INSURANCE INFORMATION MANAGEMENT SYSTEM AND METHOD

摘要

An automated system for managing insurance information is provided. The system resides on a host server (100) and communicates with participants and providers over a network (300). The system includes a database (140) for storing information and processing tools (150) including customer service tools, claim adjudication tools and a benefits calculation engine. The benefits calculation engine calculates an applicable benefit based on received information. The system further comprises benefit payment processing tools for paying a benefit and expense payment processing and adjustment tools. The system also includes claim reporting tools for performing reporting functions and claim management and plan loading tools for identifying a plan and updating the benefits calculation engine.