; 2) Express Claims; and 3) Fast Track Claims.
Core Claims may include low frequency, higher relative severity
claims that are typically handled by a human expert claim handler.
An example Core Claim may be a large commercial liability insurance
claim with multiple claimants.
[0004] Express Claims may include high frequency relatively low
severity claims that require human handling, such as insurance claims
related to vehicle damage, or personal property loss. Fast Track
Claims may include insurance claims of relatively low severity that
can be handled without human intervention, such as an insurance
claim related to only broken automobile glass or a claim related
to a relatively minor theft/vandalism incident. With Fast Track
Claims, a basic task, such as matching the loss to the policy of
the insured or issuing a payment in response to receipt of an invoice,
may be automated to be performed automatically.
[0005] However, due to the complexities and multiple separate tasks
that are associated with most insurance claims, relatively few insurance
claims may be categorized as Fast Track Claims. In addition, insurance
claims categorized as Express Claims are still handled by a human,
who performs each task manually, regardless of complexity. Accordingly,
to maximize efficiency what is needed is a system that can separate
an insurance claim into individual tasks, identify those individual
tasks that are capable of being completed in an automated fashion
versus those tasks that need a human claim adjuster. Further, what
is needed is a system capable of automated completion of more complex
tasks by taking into account other aspects of the insurance claim
that are not necessarily part of an individual task being automatically
completed.
SUMMARY
[0006] The present invention provides an insurance claim processing
system capable of automated analysis of an insurance claim, identification
of events included in the data of the insurance claim, and/or generation
of tasks that need to be performed to resolve the insurance claim.
In addition, the system is capable of performing automated processing
of some, or all of the tasks generated for an insurance claim.
[0007] The insurance claim processing system includes a task engine
component capable of generating tasks related to an insurance claim.
The tasks may be identified as capable of being performed by a human
performer, such as a claims adjuster, or an automated performer.
One automated performer included in the insurance claim processing
system is a collaborative intelligent task processor. The collaborative
intelligent task processor may receive tasks capable of being performed
by an automated performer.
[0008] For each task, the collaborative intelligent task processor
may select one or more corresponding action plans from an action
plan database. The action plans may include procedures. The procedures
may be step-by-step instructions to retrieve information related
to an insurance claim. In addition, the procedures may be step-by-step
instructions to enable sub-processes to retrieve and/or process
data. Sub-results provided by the sub-processes may be used by the
collaborative intelligent task processor, along with any other insurance
claim related data to process data and/or generate additional data
based on the procedures included in an action plan. In addition,
the sub-results from one sub-process may be used by the collaborative
intelligent task processor to obtain additional sub-results from
a different sub-process.
[0009] Based on the action plan, the collaborative intelligent
task processor may process the retrieved and/or generated data to
obtain a task result that is responsive to the task. The action
plans are fully configurable and may be developed for use by the
collaborative intelligent task processor to obtain a task result
for any task, or group of tasks. In addition, the automated collaborative
intelligent task processor may develop or modify existing action
plans or procedures based on the task, the insurance claim, sub-processing
results or any other information related to an insurance claim.
[0010] The collaborative intelligent task processor may rely on
other components included in the insurance claim processing system
to complete tasks. Accordingly, sub-process that are separate and
independent of the action plans may be initiated and monitored by
the collaborative intelligent task processor. In addition, the collaborative
intelligent task processor may execute the procedures included in
an action plan to manipulate, change and/or create new data related
to an insurance claim. The capability of the collaborative intelligent
task processor to tap into the "expertise" of various
automated components and data included in the insurance claim processing
system, while following a predetermined action plan, enables a task
result to be obtained solely by automated processing that may take
into account many different facets of an insurance related event.
[0011] Due to the leveraged insurance claim processing power provided
by the collaborative intelligent task processor, in operable cooperation
with the other components of the insurance claim processing system,
the tasks that can be performed by the collaborative intelligent
task processor may have a much higher level of complexity. In addition,
the flexible and fully configurable action plans allow both task
specific action plans, generic action plans and everything in between.
Because the action plans are provided in terms of individual procedures
having separate step-by-step instructions, efficient, repeatable
and accurate results may be obtained using automated processing
without human intervention.
[0012] Further objects and advantages of the present invention
will be apparent from the following description, reference being
made to the accompanying drawings wherein preferred embodiments
of the present invention are clearly shown.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] FIG. 1 is a block diagram of an example insurance claim
processing system.
[0014] FIG. 2 a block diagram illustrating example functionality
of a server computer included in the insurance claim processing
system depicted in FIG. 1.
[0015] FIG. 3 a block diagram of a portion of the functionality
of the server computer depicted in FIG. 2 and the functionality
of a collaborative intelligent task processor depicted in FIG. 1.
[0016] FIG. 4 an operational flow diagram of the insurance claim
processing of FIG. 1.
[0017] FIG. 5 a second portion of the operational flow diagram
illustrated in FIG. 4.
DETAILED DESCRIPTION
[0018] FIG. 1 is an example block diagram of an insurance claim
processing system 100. The insurance claim processing system 100
is an automated system that may operate on one or more computing
devices to process insurance claims. As used herein, the term "insurance
claim" refers to any data related to an identified situation,
instance, or event that may come within the coverage of a contractual
obligation to indemnify, defend or guarantee a party against loss
by a specified contingency or peril, and the corresponding activities
related to resolving the contractual obligation including first
notice of loss, investigations, payments and/or any other functions
related thereto. Insurance claims may occur when an insured customer
of an insurance organization experiences an incident, such as property
loss/damage and/or bodily injury that may be covered by an existing
insurance policy issued by an insurance organization. In addition
an insurance claim may occur in the context of a warranty contract
situation where a good or service has allegedly failed to perform
as represented or promised. Example insurance may include automobile
insurance, homeowner insurance, business insurance, warranty insurance,
liability insurance, medical insurance, etc. The insurance claim
processing system may also be used for other types of data processing.
