EP1292896A4 - Automatisiertes schadensanspruchregulierungssystem - Google Patents

Automatisiertes schadensanspruchregulierungssystem

Info

Publication number
EP1292896A4
EP1292896A4 EP01944645A EP01944645A EP1292896A4 EP 1292896 A4 EP1292896 A4 EP 1292896A4 EP 01944645 A EP01944645 A EP 01944645A EP 01944645 A EP01944645 A EP 01944645A EP 1292896 A4 EP1292896 A4 EP 1292896A4
Authority
EP
European Patent Office
Prior art keywords
claimant
automatically
suppliers
bids
mfillment
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP01944645A
Other languages
English (en)
French (fr)
Other versions
EP1292896A1 (de
Inventor
Peter Edward Richardson
John Charles Harvie
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
CGI Technologies and Solutions Inc
Original Assignee
American Management Systems Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by American Management Systems Inc filed Critical American Management Systems Inc
Publication of EP1292896A1 publication Critical patent/EP1292896A1/de
Publication of EP1292896A4 publication Critical patent/EP1292896A4/de
Withdrawn legal-status Critical Current

Links

Classifications

    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00Administration; Management
    • G06Q10/10Office automation; Time management
    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08Insurance

Definitions

  • the present invention relates to an automated claims fulfillment system which automatically coordinates activities between a claimant, an insurer and suppliers, to fulfill an insurance claim.
  • a conventional claims settlement process includes a "claims agreement" phase during which the insurer makes a decision to settle the claim, and then a " fulfillment" phase during which the insurer takes steps to mdeinnify the claimant.
  • a conventional fulfillment phase is highly ineffective and inefficient due to a number of key factors.
  • claimant satisfaction is often low because confusion over market values causes claimants to perceive that insurers "don't pay up in full.” Also, claimant satisfaction is often low because claimants are expected to complete the fulfilment phase themselves, and because the fulfillment phase takes too long.
  • insurers are not often able to use a claim as a springboard for selling other products and services because there is little or no "after fulfillment" follow-up service.
  • an apparatus which includes an automated claims fillment system, and communication channels which connect a claimant submitting an insurance claim for loss of an insured item, an insurer insuring the item, and suppliers, to the claims fulfillment system.
  • the claims fulfillment system automatically coordinates activities between the insurer, the suppliers and the claimant so that the claimant is provided with a claimant-selected product or service by at least one of the suppliers to fulfill the insurance claim.
  • FIG. 1 is a diagram illustrating a claims fulfillment system, according to an embodiment of the present invention.
  • FIGS. 2 and 3 are flowcharts illustrating the operation of a claims fulfillment system, according to an embodiment of the present invention.
  • FIG. 4 is a diagram illustrating a claims fulfillment system, according to an additional embodiment of the present invention.
  • FIG. 5 is a diagram j lusttating an example of an overall architecture for implementing a claims system, according to an embodiment of the present invention.
  • FIG. 1 is a diagram illustrating a claims fulfillment system, according to an embodiment of the present invention.
  • an insurer 10 offers insurance.
  • a representative 12 acts on behalf of an insurer 10 and would typically be an employee of insurer 10 or a contractor working on behalf of insurer 10.
  • a claimant 14 has insurance with insurer 10, and submits a claim for loss of an insured item.
  • a plurality of suppliers 16 are available to replace, re-manufacture or repair the insured item in fulfillment of the claim.
  • Communication channels 17 connect insurer 10, claimant 14 and suppliers 16 to claims fulfillment system 18.
  • Communication channels 17 might comprise public and/or private networks, the Internet, local area networks (LANs), wide area networks (WANs), optical communication networks, wireless conMnunication networks, other types of electronic networks, etc.
  • different types of communication channels 17 can be used to connect insurer 10, claimant 14 and/or suppliers 16 to claims fulfillment system 18.
  • a respective communication channel 17 connecting insurer 10 to claims fulfillment system 18 might be a different type than the respective communication channel 17 connecting claimant 14 to claims fulfillment system 18.
  • different suppliers 16 may be connected to claims fulfillment system 18 via different types of communication channels 17.
  • the same communication channel 17 might be used to connect insurer 10, claimant 14 and/or suppliers 16 to claims fulfillment system 18.
