Adaptive Call Content Flow for Faster Claim Information Gathering
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Solution Overview
Problem
Existing Software as a Service (SaaS) providers face inefficiencies in claim processing, particularly in insurance claims, due to time-consuming manual procedures and suboptimal communication with users and policy providers, leading to frustration and delays.
Innovation Solution
A computing system that utilizes artificial intelligence and machine learning to optimize claim processes by generating AI prompts, performing guided content capture, and implementing dynamic scripting and content flows to streamline information gathering, automate negotiations, and provide intelligent search and service assignments, reducing the need for manual intervention.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If manual procedures are used for claim processing, then claim handling can be performed with simple systems, but claim processing time increases and productivity decreases
Solution Approach 1:
The system enables automated claim processing where the AI assistant independently gathers information, performs content capture, executes searches, and manages negotiations without requiring manual intervention at each step. The call representative only needs to initiate the process and review final outcomes, transforming a heavily manual process into a self-service automated system that dramatically improves productivity.
Solution Approach 2:
The patent replaces manual mechanical procedures (representatives manually gathering information, making search queries, conducting negotiations) with an AI-based automated system. The AI assistant uses machine learning models, natural language processing, and automated content capture technologies to substitute human manual operations, thereby increasing processing speed while managing system complexity through modular architecture.
2Ease of operation
If dynamic content flow adaptation is implemented, then user engagement improves, but device complexity increases
Solution Approach 1:
The user interface dynamically adapts its content flow based on real-time analysis of user responses, engagement metrics, and claim processing status. The system adjusts the sequence, type, and complexity of information presented to users during calls, transforming static interfaces into dynamic ones that respond to user needs, thereby improving ease of operation and engagement without requiring users to understand the underlying complexity.
Solution Approach 2:
The system changes interface parameters (content type, presentation format, information depth) based on user behavior and claim context. By dynamically adjusting these parameters rather than maintaining a fixed complex interface, the system improves user engagement while keeping the interface adaptable and user-friendly.
3Productivity
If AI and machine learning are used to automate claim processes, then productivity increases, but device complexity increases
Solution Approach 1:
The AI system is segmented into distinct functional modules: information gathering module, content capture module, search module, negotiation module, and analysis module. Each module handles specific tasks independently, allowing the complex AI system to be managed through modular components. This segmentation enables high productivity through automation while managing complexity through modular architecture that can be developed, tested, and maintained independently.
Solution Approach 2:
The AI assistant is designed as a universal multi-functional system that performs diverse tasks (information gathering, content capture, searching, negotiating, analyzing) through a single integrated platform. This multi-functionality improves productivity by consolidating multiple specialized systems into one, while the shared underlying architecture reduces overall system complexity compared to having separate systems for each function.
Data Source
AI summary
A computing system can generate a customized user interface comprising an initial content flow for the call representative to communicate with the user over one or more call sessions to complete an information gather process pertaining to a claim event. Based on inputs provided by the call representative on the customized user interface, the system can dynamically update the customized user interface to reflect responses from the user, and dynamically adapt the initial content flow based on the responses from the user.