Virtual Assistant for Insurance Claim Arbitration
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Solution Overview
Problem
Current processes for determining insurance claim arbitration are time-consuming and inconsistent due to the need for extensive interaction with multiple parties and lack of clear information guidelines, especially for less experienced adjusters, leading to inefficient subrogation processes.
Innovation Solution
A virtual arbitration assessment assistant is implemented on computing devices to automate the determination of liability and fault in insurance claims, identifying missing information, obtaining necessary data, and recommending whether a claim should proceed to arbitration, utilizing a combination of cognitive computing and artificial intelligence.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If manual processes are used for determining insurance claim arbitration, then human judgment and flexibility are maintained, but the process becomes time-consuming and inconsistent
Solution Approach 1:
The patent replaces manual mechanical processes with an automated computer-based system that uses machine learning models and algorithms to determine arbitration recommendations. The system automatically processes claim data, applies consistent decision rules, and generates recommendations without manual intervention, thereby improving consistency while reducing processing time.
Solution Approach 2:
The system transforms unstructured claim data into structured parameters that can be processed by algorithms. By converting qualitative human judgments into quantifiable parameters and using configurable decision thresholds, the system achieves both consistency and efficiency in arbitration determinations.
2Loss of information
If multiple parties are involved in the claims process, then comprehensive information gathering is achieved, but the complexity of coordination increases
Solution Approach 1:
The patent creates a universal platform that handles multiple functions including data collection from various sources, information validation, analysis, and recommendation generation. This multi-functional system consolidates what would otherwise require multiple separate coordination mechanisms, reducing overall system complexity while maintaining information completeness.
Solution Approach 2:
The system acts as an intermediary between multiple parties (policyholders, third parties, insurance providers) by centralizing information gathering and processing. Instead of requiring direct coordination between all parties, the system mediates the information flow, simplifying the coordination structure while ensuring comprehensive data collection.
3Measurement precision
If less experienced adjusters are provided with more guidance, then decision quality improves, but the process becomes more complex
Solution Approach 1:
The system enables adjusters to independently make accurate arbitration determinations by providing them with automated analysis tools and recommendations. Instead of requiring complex external guidance mechanisms, the system empowers adjusters to self-serve with consistent, data-driven recommendations, improving accuracy without adding coordination complexity.
Data Source
AI summary
Systems and methods provide for an automated system for determining whether claims related to an insured item should proceed to an arbitrating body. A virtual assistant (also referred to herein as an “arbitration assessment assistant”) installed in a computing device (e.g., computer, laptop, tablet computer, mobile phone, etc.) may be responsible for managing and assisting an insurance representative (e.g., an insurance adjuster, subrogation representative, etc.) in determining liability and fault relating to a claim, conducting a subrogation process, and ultimately determining whether the claim should be submitted for arbitration. In one or more aspects discussed, herein the process may be fully automated.