Insurance Claims Data Aggregation and Visual Reporting
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
The insurance claims processing is complex and time-consuming, requiring large volumes of data documentation and complex calculations, which can be daunting for policy holders and inefficient for claims adjusters, lacking intuitive interfaces for data entry and transparency.
Innovation Solution
A system and method for automating claims processing by allowing claims adjusters to import and process insurance claims data using optical character recognition, generating reports, and providing a user-friendly interface for policy holders to access detailed information and calculations, enabling quick and transparent claim payouts.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If manual data entry and complex calculations are used for insurance claims processing, then detailed documentation and accuracy can be achieved, but the process becomes time-consuming and complex for both adjusters and policy holders
Solution Approach 1:
The patent replaces manual mechanical data entry and calculation processes with automated computer-based systems. The system automatically extracts data from uploaded documents, performs calculations using predefined formulas, and generates reports, eliminating the need for manual adjuster intervention in routine tasks while maintaining accuracy.
Solution Approach 2:
The system enables policy holders to self-serve by uploading their own claim documents and tracking their claims status online. The automated system processes these submissions without requiring adjuster intervention for data collection and initial processing, reducing overall processing time while maintaining documentation accuracy.
2Loss of information
If voluminous documentation is required for claims processing, then complete claim information can be captured, but the work for adjusters increases exponentially
Solution Approach 1:
The system extracts relevant claim information automatically from uploaded documents using optical character recognition and data extraction algorithms. This separates the information capture function from the adjuster's workflow, allowing complete claim documentation to be obtained without requiring adjusters to manually process voluminous paperwork.
Solution Approach 2:
The system creates digital copies of claim documents and stores them in a structured database format. This allows the original voluminous documentation to be preserved for completeness while the system works with streamlined digital representations for processing, reducing adjuster workload without losing information.
3Loss of information
If detailed reconciliation and itemization are provided to policy holders, then transparency is achieved, but obtaining this information becomes arduous
Solution Approach 1:
The system segments claim information into organized categories such as claim status, payment details, documentation status, and calculation breakdowns. This segmentation allows policy holders to access specific information types easily through a user-friendly interface while the system maintains complete detailed information in the background for full transparency.
Solution Approach 2:
The system acts as an intermediary between the complex claims processing system and the policy holder. It translates detailed claims data into user-friendly presentations, providing transparency through automated reports and online access while shielding policy holders from the complexity of underlying calculations and documentation.
4Adaptability or versatility
If manual processing methods are used, then flexibility in handling complex claims can be maintained, but productivity and efficiency decrease
Solution Approach 1:
The system combines automated processing for routine tasks with flexible human intervention capabilities when needed. Adjusters can intervene in complex cases while the system handles standard claims automatically, creating a dynamic workflow that adapts to claim complexity. This maintains flexibility while significantly improving overall productivity through automation of repetitive tasks.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
This solution simplifies the claims processing by reducing redundant data entry, automating calculations, and providing comprehensive transparency, enhancing policy holder experience and reducing loss adjustment expenses.
Implementation Method 1
The claim documentation can be automatically scanned with optical character recognition immediately upon uploading it into the system
Data Source
AI summary
Systems and methods are described for use in the context of property insurance claims. In general, the systems and methods described herein allow for a claims adjuster to visually present property insurance claim decisions input into a server by a claims adjuster audit by a policy holder of a property insurance policy. A payment list illustrating a plurality of payments with hyperlinks is displayed in a first view on a display screen of a policy holder device. An itemized statement of loss illustrating a replacement cost value and subtractions therefrom in a second view on the display screen. An itemization of coverage illustrating a list of property items with associated damages corresponding to each of the property items in a third view on the display screen, wherein only a subset of the property items with associated damages are listed that correspond to a selected hyperlink.