System for funding third-party-administered losses

摘要

A computerized system for funding third-party-administered insurance claims includes at least one processor configured to provide a claim data throughput module for receiving at least one claim transaction from at least one third party administrator, an administrative services module for receiving at least one bank transaction from at least one third party administration, for passing at least one bank transaction to a bank, and for receiving at least one paid file from a bank, and a transactions matching engine for validating at least one bank transaction based upon at least one claim transaction, and for determining completion of at least one bank transaction based upon at least one paid file.

主权项

1. A computerized system for an insurer to fund third-party-administered insurance claims comprising:
at least one processor configured to:
receive, from a third party administrator, an issue file comprising a plurality of bank transactions;wherein each of the plurality of bank transactions in the issue file is adapted to be executed by an insurer's bank to make a payment to a claimant from an insurer-owned bank account, each of the plurality of bank transactions including a transaction amount, a transaction code related to an action to be taken with regard to the insurer-owned bank account, and bank information for permitting access and disposition of money held in the insurer-owned bank account for payment to the claimant; compare the plurality of bank transactions in the issue file to a plurality of transaction confirms corresponding to a plurality of insurance claim transactions that have been accepted based on formal rules; wherein each of the plurality of transaction confirms includes a transaction amount, a transaction code related to an action to be taken with regard to the insurer-owned bank account, and bank information for permitting access and disposition of money held in the insurer-owned bank account for payment to the claimant; validate one or more of the plurality of bank transactions in the issue file if the transaction amount, transaction code, and bank information in a corresponding one of the plurality of transaction confirms match; pass the issue file received from the third party administrator to the insurer's bank so that the one or more of the plurality of bank transactions that have been validated are executed by the insurer's bank to make the payment to the claimant from the insurer-owned bank account; receive from the insurer's bank a paid file comprising a plurality of status reports corresponding to the plurality of bank transactions that have been validated; wherein each of the plurality of status reports includes a transaction amount, bank information, and a status code indicating the status of a corresponding one of the plurality of bank transactions; compare the plurality of bank transactions in the issue file to the plurality of status reports in the paid file received from the insurer's bank; and determine whether one or more of the plurality of bank transactions in the issue file is complete based on the status code in a corresponding one of the plurality of status reports in the paid file and whether the transaction amount and bank information in the corresponding one of the plurality of status reports in the paid file match.