  • Claims fulfillment system 18 automatically coordinates activities between insurer 10
  • claimant 14 (typically through representative 12), claimant 14 and suppliers 16 so that claimant 14 is provided with a claimant-selected product or service by at least one of suppliers 16.
  • claims fulfillment system 18 would typically have the ability to manage various types of products and/or services.
  • claims fulfillment system 18 preferably has the ability to manage on-catalog and non-catalog products, bespoke products/services, and specialized services.
  • On-catalog and non-catalog -products are products which are held on a catalog against a contract with suppliers 16, or that have a similar replacement to those held on the catalog. If the insured product is this type of product, the insured product would typically be replaced in fulfillment of the claim.
  • Bespoke products/services are products/services that are made specifically for a claimant or products that are made in limited numbers. If the insured item is this type of product, the insured product will typically have to be replaced by re-manufacture or replacement with an item that is similar.
  • Specialized services refers to repair/rebuild services required to essentially "fix" the insured item. Such specialized services are sometimes required to fulfill a claim.
  • FIGS. 2 and 3 are flowcharts illustrating the operation of claims fulfillment system 18. Referring now to FIGS. 2 and 3, the following is a description of each step:
  • Step 4.1.1 Can the claim be fulfilled through claims fulfillment system 18 ?
  • Input Details of the claim are received from insurer 10 (potentially manually or automatically).
  • Activity Determine whether the procurement required to meet a claim can be processed through claims fulfillment system 18.
  • Step 4.1.2 Representative 12 initiates procurement through claims fulfillment system 18
  • Activity Send a description of the required goods or services (typically including service level agreements) to claims fulfillment system 18 and typically pursue multiple procurement methods if necessary.
  • Step 4.2 Replace (On-catalog and non-catalog products).
  • Step 4.2.1 Claims fulfillment system 18 searches for the product/service in the catalog.
  • Input Product /service description from representative 12 (and, typically, service level, stock availability requirements if necessary).
  • Activity Claims fulfillment system 18 searches supplier catalog to match the description of the product/service.
  • Input A list of options for replacement products/services, typically including associated pricing, service levels and stock availability as retrieved by search.
  • Activity Representative 12 selects the best solution to meet the needs, typically based on a combination of price, availability, service level etc.
  • Output The best source for the replacement of that product according to required service level.
  • Step 4.2.3 Claims fulfillment system 18 asks representative 12 whether to search again using a more detailed product specification.
  • Activity Claims fulfillment system 18 asks representative 12 whether to search again and if so requests a more specific product description (typically via preferred technology).
  • Output Typically, e-mail, web-page, WAP phone, SMS message etc. to representative 12 (and returned to claims fulfillment system 18) containing more specific product detail and whether to search again.
  • Step 4.2.4 Representative 12 instructs claims fulfillment system 18 to search for best fit.
  • Input Search string for replacement product/service (enabled by "advanced” search).
  • Activity Representative 12 instructs claims fMfillment system 18 to search for similar options to that of the product/service required.
  • Output A list of best fit options .
  • Step 4.3 Remanufacture product (bespoke product/service).
  • claims fulfillment system 18 Details of the bespoke product or service are entered into claims fulfillment system 18.
  • claims fulfillment system 18 allows drawings, photographic images etc, to be entered.
  • Step 4.3.2 Representative 12 sets up business rules for auction, and would typically select suppliers 16 and update claims fulfillment system 18.
  • Representative 12 sets up an auction and establishes business rules (e.g. closed auction, open auction), and, typically, also establishes duration, etc.
  • representative 12 would also select suppliers 16 to be involved in the auction from, for example, an insurer's panel (based, for . example, on ability, past performance, geography).
  • Output A set of suppliers 16 to be involved in the auction and all information necessary to begin the auction.
  • Step 4.3.3 Claims fulfillment system 18 issues instructions to bid to suppliers 16.
  • Input A set of chosen suppliers 16 to be involved in the auction and the business rules set-up for that auction. (Can preferably be enhanced by additional instructions issued by representative 12).
  • Activity Claims fulfillment system 18 sends instructions to bid to suppliers 16, typically by their preferred technology.
  • Output Information about the auction and how to bid are received by each of suppliers 16 involved in the auction.
