Automated Subrogation Screening Engine for Insurance Claims
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Solution Overview
Problem
Insurance companies face inefficiencies and inaccuracies in manually determining the subrogation potential of insurance claims, which hinders their ability to identify and pursue recoveries from other parties effectively.
Innovation Solution
An automated system utilizing a subrogation engine that processes loss reports, calculates subrogation potential scores based on claim descriptions and keyword values, and outputs identified claims with high potential for recovery, facilitating an efficient and accurate screening process.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If employees manually review insurance claims to identify subrogation potential, then accuracy in determining subrogation potential can be maintained, but time consumption and labor resources increase significantly
Solution Approach 1:
The patent replaces the mechanical manual review process with an automated computer-based system that uses natural language processing and machine learning algorithms to analyze claim descriptions, extract relevant entities, and calculate subrogation potential scores, thereby eliminating time-consuming manual labor while maintaining or improving accuracy
Solution Approach 2:
The system enables the claims data to self-analyze through automated entity recognition and scoring mechanisms, where the computer system independently processes claim descriptions, identifies relevant information, and generates subrogation potential assessments without requiring human intervention for each claim review
2Reliability
If employees manually determine subrogation potential for each claim, then detailed analysis can be performed, but error rates increase due to the large volume and variety of claims
Solution Approach 1:
The patent replaces the complex manual review process with a standardized automated system that consistently applies the same analysis rules and algorithms to all claims, eliminating human errors and variability while handling the complexity of diverse claim types through programmable logic
3Reliability
If manual review of all insurance claims is conducted, then comprehensive identification of subrogation opportunities is achieved, but productivity decreases due to the impracticality of reviewing tens of thousands of claims
Solution Approach 1:
The patent replaces manual claim review with an automated computer-based system that can process tens of thousands of claims efficiently, using natural language processing and machine learning to rapidly analyze claim descriptions and generate subrogation potential scores, thereby dramatically increasing productivity while maintaining comprehensive screening capability
Solution Approach 2:
The system performs preliminary automated screening of all claims to identify those with high subrogation potential before any manual review or further action is taken, filtering the large volume of claims down to a manageable subset that requires human attention, thus improving overall productivity
Data Source
AI summary
Systems and methods are disclosed herein for screening insurance claims to identify subrogation potential. According to some embodiments, a loss report associated with a plurality of insurance claims, includes, for each insurance claim: (i) a claim identifier, (ii) a claim date, (iii) a claim loss amount, and (iv) a claim description. Data from the loss report may be loaded into a subrogation engine, such as by loading the data into cells of a spreadsheet application. The spreadsheet application may then automatically calculate a subrogation potential score for each insurance claim in the loss report based on the claim date, claim loss amount, claim description, and a library containing keywords and associated keyword values. The spreadsheet application may then output an indication of the claim identifier and associated subrogation potential score for each insurance claim in the loss report.