Real-time Override Interface for Automated Decision Denials
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Solution Overview
Problem
Current systems lack real-time over-ride capabilities for automated decision denials in organizations, leading to delays in human underwriter review and lack of mechanisms for immediate determination and memorialization.
Innovation Solution
A system and method that allow a human reviewer to over-ride denial decisions in real-time by presenting a focused interface with stored information and determination entry device, enabling immediate decision-making and storage of over-ride determinations.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If automated decision software is used to determine policy issuance, then decision-making speed and consistency are improved, but the ability to accommodate exceptional cases through human judgment is lost
Solution Approach 1:
The decision-making process is segmented into automated evaluation and human review components. The system automatically evaluates requests against predefined standards and segments those requiring further consideration into a human review queue, allowing most decisions to be made quickly while preserving human judgment for exceptional cases.
Solution Approach 2:
The system introduces an intermediary human review layer between automated denial and final rejection. When automated software denies a request, the system can route it to a human reviewer who acts as an intermediary to assess whether exceptional circumstances warrant overriding the automated decision.
2Reliability
If human underwriters review all denied requests manually, then accuracy and fairness are improved, but processing time and operational costs increase
Solution Approach 1:
Instead of having human underwriters review all denied requests, the system applies partial human review only to selected cases that meet specific criteria for further consideration. This partial action approach maintains accuracy for cases that need it while avoiding the time cost of universal human review.
Solution Approach 2:
The system changes the parameter of review intensity based on the characteristics of each denial case. By adjusting which cases receive human review based on predefined parameters, the system optimizes the balance between accuracy and processing time.
3Ease of operation
If real-time over-ride capability is implemented, then customer satisfaction is improved, but system complexity and infrastructure requirements increase
Solution Approach 1:
The system design integrates multiple functions into unified components. The decision software, review queue management, and notification systems work as integrated multi-functional units, reducing overall system complexity while enabling real-time over-ride capability.
Data Source
AI summary
Decision software implements a decision process that handles and decides a request from a requestor in a generally automated manner. The decision software denies the request according to a predefined standard. Information relating to the request and the denial decision is stored as a quote, and it is determined that further consideration of the denial decision by a human reviewer of the organization is desired. The human reviewer is contacted and retrieves the stored quote by way of an actuated interface that presents the quote as a focused screen including information from the quote and a determination entry device. The human interviewer determines based at least in part on the focused screen whether to over-ride the denial decision and enters such determination into the determination entry device. The entered determination is stored with the stored quote and the request proceeds in accordance with the stored determination.