[0019] In FIG. 1 the insurance claim processing system 100 includes
at least one data interface terminal 102 and at least one server
computer 104 all capable of communication over a network 10. In
other examples, additional terminals, servers and/or any other devices
capable of being coupled with the network 110 may be included in
the insurance claim processing system 100. As used herein, the term
"coupled", "connected", or "interconnected"
may mean electrically coupled, optically coupled, wirelessly coupled
and/or any other form of association providing an interface between
systems, devices and/or components.
[0020] The network 110 may include the Internet, a public and/or
private intranet(s), an extranet(s), a dedicated communication line(s)
and/or any other configuration to enable transfer of data and commands.
Communication within the network 110 may be performed with a communication
medium that includes wireline based communication systems and/or
wireless based communication systems. The communication medium may
be, for example, a communication channel, radio waves, microwave,
wire transmissions, fiber optic transmissions, or any other communication
medium capable of transmitting data, audio and/or video information.
[0021] The data interface terminal 102 may be any device(s) with
data viewing, data modification, and data manipulation capability
that is also able to communicate over the network 110. Examples
of data interface terminals 102 include a terminal, a laptop computer,
a desktop computer, a personal digital assistant (PDA), a wireless
phone, etc. The data interface terminal 102 may be operated by an
organizational entity associated with an insurance organization.
The organizational entity may be assigned responsibility for at
least a portion of insurance claims submitted to the insurance organization.
As used herein, the term "organizational entity," "organizational
entities" or "OE" is broadly defined to include an
individual employee, any number of individual employees, offices,
work groups, teams, etc.
[0022] an insurance organization. The term "organizational
entity," "organizational entities" or "OE"
may also refer to individuals, offices, work groups, teams, etc.
that are external to the insurance organization performing functions
based on a relationship with the insurance organization. One example
of an organizational entity operating the data interface terminal
102 may be an insurance claim handler responsible for resolving
an insurance claim.
[0023] The server computer 104 may be any form of computing device(s)
capable of receiving requests and transmitting responses over the
network 110. Operation of the server computer 104 may be based on
instructions selectively executed by at least one processor (not
shown) operating within the server computer 104. In addition to
executing instructions to provide the functionality commonly provided
in computing devices operating as servers on a network, the server
computer 104 may execute instructions to enable operation of the
insurance claim processing system 100. Instructions executed by
the server computer 104 may be stored in a memory device 106.
[0024] The memory device 106 may be one or more data storage devices
accessible by the server computer 104. The memory device 106 may
be at least one magnetic data storage device, such as a hard drive,
an optical disk, a tape, etc., and/or at least one electronic memory
device such as flash memory, random access memory (RAM), etc. The
memory device 106 may be located within the server computer 104
as illustrated. Alternatively, the memory device 106 may be located
anywhere within the network 110 that allows communication with the
server computer 104 over the network 110. In another alternative,
a portion of the memory device 106 may be located within the server
computer 104 and other portion(s) of the memory device 106 may be
located elsewhere within the network 110.
[0025] Included within the illustrated memory device 106 is at
least one rules engine 116 and at least one data storage database
118. The rules engine 116 may be executable instructions capable
of providing the functionality of the insurance claims processing
system 100. In addition, the rules engine 116 may include instructions
providing rules and other parameters for operation of the insurance
claims processing system 100. The data storage database 118 may
be a database, such as a relational database that allows data storage
capability for data related to insurance policies and/or insurance
claims. In addition, data utilized or generated during operation
of the rules engine 116 may be stored in the data storage database
118.
[0026] The server computer 104 may also communicate with and/or
access other computing devices 120 over the network 110. The computing
devices 120 may include legacy computing systems within an insurance
claim processing company, such as an insurance company, that include
data related to a claimant and/or an insurance claim. In addition,
the computing devices 120 may include integration partners of the
insurance claim processing company. Integration partners may be
providers of goods and/or services, such as a vehicle windshield
repair shop, a medical services provider, a damage estimator, a
vehicle tow service or a vehicle auto body shop that is capable
of being electronically authorized to perform work, supply materials,
submit invoices and/or be issued payment for work performed and/or
materials provided. The computing devices 120 also may be public
sources of information external to the insurance claim processing
company that are accessible over the network 110, such as databases
related to estimated vehicle costs, or criminal records. The computing
devices 120 may also include private or proprietary sources of information
such as databases related to a claimant's credit report, or a vendor
database, such as repair contractors, providers of medical services,
or any other insurance claim services.
[0027] When an insurance claim is submitted to an insurance organization,
data related to the insurance claim may be entered into the data
interface terminal 102. With an insurance claim of an insured, the
data may include identification of the insured, the insurance policy
number, details of the insurance claim, etc. The data may be transmitted
over the network 110 to the server computer 104. The server computer
104 may execute instructions within the rules engine 116 to store
the data within the data storage database 118 of the memory device
106.
[0028] The server computer 104 also may execute instructions to
manipulate and/or augment the data related to the insurance claim
to identify additional properties associated with the stored data.
As used herein, the term "properties" or "property"
is broadly defined to include the entered data associated with an
insurance claim as well as identified attributes, parameters, classifications,
categorizations, pattern results, etc., that are associated, a result
of, and/or are derived from the stored data.
[0029] FIG. 2 is a block diagram of an example functionality included
in the server 104. The server 104 includes a first notice of loss
component 202, a contract system component 204, an insurance claim
database 206, an event processor component 208, a task engine component
210, a task assistant component 212, a partner integration framework
component 214, a pattern analysis component 216, an automatic assignment
component 218, a file notes component 222, a forms component 224,
a contacts component 226 and a collaborative intelligent task processor
228. The various components may be stored as instructions in the
memory device 106, and may be selectively executed by the server
computer 104. In other examples, additional or fewer components
may be illustrated to depict the functionality of the server 104
as described herein.
[0030] The first notice of loss (FNOL) component 202 may be enabled
to allow an insurance claim to be initially entered into the insurance
claims processing system 100 by an organizational entity using the
data interface terminal 102 (FIG. 1). For example, a call center
operator may enter the basic information related to an insurance
claim of an insured, such as the name of the insured, the date of
the insurance claim, the facts related to the insurance claim, etc.
using the FNOL component 202. Alternatively, the information related
to an insurance claim may be received in another medium such as
written correspondence, and entered using the FNOL component 202.