  • Step 4.3.4 Suppliers 16 ascertain whether they have enough information to bid.
  • Prior Step: 4.3.3 Instructions to bid.
  • Input Supplier 16 receive an invitation to bid.
  • Activity Supplier 16 receiving the invitation analyze the information (specification) contained in the instruction to bid.
  • Step 4.3.5 Suppliers 16 gather more detail about the service required.
  • a supplier 16 receives an invitation to bid, but doesn't have a detailed enough specification with which to compile a bid.
  • the supplier 16 gathers more information about the service required, e.g. through an on-site visit or through a more detailed discussions with representative 12 and/or claimant 14.
  • Step 4.3.4 (Supplier survey).
  • Input Business rules are set up for auction and participants are informed.
  • Output A list of options and prices.
  • Step 4.4 Services (Repair/rebuild, professional and other services).
  • Step 4.4.1 Representative 12 decides whether it is an on-catalog service based on the type of claim and service required.
  • a service is required to fulfill or partly fulfill a claim.
  • Activity Representative 12 decides whether the service required is one that is likely to be on-catalog.
  • Step 4.5.1 Options are typically collated, representative 12 would typically refine options, selects and approves and updates claims fulfillment system 18.
  • Input An option or list of options for a replacement product/service.
  • Claims fulfillment system 18 would typically collate options to resolve the claim by replacement, rebuild, remanufacture or by providing a service.
  • representative 12 further refines the list of options and selects and approves only those options that insurer 10 would consider acceptable as a replacement for the claimed product/service.
  • Output An option or sub-set of options, from which claimant 14 can select (or confirm, whereby confirming could also be considered to be "selecting" by the claimant).
  • Owner Claims fulfillment system 18, representative 12.
  • Step 4.5.2 Claims fulfillment system 18 "white-labels" and sends choice to claimant.
  • Input An option or sub-set of options, from which claimant 14 can select (or confirm).
  • Claims fulfillment system 18 sends the option or set of options to claimant 14.
  • claims fulfillment system 18 would "white-label" the option or set of options, where white-labeling refers to claims fulfillment system 18 presenting information to claimant 14 in the colors and logo of insurer 10.
  • Output Typically, a web-view (or e-mail, WAP message, letter etc), typically formatted in the style of insurer 10 displaying the choice(s) available to claimant 14.
  • Step 4.5.3 Claimant 14 selects the option (or from a list of options) and responds to claims fulfillment system 18 (typically white labeled).
  • Input Typically, a web-view (or e-mail, WAP message, letter etc), typically formatted in the style of insurer 10, displaying the choice(s) available to claimant 14 for the replacement of their product/service.
  • Claimant 14 decides which option to select and informs claims fulfillment system 18, typically via their preferred technology.
  • Output An order for a replacement product/service as selected (confirmed) by claimant 14.
  • Owner Claimant 14
  • Step 4.5.4 If the logistics are not acceptable to claimant 14. a different option would typically be arranged by representative 12.
  • Claimant 14 confirms that they accept one of the options available, but they can not accept delivery of the product/service at the time assigned by the service providers.
  • Activity Representative 12 selects the same option, but with a different delivery date (and possibly supplier, depending on availability).
  • Output The same product/service, but with a different delivery date (and possibly supplier).
  • Step 4.5.3 (claimant 14 selects option).
  • Step 4.5.5 Claim is handled manually and procurement is tracked through claims fulfillment system 18.
  • Claimant 14 refuses all options offered by representative 12.
  • Activity The claim is processed manually. Procurement would typically be tracked through claims fulfillment system 18 (for analysis and reporting) although procurement may be for a non-catalog product or service.
  • claims Mfillment system 18 would typically obtain authorization to proceed from insurer 10.
  • Output An agreement from insurer 10 to proceed with the procurement; or the need to obtain more senior authority from insurer 10.
  • Input The need to obtain more senior authority from insurer 10 to approve the level of procurement.
  • Insurer 10 obtains the approval from a higher authority.
  • Output The approval from insurer 10 to procure a particular level of product/service.
  • Step 4.5.8 Claims fulfillment system 18 (typically white-labeled) instructs supplier 16 to proceed.
  • Input The order for the service to be supplied.
