Automated Transaction Processing System for Insurance Claims

Resolve Bottlenecks,
Find Innovative SolutionsGenerate Solutions

Solution Overview

Problem

The insurance and reinsurance industries face inefficiencies and errors in transaction processing, leading to high costs and potential lost revenue due to manual handling of claims and premium payments, with a lack of transparency and accuracy in accounting across contracts.

Innovation Solution

A system and method that allows customers to access a business's server for automated transaction processing, enabling customers to direct payments, request payments, or pair payments with upcoming events, reducing manual intervention and increasing transparency through a user-friendly interface accessible via the Internet.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Reliability

If manual handling of claims and payments is used, then trust and individual scrutiny can be maintained, but transaction processing time and labor costs increase significantly

Engineering Contradiction:

Improveclaim accuracy verificationVSAvoidtransaction processing time

Core Design Contradiction:

ReliabilityVSLoss of time

Solution Approach 1:

The system performs preliminary actions by automatically verifying claim details against contract terms before payment processing. The computer system pre-validates claim amounts, policy limits, and contract compliance, so that when human representatives review claims, the基础性 verification is already complete, reducing both time and maintaining accuracy.

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The system enables self-service through automated verification where the computer system independently checks claim validity against stored contract data without requiring manual intervention for routine validations. This handles the time-consuming aspects automatically while human representatives focus on complex judgment cases.

Inventive Principle:

Principle #25Self-service

2Reliability

If individual claim scrutiny by representatives is performed, then claim accuracy and reliability are improved, but overhead costs and labor intensity increase

Engineering Contradiction:

Improveclaim validation accuracyVSAvoidoverhead structure

Core Design Contradiction:

ReliabilityVSDevice complexity

Solution Approach 1:

The system extracts the routine verification functions from human representatives and transfers them to the computer system. The computer system handles data validation, contract compliance checking, and payment calculation, freeing human representatives to focus on complex cases requiring judgment and customer interaction.

Inventive Principle:

Principle #2Taking out (Extraction)

Solution Approach 2:

The patent replaces the mechanical system of manual claim scrutiny with an automated computer-based system that electronically validates claims against stored contract data. This substitution reduces labor intensity and overhead while maintaining validation accuracy through systematic automated checking.

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

3Productivity

If automated payment processing is implemented, then transaction efficiency and speed are improved, but accounting accuracy and contract-level tracking may deteriorate

Engineering Contradiction:

Improvetransaction processing speedVSAvoidaccounting accuracy

Core Design Contradiction:

ProductivityVSMeasurement precision

Solution Approach 1:

The system implements feedback mechanisms where the computer system continuously monitors and tracks payments against contract data. Automated accounting processes provide real-time feedback on payment status, contract limit utilization, and billing accuracy, ensuring that speed improvements do not compromise measurement precision.

Inventive Principle:

Principle #23Feedback

Solution Approach 2:

The computer system performs multiple functions simultaneously: it processes payments automatically for speed while also maintaining detailed accounting records, tracking contract-level data, and generating accuracy reports. This multi-functionality allows the system to achieve both productivity improvement and precision maintenance.

Inventive Principle:

Principle #6Universality (Multi-functionality)

4Ease of operation

If trust-based processing between reinsurance companies is used, then manual intervention is reduced, but payment delays and lack of proper accounting occur

Engineering Contradiction:

Improvetransaction simplicityVSAvoidpayment delay

Core Design Contradiction:

Ease of operationVSLoss of time

Solution Approach 1:

The system performs preliminary actions by pre-establishing trust verification through automated validation of partner credentials, contract terms, and payment conditions. This preliminary setup enables rapid trust-based processing without subsequent delays, as the computer system has already verified all necessary conditions before payment initiation.

Inventive Principle:

Principle #10Preliminary action

Data Source

PatentUS8606602B2Systems and methods for automated transactions processing

Publication Date: 2013.12.10 SWISS REINSURANCE CO LTD

AI summary

Systems and methods are disclosed for processing transactions between a customer and a business. An exemplary system includes a server used by the business and being accessible by the customer, and a customer account associated with the customer housed on the server. The customer account includes automated instructions that allow the customer to advise the business of an upcoming payment for an upcoming event, to request a payment from the business from a previous event, or to pair a payment with one or more upcoming events.