Subrogation Case Management Platform Automating Claim Processing
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Current subrogation case management processes are inefficient due to the lack of unified information management, leading to delays and increased manual efforts in processing subrogation cases, as information is often provided in multiple forms and formats, requiring manual identification of claims and lien amounts by subrogation experts.
Innovation Solution
A subrogation case management platform is implemented to centralize information management, automate claim-relatedness determination, and facilitate the generation of final lien recommendations, using AI systems for claim probability scoring and automated processes to reduce manual effort and processing time.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If manual processes are used for subrogation case management, then flexibility in handling diverse information formats is maintained, but processing time and manual effort increase significantly
Solution Approach 1:
The system enables automated self-service processing where the platform automatically retrieves, parses, and processes information from multiple sources including insurance companies, providers, and attorneys without requiring manual intervention for each task, thereby maintaining flexibility while dramatically improving processing efficiency
Solution Approach 2:
The unified platform serves multiple functions including information retrieval, claim identification, lien amount determination, and case management all in one system, allowing it to handle diverse information formats from various sources through a single multi-functional interface that improves both flexibility and productivity
2Loss of information
If multiple information sources and formats are used, then comprehensive case information is obtained, but information management complexity and processing delays increase
Solution Approach 1:
The system merges information from multiple sources including insurance companies, providers, and attorneys into a single unified platform, consolidating diverse data formats and sources into one centralized location that reduces management complexity while maintaining information comprehensiveness
Solution Approach 2:
The unified platform acts as an intermediary that standardizes and harmonizes information from various external sources with different formats, translating and normalizing data from insurance companies, providers, and attorneys into a consistent internal format that reduces complexity while preserving comprehensive case information
3Measurement precision
If manual identification of claims and lien amounts is performed, then accuracy in claim assessment is maintained, but processing time and expert effort increase
Solution Approach 1:
The system replaces manual mechanical review processes with automated electronic processing, using computer-based algorithms to identify claims and calculate lien amounts, thereby maintaining accuracy through systematic processing while dramatically reducing the time required compared to manual expert review
Solution Approach 2:
The system performs preliminary automated processing of claims and lien amount calculations before final review, pre-identifying relevant claims and computing initial lien amounts based on retrieved information, which maintains accuracy through systematic analysis while reducing the time required for final expert assessment
Data Source
AI summary
Methods, apparatus and systems for managing subrogation cases are described. In one example aspect, a method for facilitating automated subrogation case processing includes transmitting a query that includes information indicative of an incident associated with a member to a database; receiving a response to the query indicative of associated medical information for the member; retrieving, based on the received response, medical claims associated with the member; computing a first probability value for each retrieved medical claim, the first probability indicating a relatedness of the medical claim to the incident; determining, for each retrieved medical claim, whether the medical claim is related to the incident by comparing the first probability value with a first predefined threshold; computing a second probability value indicating whether all medical claims related to the incident are present; and generating a final determination for the incident by comparing the second probability value with a second predefined threshold.