  • Activity Claims fulfillment system 18 send a message, typically white-labeled, to supplier 16 to proceed with the delivery of the service.
  • white- labeling refers to claims fulfillment system 18 presenting information to supplier 16 in the colors and logo of insurer 10.
  • Output The order, typically white-labeled, is sent to the supplier 16 to proceed.
  • Owner Claims fulfillment system 18. .
  • Step: 4.5.9 (Supplier decides whether to procure).
  • Step 4.5.9 Supplier 16 ascertains if they have a need to procure goods or services -themselves, in order to fulfill the delivery of their good or service.
  • Input The supplier 16 has been sent an order to proceed with the execution of the service.
  • the supplier 16 compiles a list of goods or services that they require in order to carry out the work, e.g., a builder might require the services of an electrician and raw materials from a merchant.
  • Output A list containing goods or services that need to be procured to deliver the service.
  • Step 4.5.10 (Supplier procure), 4.5.11 (Place order)!
  • Step 4.5.10 Supplier 16 carries out procurement through claims fulfillment system 18 (as if representative 12).
  • Input A list containing goods or services that need to be procured, as a sub-set of the service to be supplied by the supplier 16.
  • Step 4.5.11 Claims fulfillment system 18 aggregates and places orders with suppliers 16.
  • Activity Claims fulfillment system 18 aggregates and places orders with suppliers 16.
  • Output An instruction to place an order.
  • Owner Claims fulfillment system 18.
  • Input A list of line items to be procured from a particular supplier 16.
  • the supplier 16 confirms the delivery date for the particular line item associated with the claim.
  • Step 4.6.2 Claims fulfillment system 18 (typically white-labeled) updates claimant 14 and insurer 10 on fulfillment route.
  • Input A confirmed delivery date for a particular item associated with a claim.
  • Claims fulfillment system 18 passes information on delivery back to insurer 10 and then onto claimant 14 (typically after white-labeling) through, preferably, the technology of choice (e.g. the insurers web page, e-mail, phone (via call center etc.)).
  • the technology of choice e.g. the insurers web page, e-mail, phone (via call center etc.)
  • Representative 12 and claimant 14 have the ability to track on-line the status of the fulfillment of goods/services ordered through claims fulfillment system 18.
  • Input A confirmed delivery date for the good or service.
  • Claimant 14 or representative 12 inquires about the status of their claim through, for example, either call center, web page, e-mail etc.
  • Step 4.6.4 Supplier 16 fulfills order and delivers goods/service to claimant 14.
  • Input A confirmed delivery date for the good or service.
  • Output The goods or service are delivered to claimant 14.
  • Step 4.6.5 Supplier updates claims fulfillment system 18 when claim is fulfilled.
  • Input The good or service has been delivered.
  • Output A confirmation to claims Mfillment system 18 that the order has been completed and a message from claims Mfillment system 18 to insurer 10 that the claim has been Mfilled.
  • Owner Supplier 16, claims Mfillment system 18.
  • Input The good or service has been delivered.
  • Supplier 16 typically submits an electronic bill for the aggregated total of the goods or services procured from them, typically including the line item for this particular good or service.
  • Step 4.7.2 Claims Mfillment system 18 aggregates and reconciles invoices across suppliers 16 before forwarding to insurer 10.
  • Claims Mfillment system 18 typically checks that the good or service has been satisfactorily received or executed and typically creates a line item on an aggregated electronic bill, across suppliers 16, for a particular insurer to settle (according to the settlement terms in individual supplier contracts).
  • Output An aggregated electronic bill due for settlement, typically presented to insurer 10.
  • Step 4.7.3 Insurer 10 issues instruction to theh bank for settlement of the electronic bill and updates claims Mfillment system 18.
  • Insurer 10 issues an instruction (typically via secure transmission), typically to their bank, to release funds to supplier 16 for the value of the aggregated line items on the order, against contract.
  • instruction typically via secure transmission
  • Output An instruction to release funds to supplier 16 is received, typically by the insurer's bank. The bank then releases the funds to supplier 16.
  • Step 4.7.4 Supplier's bank receives funds and notifies supplier of paid bill, and claims Mfillment system 18 is updated to reflect payment.
  • Input The insurer's bank releases funds to the supplier.
