Automated Insurance Claim Settlement System
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Solution Overview
Problem
Current systems for automated reimbursement interactions lack efficient and real-time processing of insurance claims and reimbursement transactions, particularly in verifying entitlement and handling payments across different locations, and do not effectively manage fraudulent claims or ensure timely documentation submission.
Innovation Solution
A computerized immediate settlement insurance claim payment system that associates an insurance policy with a payment-enabled mobile communicator, enabling real-time verification of claims, automatic payment processing, and chargeback functionality, along with fraud detection and reimbursement policy compliance, using a combination of RFID, GPS, and mobile communication technologies.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If automated verification and payment processing systems are implemented, then processing speed and efficiency are improved, but system complexity and implementation cost increase
Solution Approach 1:
The system divides the automated reimbursement process into distinct functional modules: verification module, payment processing module, fraud detection module, and documentation module. Each module handles specific tasks independently, improving processing speed while managing complexity through modular design.
Solution Approach 2:
The patent introduces an automated verification system that acts as an intermediary between the insured event occurrence and the payment processing. This intermediary automatically verifies entitlement, checks documentation, and authorizes payments, eliminating manual processing delays while maintaining controlled system complexity through standardized verification protocols.
2Reliability
If real-time verification of claims is implemented, then payment accuracy and fraud detection are improved, but processing time and computational resources increase
Solution Approach 1:
The system performs preliminary verification actions by pre-validating policy information, beneficiary details, and coverage terms before the actual claim payment is processed. This preliminary check ensures that when a claim occurs, the verification process is expedited since basic validity has already been established, improving both accuracy and speed.
Solution Approach 2:
The patent implements feedback mechanisms where the verification system continuously monitors claim patterns, payment outcomes, and fraud indicators. This feedback loop allows the system to learn from past decisions and improve verification accuracy over time while optimizing processing time through experience-based rule refinement.
3Reliability
If automated documentation requesting and verification is implemented, then compliance and record-keeping are improved, but system complexity and user interaction requirements increase
Solution Approach 1:
The system automatically requests, collects, and verifies required documentation without requiring active user participation. The automated verification system initiates documentation requests, tracks submission status, validates received documents against compliance requirements, and integrates them into the payment process. This self-service approach ensures compliance while minimizing user interaction complexity.
Data Source
AI summary
A computerized reimbursement system including at least one reimbursement-enabled mobile communicator having computerized memory functionality, computerized communications functionality and wireless payment functionality and at least one reimbursement-enabled computer server having computerized memory functionality and computerized communications functionality, at least one of the at least one reimbursement-enabled mobile communicator and the at least one reimbursement-enabled computer server storing reimbursement policy parameters which are selectable by a reimbursing party using the system, the reimbursement policy parameters including at least payee location and transaction amount, at least one of the at least one mobile communicator and the at least one computer server being operative to automatically complete payment transactions which are compliant with the reimbursement policy parameters and to automatically reject payment transactions which are not compliant with the reimbursement policy parameters.