Dynamic Claim Review Scheduling System
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
The complex and time-consuming process of claim processing in risk management, including compensation for personal injury or property damage, is hindered by manual preparation of files, outdated information, and delays, leading to increased operational burdens, prolonged recovery times for injured employees, and higher costs for employers and clients.
Innovation Solution
An integrated computing system that dynamically schedules claim reviews, providing real-time access to critical information through a customizable user interface, allowing for efficient incident reporting, early intervention, and centralized data management, reducing manual compilation and distribution burdens.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If manual preparation of files is used for claim processing, then claims adjusters can review and assess claims, but the process becomes slow and time-consuming with delays in claim resolution
Solution Approach 1:
The system creates electronic copies of claim files and distributes them automatically to relevant users through a centralized platform. Instead of manual file preparation and distribution, the system generates digital replicas of claim documentation that can be instantly accessed by multiple users simultaneously, eliminating the time-consuming manual copying and distribution process
Solution Approach 2:
The patent replaces the mechanical manual process of file preparation, compilation, and distribution with an automated computer-based system. The system automatically retrieves claim data, assembles relevant documentation, and distributes files electronically, substituting human manual labor with automated software processes that significantly reduce preparation time
2Loss of information
If information is manually compiled and distributed to claims adjusters, then claims can be assessed with current data, but the process is laborious and information becomes outdated
Solution Approach 1:
The system implements continuous automatic updates of claim information, ensuring that all users always access the most current data. Instead of periodic manual updates that result in outdated information, the system maintains a continuously synchronized database that automatically refreshes claim details, investigation results, and related information in real-time for all authorized users
Solution Approach 2:
The centralized system serves multiple functions simultaneously: it stores claim information, automatically updates data, distributes files to multiple users, tracks information currency, and provides access to all relevant parties. This multi-functional platform eliminates the need for separate manual processes for each information management task
3Productivity
If traditional claim processing methods are used, then claims can be processed through established procedures, but operational burdens increase and workflow efficiency decreases
Solution Approach 1:
The system merges multiple separate claim processing tasks into a single integrated digital platform. File retrieval, compilation, distribution, tracking, and update functions are combined into one unified system that automates the entire workflow. This consolidation reduces operational burden by eliminating the need to manage multiple separate processes and manually coordinate between different steps
Data Source
AI summary
Systems and methods for dynamically scheduling a claim review are provided. A request to display an instance of a claim review is received, the request generated by a user in a plurality of users associated with a first or second entity. The instance of the claim review includes claims by a plurality of claimants, each claim associated with both the first and second entity. Responsive to the request, a customizable template specifying an order and subset of the claims in the instance of the claim review is applied. Each claim is accessed, in electronic form, from one or more data stores, to acquire a summary of the respective claim. A customizable user interface is displayed, including a completion status for the claim review, the summary of each claim, a first affordance for updating the completion status, and a second affordance for updating a criterion.