  • Step 4.8.1 Claims Mfillment system 18 provides "after Mfillment" service, typically white-labeled as insurer 10. to determine claimant satisfaction.
  • Input The good or service for the claim are delivered.
  • Activity Claims Mfilhnent system 18 would typically contact claimant 14.
  • Claimant 14 is typically contacted on behalf of insurer 10 and typically answers questions about the level of service received in the execution of the claim. (This can also lead to the offer of sell-on products and services.)
  • Step 4.8.1 would typically be an optional step. It could happen in parallel with step 4.7.1, and not necessarily after step 4.7.1 as shown in the figure.
  • a set of quantitative ratings about the service can typically be compiled and used for management reporting. Also a set of qualitative comments on suggestions for improving the service can typically be prepared. The ratings and comments can then be added to the supplier knowledge base.
  • Owner Claims Mfillment system 18, insurer 10.
  • Input Preferably all data captured though out the claims process.
  • Output A set of reports that can be used to negotiate improved contracts with suppliers 16, monitor activity and productivity etc.
  • claims Mfillment system 18 keeps a record of the state of each of the goods or services (including goods or services procured through claims Mfillment system 18 as part of a sub-set of an overall service) to be procured in relation to the respective supplier 16, the claim, claimant 14 and insurer 10.
  • claims Mfillment system 18 might provide only retail price information to claimant 14, but provide both retail and wholesale price information to insurer 10.
  • the present invention is not limited to providing pricing information in this manner. .
  • Claims Mf ⁇ Timent system 18 would comprise a processor (not illustrated) running software which implements the steps in FIGS. 2 and 3.
  • the specific steps in FIGS. 2 and 3 are examples, and not all of the steps, or all of the operations in each respective step, are necessary in all embodiments of the present invention.
  • many obvious variations of the flow chart in FIGS. 2 and 3 can easily be made, and it is intended for the present invention to encompass such obvious variations.
  • claims Mfillment system 18 can typically check with claimant 14 to ensure that the claim has been Mfilled (see, for example, step 4.8.1 in FIG. 3). By doing so, claim Mfillment system 18 can improve satisfaction of claimant 14.
  • claims Mfillment system 18 can typically allow for the use of an advanced search (see, for example, step 4.2.4 in FIG. 2).
  • an advanced search could be a search that uses pattern recognition and not only use word recognition to find "hits.”
  • the present invention is not limited to any particular way.
  • various embodiments of the present invention relate to non-catalog products/services, on-catalog products/services and on-contract products.
  • on-catalog products/services are those for which an exact match exists in a supplier catalog and for which there is a contract governing their procurement.
  • non-catalog products/services are those for which an exact match does not exist in a supplier catalog and for which there is no contract governing their procurement.
  • On-contract products are products that exists in a supplier catalog (meaning a contract exists for their procurement) or a supplier with whom contract or discounted rates have been agreed.
  • claimant 14 is provided with a product and/or service in. Mfillment of a claim.
  • claimant 14 could be provided with cash, or preferably an electronic voucher that can be used to purchase goods and/or services from suppliers 16.
  • claimant 14 in step 4.5.5 in FIG. 2, claimant 14 has refused the presented options for goods and/or services. Therefore, in this case, claimant 14 might be given an electronic voucher in Mfillment of the claim.
  • the electronic voucher might allow claimant 14 to purchase any goods and/or services from suppliers 16 that are offered.
  • claimant 14 would be restricted to purchasing only specific goods or services offered by suppliers 16 and that have some relationship to the type of item that was insured.
  • Various embodiments of the present invention relate to "white-labeling," which refers to presenting information to a third party using the colors and logo of, and the branding of, the party that the third party is being contacted on behalf of.
  • claims Mfillment system 18 “white labels" information presented by claims Mfillment system 18 to claimant 14
  • claims fulfillment system 18 presents the information using the colors and logo of, and branding of, insurer 10.
  • the present invention is not limited to the use of white- labeling. Instead, there are many different manners and formats in which information can be presented.
  • claims Mfillment system 18 provides significant benefits. For example, claims Mfillment system 18 enables control over Mfillment of the claim to be taken at an early stage by insurer 10. This has the effect of reducing claims leakage and reducing fraud potential. Moreover, claims Mfillment system 18 automates the procurement process, to thereby reduce procurement processing costs. Further, claims Mfillment system 18
  • Mfillment system 18 enforces more on-contract procurement, thereby increasing procurement leverage (across the community) and reducing procurement spending.
