Adaptive Call Content Flows for Sub-Group Hopping in Claims

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Solution Overview

Problem

Existing SaaS providers face inefficiencies in claim processing, particularly in insurance claims, due to time-consuming manual procedures and suboptimal communication methods, leading to frustration for policy holders and delays for policy providers.

Innovation Solution

A computing system that utilizes artificial intelligence and machine learning to optimize claim processes, including guided content capture, dynamic scripting, and adaptive content flows, to streamline information gathering and automate negotiations, reducing processing time and resource usage.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Productivity

If manual procedures are used for claim processing, then flexibility and human judgment are maintained, but processing time increases and productivity decreases

Engineering Contradiction:

Improveclaim processing speedVSAvoidmanual procedure dependency

Core Design Contradiction:

ProductivityVSExtent of automation

Solution Approach 1:

The system dynamically adapts the level of automation based on claim complexity and historical data. Simple claims are fully automated through AI processing, while complex claims escalate to human agents, creating a flexible hybrid workflow that optimizes both speed and judgment

Inventive Principle:

Principle #15Dynamics

Solution Approach 2:

An AI assistant acts as an intermediary between manual procedures and automated processing. The AI handles routine information gathering and preliminary analysis, freeing human agents to focus on complex decision-making, thereby increasing overall productivity without complete automation

Inventive Principle:

Principle #24Intermediary (Mediator)

2Ease of operation

If traditional communication methods are used, then simplicity is maintained, but user engagement decreases and communication effectiveness worsens

Engineering Contradiction:

Improvecommunication simplicityVSAvoidpersonalized communication capability

Core Design Contradiction:

Ease of operationVSAdaptability or versatility

Solution Approach 1:

The system performs preliminary analysis of user preferences, claim history, and communication patterns before initiating interactions. This allows the system to pre-customize communication style, channel selection, and content formatting, making personalized communication feel natural and immediate

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The system dynamically adjusts communication parameters such as tone, formality, channel selection (email, SMS, portal), and information density based on user profile attributes and real-time context, maintaining simplicity while adapting to individual user needs

Inventive Principle:

Principle #35Parameter changes

3Reliability

If comprehensive information gathering is performed, then claim accuracy improves, but processing time increases and resource consumption increases

Engineering Contradiction:

Improveclaim processing accuracyVSAvoidinformation gathering time

Core Design Contradiction:

ReliabilityVSLoss of time

Solution Approach 1:

The system extracts and utilizes existing data from multiple sources (policy records, previous claims, third-party databases) without requiring users to manually provide all information. This extraction of pre-existing data maintains accuracy while significantly reducing the time users spend providing information

Inventive Principle:

Principle #2Taking out (Extraction)

Solution Approach 2:

The system implements feedback loops where AI analyzes incoming information in real-time and dynamically determines what additional data is needed. This prevents unnecessary information gathering by stopping the process when sufficient data for accurate processing is obtained, balancing completeness with efficiency

Inventive Principle:

Principle #23Feedback

4Adaptability or versatility

If multiple sub-flows are used for different claim types, then adaptability improves, but system complexity increases and navigation difficulty increases

Engineering Contradiction:

Improveclaim type handling capabilityVSAvoidcontent flow structure complexity

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The system segments claim processing into modular sub-flows for different claim types (property, casualty, liability, etc.), each with specialized handling procedures. This segmentation allows the system to adapt to specific claim requirements while keeping each individual sub-flow simple and manageable

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

A universal orchestration layer manages all specialized sub-flows through a common interface and navigation system. This universal controller handles routing, state management, and user interaction consistently across different claim types, hiding the underlying complexity while maintaining adaptability to various claim scenarios

Inventive Principle:

Principle #6Universality (Multi-functionality)

Data Source

PatentUS20260095523A1Facilitating sub-group hopping in call sessions for adaptive content flows

Publication Date: 2026.04.02 ASSURED INSURANCE TECH INC

AI summary

Based on an initial set of claim data for a claim event of a user, a computing system can generate an initial script and a content flow that includes the initial script for a call representative to utilize in a call session with the user, the content flow comprising a plurality of sub-flow groupings. Based on the user initiating a topic corresponding to a respective sub-flow grouping from the plurality of sub-flow groupings, the system can update the content flow to enable the call representative to hop to the respective sub-flow grouping within the content flow.