[0031] The FNOL component 202 may also analyze the data being input,
and provide real-time lookup and/or verification of insurance policy
coverage and/or contractual obligation related information. For
example, while the organizational entity in the call center is discussing
the insurance claim with the insured, the FNOL component 202 may
provide the organizational entity with the insured's policy information.
[0032] The FNOL component 202 may enable the contract system component
204 to access the contract related information, such as the policy
related information of a claimant. Accordingly, the contract information
may be stored, accessed and manipulated by the contract system component
204. Alternatively, the contract system component 204 may be an
interface to another computing system, such as a legacy system,
within an insurance company or other insurance claim processor to
enable access storage and/or retrieval of the contract related information.
[0033] In addition, the FNOL component 202 may interactively provide
prompts to the organizational entity to query the claimant for additional
information. As additional information is entered by the organizational
entity, additional prompts may be generated. Information entered
with the FNOL component 202 may be stored in the insurance claim
database 206. The insurance claim database 206 may be part of the
data storage 118 of FIG. 1, and may store all information related
to an insurance claim.
[0034] Information stored in the insurance claim database 206 related
to an insurance claim, including the data captured with the FNOL
component 202 may be iteratively monitored and analyzed by the event
processor component 208. The event processor component 208 may generate
an event or identify an investigation. An event or investigation
may be generated by the event processor component 208 when there
is a change in the state of an insurance claim. In other words,
when the data in the insurance claim database 206 is changed "significantly",
as determined by the event processor component 208, an event or
investigation may be generated. Events and investigations may also
be generated manually. Events and investigations may be generated
by the event processor component 208 based on automated evaluation
of the data by the event processor component 208. For example, changes
in overall complexity, the severity of the loss, the extent of the
loss, the loss history of the claimant, etc. may trigger generation
of an event or an investigation. Thus, each insurance claim can
trigger generation of different events and/or investigations based
on the nature of the insurance claim, the specific facts involved,
the claimant and/or any other data related to the insurance claim.
[0035] The task engine component 210 is executable to iteratively
monitor and generate tasks, or execution tasks, based on generated
events and investigations. As used herein, the terms task, or execution
task refers to each of the discrete activities that are to be performed
to complete the processing of an insurance claim. Thus, each insurance
claim may include different tasks, or combinations of tasks, based
on the events and/or investigations generated. The automated task
generation may be based on account servicing requirements, company
policy, company best practices, regulatory requirements, and customizable
task profiles in view of the data associated with the insurance
claim. A task library of tasks may be accessed by the task engine
component 210. Tasks may be selected from the task library based
on rules that match conditions in the insurance claim to one or
more of the tasks in the task library. Example tasks include correspondence
tasks, phone tasks, ad hoc tasks, authority tasks, research tasks,
data gathering tasks, claim allocation tasks, policy match to loss
tasks, claim closing tasks, invoice payment tasks, etc.
[0036] The task assistant component 212 may receive, organize and
manage the execution of tasks generated by the task engine component
210. The execution tasks may be included in a task plan created
by the task assistant component 212. A task plan may be created
for each insurance claim or each part of an insurance claim. The
task plan may include one or more tasks that are specifically selected
to represent the steps that are to be executed to complete the processing
of a specific insurance claim or a specific part of an insurance
claim. Tasks in the task plan may be date sensitive and may serve
a diary function with respect to each insurance claim or each portion
of an insurance claim. Accordingly, the task assistant component
212 may provide automated scheduling and tracking of insurance claim
related activities. In addition, the task assistant component 212
may provide organization and management of complex insurance claims
or parts of complex insurance claims.
[0037] As the data in the insurance claim database 206 related
to an insurance claim is added, updated and/or changed, the event
processor component 208 may analyze the data and generate additional
events. In response to the events, the task engine component 210
may generate tasks to include in the task plan. In addition, the
task engine component 210 may delete or change existing tasks in
the task plan in response to events. Tasks that are generated, changed
or deleted are provided to the task assistant component 212 to update
the task plan.
[0038] Each task in the task plan may include identification of
a performer to complete the task. The performer may be a specific
organizational entity, a category of organizational entities or
another component included in the server computer 104. The task
assistant component 212 may also create and maintain a historical
record of tasks that are completed. The historical record may include
an indication of the performer that completed the task, the insurance
claim associated with the task, file notes, date of completion,
etc.
[0039] Some of the tasks may identify the FNOL component 202 as
the performer. Such tasks may instruct the FNOL component 202 to
push data and/or work to external suppliers (integration partners)
of the insurance claim processing company. The FNOL component 202
may push such data and/or work to the external business partners
using the partner integration framework component 214. For example,
FNOL component 202 may arrange for a vehicle tow, a rental vehicle
or vehicle repairs at a repair shop for an insurance claim related
to a vehicle accident.
[0040] The partner integration framework component 214 may be an
interface to the computing devices 120 (FIG. 1) that are maintained
by one or more of the external business partners of the insurance
company. Alternatively, the partner integration framework component
214 may include a communication port, a terminal or other interface
device that allows external business partners to communicate with
the server 104.
[0041] The FNOL component 202 may also enable the pattern analysis
component 216. The pattern analysis component 216 may identify patterns
from the data included in the insurance claim database 206. The
patterns may be used to segment and/or categorize all or parts of
the insurance claim. As used herein, "categorizing" or
"categorization" refers to classification of an insurance
claim into a predetermined category(s) that has been identified
by a insurance claim processing organization. In general, various
patterns may be developed that are representative of different segments
within insurance claims. The patterns may be matched to an insurance
claim. Outcomes from each of the patterns may be aggregated to generate
pattern results to further categorize the insurance claim.
