Insurance Claims Chatbot for Complaint Categorization and Reporting
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Solution Overview
Problem
Current solutions for companies to respond to social media posts are cumbersome and inefficient, and insurance companies face difficulties in sorting and addressing a large volume of insurance claims complaints.
Innovation Solution
A chatbot system that categorizes social media posts, determines relevant entities to contact, and builds responses, while also analyzing insurance claims complaints to identify categories and trends, and generating reports for customer service.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If manual review and response to social media posts and insurance claims complaints is performed, then accuracy and contextual understanding are maintained, but time consumption and operational complexity increase significantly
Solution Approach 1:
The chatbot system enables self-service automated processing of insurance claims complaints and social media posts. The system autonomously categorizes complaints, identifies relevant entities, determines appropriate responses, and generates reports without requiring manual human intervention for each individual complaint, thereby reducing time consumption while maintaining processing capability
Solution Approach 2:
The patent replaces the mechanical manual review process with an AI-based chatbot system that uses natural language processing, machine learning, and automated reasoning. This substitution transforms the manual cognitive task into an automated computational process, significantly reducing time loss while handling large volumes of complaints
2Productivity
If automated chatbot processing is implemented, then processing speed and efficiency are improved, but complexity of the system increases
Solution Approach 1:
The chatbot system is divided into distinct functional modules: complaint reception module, categorization module, entity identification module, response determination module, and report generation module. Each module handles a specific aspect of the processing workflow, making the overall complex system manageable through functional segmentation and independent development of each component
Solution Approach 2:
The chatbot system is designed as a universal platform that can handle multiple types of inputs (insurance claims complaints, social media posts), perform various categorization tasks, identify different entities, and generate diverse outputs. This multi-functionality consolidates multiple specialized tools into a single system, managing complexity through consolidation rather than proliferation of separate systems
3Reliability
If comprehensive analysis of all complaint details is performed, then accuracy of response determination is improved, but processing time and computational resources increase
Solution Approach 1:
The chatbot system performs preliminary categorization of complaints into broad categories (e.g., claim denial, delayed payment, service quality) before conducting detailed analysis. This preliminary action filters and organizes the data structure, enabling subsequent focused analysis on specific aspects relevant to each category, thereby reducing overall computational requirements while maintaining response accuracy
Data Source
AI summary
The following relates generally to AI-based review of insurance claims complaints. In some embodiments, one or more processors: (1) receive, via a chatbot, an insurance claim complaint; (2) categorize, via the chatbot, the insurance claim complaint by determining a category of the insurance claim complaint, the category comprising a tone category or a policy category; (3) build, via the chatbot, a complaint report including information of the insurance claim complaint and an indication of the category; and/or (5) send, via the chatbot, the complaint report to an insurance complaint administrator computing device.