Insurance Claim Data Reconciliation via Pattern Recognition
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Solution Overview
Problem
Insurance claim adjustments and reprocessing often require the insured party to manually compare physical documentation to determine changing financial responsibilities, which is burdensome and prone to errors due to incorrect calculations or rejections by insurance providers.
Innovation Solution
A method and system using pattern recognition to identify and manage insurance claim data, determining financial responsibilities, and presenting this information through a graphical user interface (GUI), allowing the insured party to easily track changes and responsibilities associated with their insurance claims.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If the insured party manually compares physical documentation to determine financial responsibility, then they can track changes in insurance claims, but the process becomes burdensome and prone to errors
Solution Approach 1:
The system allows the insured party to automatically access and review their own insurance claim data through an online portal without requiring manual comparison of physical documentation. The system self-updates with adjusted claim information, eliminating the need for the insured party to manually track changes across multiple documents.
Solution Approach 2:
The manual mechanical process of physically comparing documentation is replaced with an electronic system that automatically presents updated claim information in a structured format. The system substitutes physical document handling with digital data display, reducing errors and burden on the insured party.
2Measurement precision
If insurance claims are adjusted and reprocessed, then accuracy of financial responsibility is improved, but the complexity of managing documentation increases
Solution Approach 1:
The system merges multiple insurance claim data elements (original claim, adjustments, reprocessing information) into a single integrated online record. Instead of managing separate physical documents for each adjustment, all claim information is consolidated in one accessible location, reducing documentation complexity while maintaining accuracy.
Solution Approach 2:
The online system serves multiple functions: it stores original claim data, tracks adjustments, presents reprocessed information, and calculates financial responsibility all in one platform. This multi-functional approach eliminates the need for separate documentation systems for each claim management task.
3Loss of time
If the insured party maintains physical insurance documentation, then they can determine financial responsibility, but time is lost in manually comparing documents
Solution Approach 1:
The system prepares and makes available all necessary claim information in advance, including adjusted claims and reprocessed data, before the insured party needs to review it. Information is pre-organized and presented in a clear format, eliminating the time needed to manually search through and compare physical documents.
Solution Approach 2:
The system provides immediate feedback to the insured party when claim adjustments or reprocessing occurs. Updated information is automatically communicated through the online portal, reducing ambiguity and eliminating the delay associated with manually receiving and comparing physical documentation.
Data Source
AI summary
A method for managing insurance claim data involves identifying a first insurance claim data and a second insurance claim data using pattern recognition on multiple insurance claim data associated with an insured party, where the first insurance claim data and the second insurance claim data are associated with a single insurance claim associated with the insured party, where the second insurance claim data is later in time than the first insurance claim data, and where the second insurance claim data includes a modification of the single insurance claim relative to the first insurance claim data. The method further involves determining a financial responsibility of the insured party for the single insurance claim based on the second insurance claim data, and presenting the first insurance claim data, the second insurance claim data, and the financial responsibility in a graphical user interface (GUI).