[0042] The pattern analyzer component 216 may analyze the data
associated with an insurance claim and return one or more pattern
results. To obtain the pattern results, the properties associated
with individual insurance claims may be divided into segments or
dimensions that may also be referred to as pattern types. Each of
the segments may be identified by matching the properties associated
with the insurance claim to one or more associated patterns that
may also be referred to as components. Each of the matched patterns
may provide an outcome resulting from analysis of the data associated
with the insurance claim that is matched to the pattern.
[0043] The outcomes from each of the patterns may be aggregated
to form pattern result(s). Aggregation may involve automated analysis
of the outcomes with respect to each other to arrive at a result
that is representative of the patterns when considered in totality.
For example, in an insurance claim, a first outcome from a first
pattern may be indicative of unusually high financial losses. A
second outcome from a second pattern may be indicative of an unusually
high number of previous insurance claims. Aggregation of the first
and second outcomes may therefore indicate a pattern results of
high potential for fraud. The pattern result(s) may provide additional
information that can be used in many different aspects of the processing
of an insurance claim.
[0044] The pattern results and the data in the insurance claim
database 206 may be used by the auto assignment component 218 to
identify target organizational entities best able to handle the
insurance claim. Target organizational entities may be identified
based on matching the data and pattern results identified for the
insurance claim with the skill set of organizational entities. The
skill set of an organizational entity(s) may be matched to an insurance
claim based on, for example, identified skills, expertise, experience,
efficiency, grouping with other similar insurance claims, geographic
location, or any other criterion related to the organizational entity(s).
The insurance claims may be automatically assigned to any organizational
entity, such as internal or external adjusters, vendors and/or any
other third parties without the need for human intervention. Automated
assignment may be performed with a systematic process of choosing
an organizational entity(s) based on the pattern results and insurance
claim data.
[0045] Once assigned, the organizational entity may use the task
plan provided by the task assistant component 212 to work through
the processing of the insurance claim. The organizational entity
may also reorganize the task plan, delete tasks and add tasks to
the task plan. In addition, the organizational entity may enable
the file notes component 222.
[0046] The file notes component 222 may be a word processor based
functionality that allows the organizational entity to generate,
maintain and/or send file notes related the insurance claim. The
file notes may include fields and/or free form text entries. The
file notes component 222 may include word processing functionality
such as spell checking, word wrap, etc. In addition, the file notes
component 222 may allow categorization of the file notes based on
key fields, searching, sorting, etc.
[0047] The organizational entity may also enable the forms component
224. The forms component 224 may be enabled to automatically generate
forms, letters and other types of template documents. The templates
may be included in a template library for ready access. The templates
may be located using context sensitive menus to navigate through
the available templates. Upon selection of a template, the forms
component 224 may automatically access data in the insurance claim
database 206 to populate the template chosen for a particular insurance
claim with some of the header information related to the insurance
claim. Example insurance claim specific header information that
may be automatically populated into a selected template by the forms
component 224 includes an address, insurance claim number, date
of loss, name of the claimant, name of the insured, policy number,
etc.
[0048] The contacts component 226 may be populated with contact
information, such as name, telephone number, etc. of the claimant,
individuals involved in the insurance claim, witnesses, business
partners involved in the insurance claim, or any other individuals
or entities associated with the insurance claim. The contact information
may be automatically extracted from the insurance claim database
206 and stored in a contacts database associated with the insurance
claim. The contact information may be manually or automatically
accessed as needed.
[0049] The pattern analysis component 216 may also categorize the
insurance claim as one that includes tasks that are eligible for
performance by an automated performer. One automated performer is
the previously discussed FNOL component 202. Another automated performer
is the collaborative intelligent task processor 228.
[0050] The collaborative intelligent task processor 228 is automated
to perform tasks. The tasks performed by the collaborative intelligent
task processor 228 may represent the entire insurance claim. The
collaborative intelligent task processor 228 may also perform a
selected task associated with an insurance claim, while other tasks
associated with an insurance claim may be performed by a human organizational
entity. Tasks attempted to be performed by the collaborative intelligent
task processor 228 may also be redirected to a human organizational
entity based on predetermined triggers, thresholds and/or scenarios
related to and/or determined during performance of the task by the
collaborative intelligent task processor 228.
[0051] Tasks may be assigned or allocated to the collaborative
intelligent task processor 228 by the task assistant component 212
and/or the auto assignment component 218. Alternatively, the collaborative
intelligent task processor 228 may analyze the tasks in the task
plan and select those tasks that are capable of automated performance.
Tasks capable of automated performance may be determined based on
analysis of the task by the collaborative intelligent task processor
228 and/or identified with a flag or other indicator associated
with a task. Accordingly, tasks may be allocated for automated processing
by other components in the insurance claim processing system, an
organizational entity, and/or by the collaborative intelligent task
processor 228 itself.
[0052] Automated performance of tasks by the collaborative intelligent
task processor 228 may involve automated analysis of the task and
automated selection of an action plan corresponding to the task.
The action plan may include a plurality of procedures or subroutines
that enable the collaborative intelligent task processor 228 to
acquire and/or process information related to the insurance claim.
In addition, the action plan may include one or more procedures
executable by the collaborative intelligent task processor 228 to
process the acquired information, the data from the insurance claim
database 206 and/or pattern matching data to yield a result. The
task result may be responsive to the task. Alternatively, the result
may be additional data that is leveraged by the collaborative intelligent
task processor 228 to acquire additional information and/or further
process the acquired information, the data from the insurance claim
database 206 and/or pattern matching data to yield a further result.
The collaborative intelligent task processor 228 may iteratively
acquire, generate and/or process data related to an insurance claim
based on one or more tasks until the action plan is completed.
[0053] For example, the partnership integration component 214 may
receive and associate an invoice with an insurance claim stored
in the insurable event database. The event processor 208 may identify
the invoice as an event, and the task engine 210 may generate a
task to process the invoice for payment. The task assistant may
assign the task to the collaborative intelligent task processor
228. The collaborative intelligent task processor 228 may receive
the task and select an action plan responsive to the task. In this
example, an action plan to process an invoice may be selected by
the collaborative intelligent task processor 228.
