Claims Adjuster Allocation via Threshold Workload Control
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Solution Overview
Problem
Current insurance claim handling systems face inefficiencies in managing adjuster workloads during catastrophic events, leading to increased processing times due to the volume of claims and limitations in scheduling and allocation methods.
Innovation Solution
A system and method that automatically assigns claims adjusters a threshold level of cases, with excess cases being held in a 'parking lot' until an adjuster becomes available, utilizing a central adjuster control unit that communicates with internal and external databases to manage and schedule adjusters across multiple catastrophes.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If manual spreadsheet analysis is used to determine adjuster allocation, then flexibility in managing individual cases is maintained, but processing time increases and efficiency decreases
Solution Approach 1:
The system segments claims into different categories based on complexity, type, and resource requirements. This segmentation enables automated routing of routine claims while flagging complex claims for manual review, thereby improving processing efficiency without sacrificing flexibility in managing individual cases.
Solution Approach 2:
The patent introduces an intermediary automated allocation system that acts as a mediator between claim intake and adjuster assignment. This intermediary uses algorithms to optimize initial allocations based on historical data and current workload, while allowing human supervisors to override and adjust allocations as needed, thus maintaining flexibility while improving overall efficiency.
2Productivity
If more claims adjusters are hired to handle increased claim volume during catastrophes, then claim processing capacity increases, but operational costs increase
Solution Approach 1:
The system implements dynamic allocation of adjusters based on real-time claim volume, complexity, and adjuster availability. During high-volume events like catastrophes, the system automatically optimizes workload distribution across the existing adjuster force, maximizing their utilization without requiring proportional increases in headcount. This dynamic approach allows the organization to scale capacity efficiently without linearly increasing the number of adjusters.
Solution Approach 2:
The patent changes key parameters such as adjuster workload thresholds, claim priority levels, and allocation algorithms based on the severity and scale of catastrophic events. By adjusting these parameters dynamically, the system optimizes the use of existing adjuster resources during high-volume periods, avoiding the need to permanently hire additional staff while maintaining adequate processing capacity.
3Productivity
If claims are assigned to adjusters without threshold limits, then all claims can be processed continuously, but adjuster workload becomes unmanageable and quality decreases
Solution Approach 1:
The system implements threshold limits on adjuster workloads as a form of partial action, recognizing that completely unlimited assignment would compromise quality. By setting reasonable thresholds and automatically assigning claims that exceed these thresholds to different adjusters or requiring supervisory review, the system maintains continuous processing while preserving quality standards through controlled distribution of workload.
Data Source
AI summary
A central claims adjuster control unit associated with an entity may oversee the assignment of claims cases to claims adjusters. The control unit may designate that a threshold number of cases may be assigned to certain claims adjusters. When new claims cases arrive, the control unit may monitor the workload of each of the claims adjusters and the threshold value assigned to any of the claims adjusters before assigning the case to one of the adjusters. If no adjuster is available, the control unit may store the case(s) in a memory until one of the adjusters becomes available. An additional feature of the control unit includes a user interface for modifying information about claims adjusters, including whether or not a threshold value is associated with them, the value of any associated threshold, and the reassignment of cases from one adjuster to another.