Dynamic Rule Generation for Insurance Claim Processing
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Solution Overview
Problem
Insurance claim processing systems require complex modifications, necessitating skilled personnel and resulting in downtime and increased costs due to the need for programming language expertise and system shutdowns when changing graphical user interfaces or adding questions.
Innovation Solution
A rule generation system that dynamically generates rules for insurance claim processing systems, allowing for streamlined creation and modification of graphical user interfaces without requiring extensive programming knowledge, using modules and evaluative expression frameworks to manage navigation, display, and discrepancy rules.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If modifications are made to the insurance claim processing computer system to change the order or display of graphical user interfaces, then the system functionality is improved, but the system must be shut down resulting in downtime and lost productivity
Solution Approach 1:
The patent implements dynamic rule generation that allows the insurance claim processing system to modify its graphical user interface presentation order without requiring system shutdown. The rule generation system dynamically creates and modifies rules during system operation, enabling real-time adaptation of interface display sequences while maintaining continuous productivity.
2Adaptability or versatility
If modifications are made to the insurance claim processing computer system, then the system functionality is improved, but specialized programming skills and additional costs are required
Solution Approach 1:
The patent introduces an intermediary rule generation system that acts as a bridge between users and the complex insurance claim processing computer system. This intermediary layer translates simple user-defined parameters into the complex programming rules required by the system, eliminating the need for users to possess specialized programming skills while still enabling system modifications.
Solution Approach 2:
The rule generation system creates simplified copies or representations of the complex system rules that users can easily modify. Instead of requiring users to directly edit complex programming code, the system provides simplified rule templates that can be copied, modified, and applied without understanding the underlying programming complexity.
3Adaptability or versatility
If the insurance claim processing center hires or trains personnel with technical skill sets, then the ability to modify the system is improved, but additional expenses are incurred
Solution Approach 1:
The patent enables non-technical insurance claim processing center personnel to independently modify system rules without requiring external training or hiring of specialized programmers. The rule generation system provides self-service capabilities where users can define and implement their own system modifications using intuitive interfaces, eliminating the need for expensive training programs or specialized staff.
Data Source
AI summary
A rule generation system facilitates the dynamic generation of rules for an insurance claim processing computer system. The rule generation system includes various modules and graphical user interfaces that provide a streamlined mechanism for creating new rules for the insurance claim processing architecture. The rule generation system may include various levels of usability that distinguish between an advanced user of the rule generation system and basic user that uses the generated rules. The rule generation system may also include graphical user interfaces directed to adding, editing, removing, or maintaining rules for the insurance claim processing computer system.