[0054] The procedures and subroutines included in the selected
action plan may enable the intelligent task processor 228 to confirm
the invoice is correct and process the invoice for payment without
human intervention. Confirmation that the invoice is correct may
involve comparing the work performed with the insurance claim, confirming
the amount does not exceed a determined amount, confirming a deductible
was met, etc. Processing the invoice for payment may involve generating
a check for the correct amount made out to the correct entity with
a mailing envelop or transmittal instructions to transmit the check
to the entity.
[0055] FIG. 3 is a block diagram illustrating a portion of the
server 104 that includes the insurance claim database 206, the task
engine component 210, the task assistant component 212, the file
notes component 222, the forms component 224, and the contacts component
226. In addition, FIG. 3 includes the functionality of an example
collaborative intelligent task processor 228. In other examples,
fewer or greater numbers of components could be used to describe
the functionality described herein.
[0056] The illustrated collaborative intelligent task processor
228 includes a task handler component 302 and a data handler component
304 that are fully automated. In general, the task handler component
302 is executable to automatically analyze and process a task provided
to the collaborative intelligent task processor 228. In addition,
the task handler component 302 may determine and/or develop an action
plan for each task.
[0057] The data handler component 304 is automatically executable
to request, receive, analyze, and/or transmit data available from
various sources based on procedures included in the action plan.
In addition, the data handler component 304 is executable to initiate
automated sub-processing by other components in the server 104 in
order to obtain data. Further, the data handler component 304 is
automatically executable to logically analyze the data received
from a number of requests to derive and/or generate a result that
is responsive to the task. The data handler component 304 may also
forward data received from one sub-process to another sub-process
for additional processing.
[0058] The task handler component 302 includes a task list component
308, a task analysis component 310, an action plan database 312
and a task interface component 314. As previously discussed, tasks
may be generated by the task engine component 210 and included in
a task plan by the task assistant component 212. The tasks may be
acquired and/or provided to the task handler component 304.
[0059] The task handler component 304 may wait to receive tasks
transmitted from the task assistant 212. Such tasks may be stored
in a task queue accessible by the task list component 308. Alternatively,
the task handler component 304 may be executable to review task
plans of those insurance claims that have been identified by pattern
matching with the pattern analysis component 216 (FIG. 2) as having
tasks that are performable by an automated performer. Based on the
automated review, the task handler component 304 may select tasks
to be stored in the task queue.
[0060] Selection of tasks to be stored in the task queue may be
based on a predetermined list of tasks that have been identified
as capable of being performed by the collaborative intelligent task
processor 228. Alternatively, automated selection of the tasks by
the task list component 308 may be based on the existence of a predetermined
parameter, such as a flag, that is included in tasks capable of
being completed by the collaborative intelligent task processor
228. In another alternative, the task list component 308 may analyze
the task and determine if the task is capable of being performed
by the collaborative intelligent task processor 228. Analysis may
be based on, for example, comparison of the available action plans
to the tasks in the task plan.
[0061] The task analysis component 310 may analyze each task and
determine at least one corresponding action plan capable of being
used to complete the task. Determination of at least one corresponding
action plan may be based on a parameter such as a task type identifier
included with the task. The task type identifier may identify the
type of task that is to be performed and a corresponding one or
more action plans associated with the task. Based on the task type
identifier, the task analysis component 310 may further analyze
the task to identify a subset of action plans capable of performing
the task. For example, the task type may identify the task as an
invoice related task, a set reserve type task, etc. In the case
of an invoice type task, the task analysis component 310 may further
analyze to determine if the invoice is a medical services invoice,
a legal services invoice, a car repair invoice, etc. Based on the
analysis, different action plans may be chosen. In other examples,
one or more other predetermined parameters may be associated with
each task. The predetermined parameter(s) may, for example, specifically
identify one or more action plans capable of being executed to complete
the task.
[0062] Alternatively, the task analysis component 310 may utilize
pattern matching performed by the pattern analysis component 216
(FIG. 2) as a basis for selection of one or more action plans. For
example, the task may be to determine and set a reserve amount (maximum
possible payout) for an insurance claim. The pattern analysis component
216 may have performed pattern matching that indicates that the
insurance claim is an automobile damage claim, without bodily injury,
involving only two vehicles, where the vehicle damage is moderate.
Based on the pattern matching results, one or more action plans
may be selected to determine a reserve amount for the insurance
claim.
[0063] In another alternative, the task analysis component 310
may analyze the data in the insurance claim database 206 as the
basis for choosing one or more action plans. For example, where
the task is to determine and set a reserve, the task analysis component
310 may determine that the insurance claim is a homeowner fire and
choose one or more action plans associated with retrieval and analysis
of data related to damage to private dwellings. The task analysis
component 310 may use any combination of the type, other predetermined
parameters, data associated with the insurance claim and/or pattern
matching results as the basis for selection of one or more action
plans.
[0064] The action plans may include one or more procedures. The
procedures may be specific instructions to be performed in an automated
fashion in a determined sequence to complete the task. Where there
are multiple procedures in an action plan, the procedures may be
step-by-step sequential and/or parallel instructions to obtain one
or more results. For example, in the case of a damaged vehicle bumper
insurance claim, a first procedure in a selected action plan may
be an instruction to access the insured's policy information and
determine the deductible for vehicle collision. A second procedure
may be an instruction to access the insurance claim database to
obtain a make, a model and a year of the vehicle that was damaged.
A third procedure in the action plan may be an instruction to access
a business partners database and obtain the costs of a new bumper
and associated installation for the vehicle make, model and year
retrieved in the second procedure. A fourth procedure may be an
instruction to apply the deductible retrieved in the first procedure
to the total cost and calculate a payout, and a fifth procedure
may be to issue a check to the business partner for the calculated
payout. The previous example was a simple illustration and should
in no way be construed as a limitation. Since action plans are fully
configurable, any number of procedures with any level of complexity
related to any task may be included in an action plan.
