Algorithm Engine for Dynamic Insurance Claim Assignment
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Solution Overview
Problem
The insurance claims process is inefficient due to labor-intensive human interaction in assigning claims, leading to increased costs and cycle times, with no effective method to balance work distribution among body shops or account for adjuster skills and real-time location.
Innovation Solution
A cloud-hosted SaaS application with a proprietary user interface and algorithm engine that uses real-time geographic data to efficiently assign claims to the most suitable adjusters and resources based on skills, location, and capacity, reducing manual intervention and optimizing resource allocation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If manual human interaction is used to assign claims, then flexibility in decision-making is maintained, but labor intensity increases and processing time increases
Solution Approach 1:
The patent replaces manual human decision-making with an automated algorithm engine that processes claims assignments. The system uses real-time data from multiple sources including adjuster locations, body shop capacities, and claim details to automatically route claims, eliminating manual intervention while maintaining optimal decision-making through structured algorithms.
Solution Approach 2:
The system enables self-service through automated claim routing where the algorithm engine independently processes claim assignments without human intervention. The algorithm continuously monitors real-time data and automatically assigns claims to appropriate resources based on predefined criteria and dynamic conditions.
2Productivity
If real-time tracking of adjusters is implemented, then optimal claim assignment based on location is achieved, but system complexity increases
Solution Approach 1:
The algorithm engine serves multiple functions simultaneously: it processes claim data, tracks adjuster locations in real-time, monitors body shop capacities, evaluates claim priorities, and makes assignment decisions. This multi-functional approach consolidates what would otherwise require separate systems into a single integrated platform.
Solution Approach 2:
The system introduces a centralized algorithm engine as an intermediary that mediates between various data sources (adjuster locations, claim databases, body shop systems) and the claim assignment process. This intermediary layer standardizes data collection, processing, and decision-making, simplifying the overall system architecture.
3Productivity
If automated algorithm-based assignment is used, then processing speed increases, but adaptability to unique claim circumstances decreases
Solution Approach 1:
The algorithm engine dynamically adapts to changing conditions by continuously receiving real-time data on adjuster locations, body shop capacities, and claim priorities. The system can adjust its assignment logic on-the-fly based on current conditions, allowing it to handle unique situations while maintaining high processing speed through automated decision-making.
Solution Approach 2:
The system incorporates feedback mechanisms where performance data from claim assignments is continuously monitored and fed back into the algorithm. This enables the algorithm to learn from past decisions and improve its performance over time, adapting to unique claim circumstances while maintaining automated processing efficiency.
4Manufacturing precision
If manual claim assignment is used, then detailed consideration of individual claim factors is possible, but overall processing time increases
Solution Approach 1:
The system performs preliminary actions by pre-establishing assignment criteria, priorities, and routing rules in the algorithm engine. Real-time data collection on adjuster locations and body shop capacities is continuously updated in advance, allowing the system to make accurate assignment decisions quickly without manual review of each individual factor.
Solution Approach 2:
The patent replaces manual analysis of individual claim factors with an automated algorithm that processes multiple criteria simultaneously. The algorithm engine evaluates claim priorities, adjuster qualifications, locations, and body shop capacities in parallel, achieving both accuracy and speed that manual processing cannot achieve.
Data Source
AI summary
The present invention relates to methods and systems that automate the assignment of insurance claims to the best available resource utilizing the loss, location, and other criteria. Disclosed embodiments incorporate real-time dynamically updated geographic data into the claims assignment process. In accordance with the geographic data and other data related to particular claims, the resources, which include adjusters, can be assigned to claims in close proximity to their real-time location, and the dynamic nature of the geographic data means that claims are assigned to adjusters as received. An adjuster already in proximity to a location of incoming new claims can have claims added and removed based on real-time geographic data and as claims are filed. Some disclosed embodiments effect the assignment of automobile insurance repair claims to the best available resource, where the resource is a person or entity which operates to resolve automobile repairs.