METHOD OF PROVIDING PERSONAL ENGAGEMENT IN RECOVERY AND RETURN TO WORK FOR INDIVIDUALS ON DISABILITY INSURANCE

摘要

A user interface, system and method are described for assigning an insurance claim to a claim manager. The user interface allows teams of claim managers to be built so to efficiently process insurance claims as they are presented to a disability insurance carrier. The process of assigning the claim begins upon receiving an indication of a new insurance claim from a claim intake engine. Subsequently, the system determines the type of insurance claim based on metadata associated with the claim. Based on the metadata associated with the claim, a list of members in a team of claim managers is obtained, and a specific member is assigned as a claim manager for that claim.

主权项

1. A system for processing a subscriber reported disability claim from a subscriber of a disability insurance carrier, the reported claim data including subscriber reported medical conditions data, the system comprising:
an interface configured for receiving the medical conditions data and converting said medical conditions data to first elements of first metadata; at least one database configured to receive and store: (i) the first metadata; and (ii) a plurality of second metadata, each of the plurality of second metadata containing second elements representing assigned medical conditions that each of a plurality of claim managers are assigned for handling; at least one server for electronically:
(i) accessing the first and second metadata;(ii) identifying, based on a comparison, at least one second metadata wherein all of the first elements are at least a subset of the second elements, thereby identifying one or more claim managers, of the plurality of claim managers, for handling each of the reported medical conditions; and(iii) based on a weighting analysis, assigning responsibility to one of the one or more claim managers for handling the disability claim on behalf of the disability insurance carrier, the server comprising:
a processor; anda memory, wherein the processor is configured to execute computer-executable instructions stored in the memory to perform operations of:
receiving notification of the medical conditions data being received at the interface;acquiring the first elements of the first metadata of the medical conditions data and the second elements of the second metadata from the database;comparing the first elements of the first metadata of the medical conditions data with the second elements of the second metadata to obtain a list of the one or more claim managers capable of being assigned responsibility of the disability claim;filtering the list of the one or more claim managers capable of being assigned responsibility of the disability claim by determining which claim managers have capabilities most suitable to process the disability claim;selecting, via the weighting analysis, at least one individual claim manager to assign the disability claim from the filtered list of the one or more claim managers capable of being assigned responsibility of the disability claim; andassigning the at least one individual claim manager as being responsible for the insurance claim by updating the first metadata stored in the database to reflect that the at least one individual claim manager is responsible for the disability claim.