[0065] The action plan database 312 may also include individual
procedures and/or procedures. In response to analysis of a task,
the task analysis component 310 may build an action plan from the
procedures and/or groups of procedures. The action plan may be built
based on the task, data requests included in the task, the type
of task, pattern matching results, insurance claim data and/or one
or more other parameters associated with the task and or the procedures.
For example, the parameter(s) in a task may identify one or more
specific procedures and/or groups of procedures, match procedures
to tasks, etc.
[0066] Alternatively, the procedures and/or groups of procedures
may be arranged in categories, such as vehicle damage related, dwelling
damage related, insurance claim allocation related, insurance claim
closing related, invoice payment related, etc. The parameter(s)
may identify a category that may be used in conjunction with the
pattern matching results and/or the insurance claim data to select
one or more procedures and/or groups of procedures. Additional procedures
and/or groups of procedures also may be added and/or removed from
a predetermined action plan by the task analysis component 310 based
on the task, the type, data requested in the task, pattern matching
results, the insurance claim data and/or one or more parameters
associated with the task, the action plan, the procedures and/or
the groups of procedures. Existing procedures and/or groups of procedures
that are in action plans or not, also may be modified by the task
analysis component 310 based on the task, the type, data requested
in the task, pattern matching results, the insurance claim data
and/or one or more parameters associated with the task, the action
plan, the procedures and/or the groups of procedures.
[0067] The task analysis component 310 may also develop a portion
of an action plan from procedures and/or groups of procedures that
are specific to the particular insurance claim and associated task.
The portion of the developed action plan may be combined with an
existing action plan that is of a more generic nature. In the case
of a task that is identified as an invoice type task, different
procedures may be included in the action plan if the invoice is
for different goods or services. For example, a task related to
a medical invoice may include procedures regarding analysis of usual
and customary charges for the medical procedure performed. A task
related to a vehicle towing invoice, on the other hand, will have
no similar procedures. However, a portion of the action plan that
is developed, such as confirmation of authorization to pay, auto
payment procedures, etc. may be generic to any invoice payment task
regardless of the insurance claim. Accordingly, a portion of an
action plan may be developed based on the specific task, and a portion
of the action plan may be an already existing action plan identified
based on the task type of the task.
[0068] When multiple action plans are developed and/or selected
by the task analysis component 310, the actions plans may be ranked
in a hierarchal ranking by the task analysis component 310. The
hierarchal ranking may be determined by the task analysis component
310 based on a score developed by the task analysis component 310.
The score may be based on a degree of applicability of the procedures
in an action plan to the specific circumstances present in an insurance
claim. For example, with a task to determine and set a reserve in
a vehicle damage insurance claim that is related to vehicle damage
to a motor home, an action plan that included procedures related
to determining the costs associated with vehicle damage to motor
homes would be ranked higher than actions plans related to vehicle
damage generally.
[0069] The hierarchal ranking may also be based on comparison of
specific information and/or parameters associated with the action
plan and the task, data requests included in the task, pattern matching
results, insurance claim data and/or one or more parameters associated
with the task. In other examples, any other measurement criteria
to ascertain the action plan that would best perform the task may
be used to assign a hierarchal rank to the action plans. The procedures
and/or groups of procedures used to develop the action plans may
also be hierarchal ranked as previously discussed.
[0070] The procedures included in the action plans may be generally
categorized as procedures to acquire data, and procedures to process
data to obtain a result. Acquisition and processing may be performed
by the collaborative intelligent task processor 228, and/or other
components included in the server computer 104 (FIG. 2). Each of
the procedures in an action plan may be performed and/or delegated
by the data handler 304. The data handler component 304 includes
a data retrieval component 320, a data buffer component 322, an
enable actions component 324, a process rules component 326, and
a data analysis component 328. In other examples additional or fewer
components may be depicted to represent the functionality of the
data handler component 304.
[0071] The data retrieval component 320 enables retrieval of data
from the insurance claim database 206 and/or any other computing
devices 120 (FIG. 1) on the network 110 (FIG. 1). For example, the
data retrieval component 320 may access the Property Loss Claims
Bureau (PLRB) over the Internet and obtain data as part of an action
plan related to a homeowner's insurance claim. In another example,
a database of a widget vendor may be accessed to determine statistics
related to the past occurrence of similar failures of a widget while
under warranty. In addition, the data retrieval component 320 enables
retrieval and/or generation of data with the file notes component
222, with the forms component 224, and with the contacts component
226.
[0072] With regard to the file notes component 222, the data retrieval
component 320 may access existing notes and obtain associated data.
In addition, the data retrieval component 320 may create additional
notes as part of the procedures in an action plane. For example,
the action plan may include procedures to generate structured file
notes that include data obtained by other procedures in the action
plan. As another example, an electronic document obtained as a result
of a procedure may be attached to the file as a note in the file
notes component 222 by the data retrieval component 320.
[0073] The data retrieval component 320 may also cooperatively
operate with the forms component 224 based on procedures included
in an action plan. For example, an action plan to prepare a form
letter may include procedures to obtain data, such as a deductible
amount, or an estimated total cost to include in the form letter.
In addition, when such a letter is to be sent, whom the letter is
sent to, method of delivery, address, etc. may be determined with
the data retrieval component 320 based on procedure(s) in the action
plan.
[0074] The data retrieval component 320 may not only enable retrieval
of the appropriate data, but may also fill in the form letter with
the retrieved data. Alternatively, the data retrieval component
320 may perform the functions of filling in the body of the form
letter and also retrieve and fill in the header information, such
as the address information, etc. in place of the forms component
224. Accordingly, using the automated functionality of the data
retrieval component 320, user entry screens and other forms of manual
data entry may be avoided.
[0075] The data retrieval component 320 may also retrieve contact
data from the contacts component 226. As previously discussed, the
contact data may be used by the data retrieval component 320 in
conjunction with preparing forms, such as a form letter. In addition,
the data retrieval component 320 may populate the contacts component
226 with contact information retrieved by the data retrieval component
320. For example, the data retrieval component 320 may retrieve
information related to the owner of vehicle involved in an accident
while being driven by someone else. Such contact information may
be stored in the contacts component 226.
