Insurance Claims Dashboard for Missing Information Detection

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Solution Overview

Problem

Evaluating insurance claims requires significant human effort to search through paper files and find relevant information, with inconsistencies in data gathering and missing important details, making the process inefficient.

Innovation Solution

A computer-based system that uses machine learning and large language models to parse data from various formats, determine claim types, identify needed information, and fill in missing data, displaying it in a user-friendly interface.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Measurement precision

If human evaluators manually search paper files to evaluate insurance claims, then they can review and understand the information, but the process requires significant time and effort

Engineering Contradiction:

Improveinformation completenessVSAvoidevaluation time

Core Design Contradiction:

Measurement precisionVSLoss of time

Solution Approach 1:

The patent replaces the mechanical manual search process with an automated computer-based system that uses optical character recognition (OCR), natural language processing (NLP), and machine learning algorithms to extract and analyze information from claim documents, thereby eliminating the time-consuming manual evaluation while maintaining information completeness

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

Solution Approach 2:

The system enables self-service by automatically gathering, organizing, and presenting relevant claim information without requiring human evaluators to manually search through files. The automated system performs data extraction, validation, and presentation functions that would otherwise require significant human effort and time

Inventive Principle:

Principle #25Self-service

2Reliability

If human evaluators manually gather claim information from various sources, then they can find relevant details, but important information is often missing and data gathering is inconsistent

Engineering Contradiction:

Improvedata consistencyVSAvoidmissing information

Core Design Contradiction:

ReliabilityVSLoss of information

Solution Approach 1:

The patent implements a universal data gathering system that can process multiple document types (medical records, attorney letters, repair estimates, etc.) through a single integrated platform. The system uses multiple extraction methods including OCR, NLP, and structured data parsing to ensure comprehensive and consistent information collection across all claim types and sources

Inventive Principle:

Principle #6Universality (Multi-functionality)

Solution Approach 2:

The system incorporates feedback mechanisms where extracted information is validated against expected formats and completeness criteria. The automated system cross-references data across multiple sources, identifies missing information, and prompts for additional data collection, thereby ensuring consistent and complete information gathering

Inventive Principle:

Principle #23Feedback

3Adaptability or versatility

If human evaluators review multiple document types such as medical records and attorney letters, then they can assess the claim, but the different task requirements make analysis challenging

Engineering Contradiction:

Improvedocument type handlingVSAvoidanalysis complexity

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The patent segments the complex analysis task into distinct processing modules, each specialized for different document types and information extraction needs. The system separates OCR processing, NLP analysis, data validation, and presentation functions into independent components that can be applied selectively based on the specific claim type and document format

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

The system dynamically adjusts processing parameters and analysis methods based on the document type being evaluated. Different extraction rules, validation criteria, and presentation formats are applied automatically depending on whether the system is processing medical records, legal documents, repair estimates, or other claim-related materials

Inventive Principle:

Principle #35Parameter changes

4Loss of information

If human evaluators search through files and outside sources to find missing information, then they can complete the evaluation, but the process becomes inefficient and time-consuming

Engineering Contradiction:

Improveinformation completenessVSAvoidevaluation efficiency

Core Design Contradiction:

Loss of informationVSProductivity

Solution Approach 1:

The system performs preliminary automated information gathering and validation before human review. It proactively extracts available information from all submitted documents, identifies missing data elements, and prepares a comprehensive information package in advance, thereby eliminating the need for evaluators to manually search for information during the evaluation process

Inventive Principle:

Principle #10Preliminary action

Data Source

PatentUS20250335999A1Improved interface for insurance claims

Publication Date: 2025.10.30 CCC INTELLIGENT SOLUTIONS INC

AI summary

The system and method may determine a claim type and may determine needed claim information for the claim type. The system and method may review material submitted for needed claim information and determine missing information from needed claim information. The missing information may be obtained from an additional source, the needed claim information may be completed, and the needed claim information may be displayed in a user interface or dashboard which may contain all the data needed to determine a claim.