AI Reminder Strategy 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 policy holders, leading to frustration and delays.
Innovation Solution
A computing system that utilizes artificial intelligence and machine learning to optimize information gathering processes, including dynamic scripting, guided content capture, and adaptive communication strategies to streamline claim handling, leveraging large language models for summarization and automated negotiation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If manual procedures are used for claim processing, then personal attention and flexibility can be maintained, but processing time increases and efficiency decreases
Solution Approach 1:
The patent introduces an AI-based virtual assistant as an intermediary between policyholders and human agents. The virtual assistant handles initial claim intake, information gathering, and routing, providing automated efficiency while preserving the option for human intervention when complex judgment or empathy is needed. This mediator approach maintains personal attention quality while dramatically improving processing throughput.
2Reliability
If extensive information gathering is performed, then claim accuracy and completeness improve, but time consumption and policy holder frustration increase
Solution Approach 1:
The system performs preliminary actions by proactively gathering available claim information automatically before human review. The virtual assistant immediately collects policyholder data, accident details, and relevant documentation upon claim initiation. This preliminary automated gathering reduces the information burden on policyholders and allows human agents to focus only on complex verification, thereby improving accuracy while reducing overall time consumption.
Solution Approach 2:
The system implements feedback loops where the AI continuously monitors claim processing status, policyholder responses, and information completeness. Based on this feedback, the system dynamically adjusts information gathering strategies - requesting additional information only when necessary and notifying agents of complete claims ready for processing. This feedback mechanism ensures claim accuracy without unnecessary time consumption.
3Productivity
If automated systems are implemented, then processing efficiency increases, but communication quality and policy holder satisfaction may deteriorate
Solution Approach 1:
The patent implements a dynamic communication system where the level of automation adapts based on claim complexity, policyholder preferences, and interaction context. The virtual assistant provides automated efficiency for routine tasks but seamlessly transitions to human agent communication when complexity arises or when policyholders indicate preference for human interaction. This dynamic approach maintains high processing efficiency while preserving communication quality through context-appropriate interaction modes.
Data Source
AI summary
A computing system can induce a network effect for an information gathering process by receiving information from a computing device of a user, the information identifying one or more individuals to provide additional information for a claim process of the user. The system can initiate first contact through communications with a computing device of each of the one or more individuals to receive information pertaining to the claim process. Based on a set of response data from each individual of the one or more individuals, the system can generate an optimized reminder strategy to provide reminders to each individual to complete a content flow corresponding to the claim process.