[0076] Data retrieved with the data retrieval component 320 may
be stored in the data buffer component 322. The data buffer component
322 may also store any other data generated, retrieved or otherwise
processed by the data handler component 320. The data buffer component
322 may store information in the memory device 106 (FIG. 1).
[0077] The enable actions component 324 is executable to enable
automated subroutines and/or other sub-processes related to an action
plan. The subroutines and/or sub-processes may be completely independent
from, and not associated with, an action plan. The sub-processes
may provide additional data related to the insurance claim. In addition,
the sub-processes may provide sub-results. The sub-results may be
used in additional automated sub-processes and/or automated processing
by the collaborative intelligent task processor 228. For example,
the enable actions component 324 may follow the procedures in an
action plan to move data stored in the data buffer component 322
to the insurance claim database to trigger an event by the event
processor 208 (FIG. 2). The event may in turn trigger generation
of a task by the task engine 210 directing the pattern analysis
component 216 to perform additional pattern analysis of the data
in the insurance claim database.
[0078] In this example, the enable actions component 324 may follow
additional procedures in the action plan to enable the data retrieval
component 320 to retrieve the results of the pattern analysis (sub-results)
from the insurance claim database 206 for further processing. Accordingly,
enablement of multiple independent sub-processes with the enable
actions component 324 based on sequential and/or parallel procedures
in an action plan may be leveraged to perform automated iterative
processing. The iterative processing may be used to generate, obtain
and/or derive new data related to an insurance claim without including
the details of such subroutines and/or sub-processes as procedures
in the action plan. The sub-routines may provide sub-results. The
sub-results may be logically combined by the collaborative intelligent
task processor 228 to derive a task result responsive to the task.
[0079] The subroutines and/or sub-processes enabled by the enable
action plan component 324 may also include exit points to terminate
the automated sub-process, or the automated processing of a task
by the collaborative intelligent task processor 228. For example,
a sub-process may determine that an insurance claim includes bodily
injury and that the task should therefore not be performed automatically
by the collaborative intelligent task processor 228 without human
intervention. In this situation, the collaborative intelligent task
processor 228 may be stopped from further processing the task, and
the task may be automatically re-assigned to a human organizational
entity. The sub-routine may also indicate or cause to be indicated
to the human organizational entity the reason for termination of
processing of the task by the collaborative intelligent task processor
228.
[0080] In other examples, the enable actions module 324 may trigger
the generation of additional tasks for a human organizational entity,
the collaborative intelligent task processor 228 and/or any other
automated or non-automated performer. Additional tasks may be triggered
by triggering additional pattern analysis with the pattern analysis
component 216 (FIG. 2), storing additional data in the insurance
claim database, etc. The enable actions component 324 also may trigger
the cancellation or modification of tasks generated by the task
engine 210. In still another example, the enable actions component
324 may trigger analysis of data by the data analysis component
328.
[0081] The enable actions component 324 may use logic based rules
included in the process rules component 326 to trigger activity
by other components. The logic based rules may be predetermined
statements in a format that is compatible with the component being
enabled to perform sub-processing by the enable actions component
324. For example, storage of data in insurance claim database may
include logic based rules that are SQL statements to store the data
in a relational database. The logic based rules may also indicate
to the enable actions component 324 conditions that trigger the
automated execution of sub-processes, for example, changes to the
data in the insurance claim database 206 that will trigger the generation
of events by the event processor 208. The logic based rules may
be data driven. For example, automated selection of logic based
rules to apply may be based on the data associated with the insurance
claim and/or retrieved by the data retrieval component 320.
[0082] The data analysis component 328 is executable to analyze
data retrieved by the data retrieval component 320. The data analysis
component 328 may also generate additional data that is stored in
the data buffer component 322. The additional data may include a
task result that is responsive to the task.
[0083] Processing by the data analysis component 328 may be based
on procedures included in the action plan selected for a particular
task, data associated with the insurance claim, and/or logic based
rules included in the process rules component 326. The logic based
rules may provide unit conversions, (such as centimeters to inches,
or Euros to US Dollars), data combination mechanisms, and/or any
other data manipulation related rules. Processing by the data analysis
component 328 may also include communication with the task interface
314.
[0084] The task interface component 314 may communicate with the
task assistant 212 to allow automated deletion of existing tasks
modifications to existing tasks and updates to the history of a
task. The task plan may also be reorganized in an automated fashion
at the direction of the task interface component 314. Updates to
the history of a task include indication that the task is completed,
the date, and any other pertinent information may also be performed
with the task interface component 314. Accordingly, the data analysis
component 328 may enable the task interface component 314 to indicate
to the task assistant 212 that a task is completed, other task should
be modified or deleted, and/or to provide any other information
related to the history of a task.
[0085] FIG. 4 is an operational flow diagram illustrating example
operation of the collaborative intelligent task processor 228 within
the insurance claims processing system 100 as depicted in FIGS.
1-3. The operation begins at block 402 when an insurance claim is
entered into the insurance claim processing system 100. At block
404, tasks are generated by the task engine component 210 and formulated
into a task plan by the task assistant component 212. It is determined
if a task can be identified as being capable of execution by an
automated performer at block 406. As previously discussed, determination
of the capability of an automated performed to perform the task
may be by the task assistant component 212, the auto assignment
component 218 and/or the automated performer. Identification may
be performed by the task engine component 210 and/or the task assistant
component 212, or may be performed by the collaborative intelligent
task processor 228. If the task is not identified as being performable
by an automated performer, the task may be performed by a human
organizational entity at block 408.
[0086] At block 410 the task assistant component 212 may determine
if the entire task was performed by the human organizational entity.
If the task was completed, it is determined if there are additional
tasks that have not yet been identify as performable by an automated
performer at block 412. If not, the operation continues to monitor
for additional tasks at block 412. If there are additional tasks,
the operation returns to block 406 to determine if another task
can be identified as being capable of execution by an automated
performer. If at block 410, the human organizational entity performed
only some portion of the task, the operation returns to block 406
so that the task may be re-evaluated to identify if the task is
now performable by an automated performer.
