Chatbot Claim Adjudication for Distributed Service Catalogs
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Solution Overview
Problem
Existing systems for product catalog mapping and integration across distributed systems and interfaces are inefficient, particularly in automating the process of purchasing and managing add-on services like product protection plans and shipping protection plans, leading to difficulties in claim submission and adjudication for consumers.
Innovation Solution
A technology platform for product catalog mapping and integration across distributed systems, featuring a computer-implemented offer management system with a multilayer chat application/bot for claim adjudication, real-time dynamic offer determination, and automated processing of protection plan claims, utilizing AI and ML for eligibility assessment and claim processing.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Extent of automation
If existing systems are used for product catalog mapping and integration, then basic service offering is possible, but the process is inefficient and lacks automation
Solution Approach 1:
The system enables self-service through automated claim adjudication where the chatbot independently processes claims by asking questions, evaluating eligibility, and making decisions without manual intervention. The offer management system automatically determines and presents customized service offers based on product catalogs and customer data.
Solution Approach 2:
Manual mechanical processes are replaced with AI/ML-based automated systems. The chatbot uses natural language processing to communicate with customers, while machine learning algorithms automatically adjudicate claims and determine service eligibility, replacing traditional manual processing workflows.
2Ease of operation
If separate entities process protection plans, then service specialization is achieved, but claim submission and dispute resolution become difficult for consumers
Solution Approach 1:
The system merges previously separate entities into an integrated platform where the offer management system, chatbot, and claim adjudication function as a unified ecosystem. This integration allows seamless communication between service providers and consumers while maintaining specialized processing capabilities.
Solution Approach 2:
The chatbot serves as an intermediary between consumers and the complex distributed system. It translates customer queries into system actions and presents processed information in user-friendly formats, simplifying the interaction with the underlying complexity of multiple integrated systems.
3Adaptability or versatility
If real-time dynamic offer determination is implemented, then customization and relevance of service offers improve, but system complexity and processing requirements increase
Solution Approach 1:
The offer management system dynamically adapts service offers based on real-time data from product catalogs, customer profiles, and purchasing context. Offers are continuously adjusted and personalized without requiring system redesign, enabling flexibility through configured parameters and rules.
Solution Approach 2:
The system changes parameters such as service pricing, availability, and customization options based on real-time conditions. Machine learning models process multiple variables simultaneously to determine optimal offer parameters, managing complexity through data-driven parameter adjustment rather than system complexity.
Data Source
AI summary
Embodiments of the presently disclosed technology provide systems and methods for catalog integration across distributed systems and interfaces. Such systems and methods may involve: (1) receiving, at an integration platform, a catalog of items from a merchant, the catalog of items including a first item; (2) determining, by the integration platform, a set of protection plan offers to display in a live website associated with the merchant, the live website displaying the first item with a frame object comprising the set of protection plan offers; (3) receiving, by the integration platform, a notification related to a transaction involving the first item and a customer; and (4) performing, by the integration platform, an action associated with the transaction and a first protection plan offer of the set of protection plan offers.