Automated Payment Processing System Parallel Exposure Handling
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Solution Overview
Problem
Current payment processing systems for insurance claims, such as auto accidents, are inefficient and require lengthy processing times, leading to customer dissatisfaction due to the need for individualized attention amidst numerous claims, often resulting in lengthy and complex interactions.
Innovation Solution
An automated payment processing system comprising a data store, rules engine, audit engine, and payment engine that processes loss information to derive payees, determine coverage, and facilitate automatic payments, allowing for parallel processing of exposures and integration with medical claims processing, reducing the need for human intervention.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If automated payment processing is implemented, then processing speed and efficiency are improved, but system complexity increases
Solution Approach 1:
The system divides the payment processing workflow into distinct modular components: notice receiving module, payee derivation module, rules processing module, automatic payment determination module, and fund transfer module. Each module handles a specific aspect of the processing workflow, enabling independent development, testing, and maintenance while collectively achieving high-speed automated processing.
Solution Approach 2:
The patent introduces an intermediary rules engine that acts as a mediator between the input data and the payment decision. This rules processing module evaluates multiple business rules and conditions to determine whether automatic payment should be made, thereby simplifying the overall system architecture by centralizing complex decision logic in a dedicated intermediary component.
2Ease of operation
If individualized attention is provided for each claim, then customer satisfaction is improved, but processing time increases
Solution Approach 1:
The system enables self-service automated payment processing where the rules engine autonomously evaluates claims against predefined business rules and automatically determines payment eligibility without requiring manual review. This self-service capability allows each claim to receive individualized assessment while eliminating the time-consuming manual intervention, thereby maintaining customer satisfaction while dramatically reducing processing time.
3Reliability
If manual review and human intervention are used, then accuracy and fraud detection are improved, but processing efficiency decreases
Solution Approach 1:
The patent incorporates an audit engine that provides feedback mechanisms to verify the accuracy of automated payment decisions. The audit functions review the rules processing outcomes and can flag suspicious claims for additional review, creating a feedback loop that maintains high fraud detection accuracy while allowing the majority of straightforward claims to proceed through automated processing, thereby preserving both reliability and efficiency.
Data Source
AI summary
Apparatus and methods to process loss payments are described herein. In one example, an apparatus includes one or more data stores, a rules engine, an audit engine and a payment engine. In another example, the method may include receiving a notice of loss, deriving a payee, processing one or more rules using the information, determining whether an automatic payment can be made and transferring funds if the automatic payment can be made. In a further example, the method may include receiving a notice of loss, the loss having one or more exposures, processing one or more rules for each of the exposures in parallel, determining if an automatic payment can be made for each of the exposures and removing the automatic payment for an exposure if it can not be made while continuing processing payments for the remaining exposures.