[0087] If at block 406, a task is identified as being capable of
execution by an automated performer, the task may be stored in the
task queue of the task list component 308 at block 418. At block
420 it is determined if there are additional tasks that have not
yet been identify as performable by an automated performer. If not,
the operation continues to monitor for additional tasks at block
420. If there are additional tasks, the operation returns to block
406 to determine if another task can be identified as being capable
of execution by an automated performer. In additions to determining
if there are additional tasks at block 420, the operation may also
select a task for analysis with the task analysis component 310
at block 422.
[0088] At block 424, the task analysis component 310 may access
the action plan database 312 to identify one or more action plans
that are capable of performing the task. The action plans may be
determined from the task, data related to the insurance claim, pattern
matching results, a data type associated with the task, data requested
with the task, parameters included in the task and/or the action
plan(s). At block 426 it is determined if there are multiple action
plans that have been identified. If so, the action plans are ranked
at block 428. The hierarchal ranking may be based on a score developed
for each action plan, comparison of specific information and/or
parameters associated with the action plan and/or the task, data
requests included in the task, pattern matching results, insurance
claim data and/or one or more parameters associated with the task
or the action plan. At block 430, the highest ranked action plan
may be selected.
[0089] Referring to FIG. 5, the action plan may be evaluated to
determine if the action plan needs modification at block 432. Modification
may, for example, involve adding task and insurance claim specific
procedures and/or groups of procedures to an otherwise generic action
plan. If no modification is needed, the action plan is provided
to the data handler component 304 at block 434. If the action plan
needs to be modified to most effectively perform the task, procedures
are selectively added, removed and or modified by the task analysis
component 310 at block 436. The operation then proceeds to block
434 to provide the modified action plan to the data handler component
304.
[0090] Returning to block 426, if multiple action plans are not
identified, it is determined if one action plan was identified at
block 442. If an action plan was identified, the operation proceeds
to block 432 to determine if the identified action plan needs modification
to complete the task. If no action plan was identified, the task
analysis module 310 may initiate development of an action plan at
block 444. At block 446, procedures and/or groups of procedures
may be selected for inclusion in the action plan being developed.
Selection of the procedures or groups of procedures may be based
on the task, the task type, data requested in the task, pattern
matching results, the insurance claim data, one or more parameters
associated with the task, the action plan, the procedures and/or
the groups of procedures. Once the action plan is developed, the
operation may continue to block 432 to determine if the developed
action plan needs modification.
[0091] Returning again to block 434, procedures in the action plan
related to data retrieval may be performed by the data retrieval
component 320 at block 450. At block 452, the procedures related
to enabling sub-routines and/or sub-processes with the enable actions
component 324 may be performed. The data analysis component 328
may analyze, process and modify the retrieved data based on procedure(s)
in the action, plan logic based rules and/or the data related to
the insurance claim at block 454. At block 456, it is determined
if additional procedures to retrieve data, enable sub-processes,
and/or analyze data to arrive at a task result are to be performed.
If yes, the data retrieval component 320, the enable actions component
324 and the data analysis component 328 are selectively automatically
executed to perform the procedures. If no additional procedures
in the action plan are to be performed, the task result is stored
in the insurance claim database 206 at block 458. At block 460,
the task interface component 314 is enabled direct the task assistant
212 to delete, add and/or modify tasks, and the history data related
to the task just completed by the collaborative intelligent task
processor 228. The operation then returns to block 422 to select
another task from the task queue and the operation continues.
[0092] In another example of an insurance claim processing system,
the insurance claim processing system includes an insurance claim
database configured to receive, store and provide information related
to an insurance claim. The system also includes a pattern analyzer
executable with a computer to segment the insurance claim into predetermined
categories based on the information stored in the insurance claim
database. In addition, the system includes a task engine component
executable with a computer to generate tasks to be performed based
on the information stored in the insurance claim database and the
segmentation of the insurance claim.
[0093] A collaborative intelligent task processor executable with
a computer to receive a task generated by the task engine component
and an action plan database accessible by the collaborative intelligent
task processor is also included in the system. The action plan database
includes a plurality of predetermined action plans, and the collaborative
intelligent task processor is executable to select one of the action
plans as a function of the task, information related to the insurance
claim, and the predetermined categories. The action plan comprises
a plurality of procedures that are each performed or directed by
the collaborative intelligent task processor. The selected one of
the action plans is performable by the collaborative intelligent
task processor to complete the task.
[0094] The collaborative intelligent task processor is also executable
to acquire additional information related to the insurance claim.
The additional information is useable by the collaborative intelligent
task processor with at least one of the information related to the
insurance claim, and the predetermined categories to complete the
task. The collaborative intelligent task processor is further configured
to store data responsive to the task in the insurance claim database.
[0095] The previously discussed collaborative intelligent task
processor and insurance claim processing system may allow the skills
of human organizational entities to be allocated to those tasks
and/or insurance claims with higher levels of complexity. By relying
on the other components in the insurance claim processing system
the complexity level of tasks capable of being performed by the
collaborative intelligent task processor may be dramatically increased.
In addition, due the highly configurable nature of the action plans
used by the collaborative intelligent task processor to complete
tasks, the number, complexity levels and diversity of tasks capable
of being completed successfully by the collaborative intelligent
task processor is almost unlimited. The collaborative intelligent
task processor also provides the capability to dynamically develop
and/or modify action plans to allow the collaborative intelligent
task processor to adapt an action plan to the specific circumstances
of a task associated with a specific insurance claim. Further, due
to the checks and balances provided by the sub-processes executed
by the collaborative intelligent task processor in arriving at a
task result, erroneous task results and or erroneous task performance
by the collaborative intelligent task processor may be avoided.
[0096] While the present invention has been described with reference
to specific exemplary embodiments, it will be evident that various
modifications and changes may be made to these embodiments without
departing from the broader spirit and scope of the invention as
set forth in the claims. Accordingly, the specification and drawings
are to be regarded in an illustrative rather than a restrictive
sense.
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