  • claims Mfillment system 18 makes significant improvements to cost, efficiency, customer service and delivery in MfMling an insurance claims.
  • the above embodiments of the present invention relate to an insurer which insures an item.
  • the insurer would typically be an insurance company.
  • the present invention is not limited to the insurer being an insurance company. Instead, the insurer could be virtually any type of company, organization, financial institution or entity winch provides insurance.
  • the above embodiments of the present invention relate to a representative of the insurer, such as representative 12 in FIG. 1.
  • a representative refers to an entity which acts on behalf of the insurer.
  • the representative would be an employee of the insurer, but the present invention is not limited to being an employee of the insurer.
  • the representative might be, for example, a contractor hired by the insurer. In some embodiments, it might be possible for the representative to be a software agent working on behalf of the insurer.
  • communication channels connect a claimant submitting an insurance claim for loss of an insured item, an insurer insuring the item, and suppliers, to a claims Mfillment system.
  • the claims Mfillment system automatically coordinates activities between the insurer, the suppliers and the claimant so that the claimant is provided with a claimant-selected product or service by at least one of the suppliers to MfiU the insurance claim.
  • the claimant confirms, selects or agrees that a specific product or service can be used to MfiU the insurance claims, the claimant's actions should be considered as "selecting" the product or service.
  • the claims Mfillment system "automatically" coordinates activities between the representative, the suppliers and the claimant.
  • the term “automaticaUy” indicates performance by a computer in an automated manner.
  • the claims Mfillment system coordinates activities between the insurer, the suppliers and the claimant via computer processing in accordance with data received from, and provided to, the insurer, the suppliers and the claimant by the claims Mfillment system.
  • the present invention relates to the use and management of electronic catalogs.
  • Electronic catalogs are known, and there are various known systems for using and managing electronic catalogs.
  • claims Mfillment system 18 could allow parties other than claimant 14 or insurer 10 to purchase goods or services from suppliers 16.
  • all insurance policy holders of insurer 10 might be allowed to purchase goods or services from suppliers 16, to thereby allow the policy holders to take advantage of the buying power provided by claims Mfillment system 18.
  • the filing of a claim by a policy holder would draw the policy holder to claims Mfillment system 18, and may be a catalyst for additional purchases, or future purchases by the policy holder through claims Mfillment system 18.
  • parties other than policy holders might be allowed to purchase goods or services through claims fulfillment system 18.
  • such other parties would be customers of insurer 10, or might be members of a community of users provided access to claims Mfillment system 18.
  • FIG. 4 is a diagram illustrating other parties 19 connected to claims Mfillment system 18 through a communication channel 17, according to an embodiment of the present invention. As indicated above, other parties 19 are allowed to electronically purchase goods or services from suppliers 16 through claims Mfillment system 18.
  • FIG. 5 is a diagram illustrating an overall architecture for implementing claims Mfillment system 18, according to an embodiment of the present invention.
  • claimant 14 a plurality of insurers 10 and a plurality of suppliers 16 are connected to claims fulfillment system 18 via the Internet 20.
  • claimant 14 accesses the Internet 20 via an Internet Service Provider (ISP) 22.
  • ISP Internet Service Provider
  • a loss adjuster 24 is shown as accessing claims Mfillment system 18 via a Wireless Application Protocol (WAP) or an ISP 26.
  • WAP Wireless Application Protocol
  • various insurers 10 might have a local catalog 28, while some suppfiers 16 might have a supplier private catalog 30. External hosted catalog services 31 might also be provided.
  • An insurer 10 might provide the capability for internal e-procurement 32. External hosted e-procurement 34 might also be provided.
  • Claims Mfillment system 18 could typically provide central services 36, such as hosted catalog services 36a, trading relationships 36b, routing 36c, data management 36d, hosted e- procurement 36e and translation 36f. Settlement services 37 might also be provided.
  • central services 36 such as hosted catalog services 36a, trading relationships 36b, routing 36c, data management 36d, hosted e- procurement 36e and translation 36f.
  • Settlement services 37 might also be provided.
  • claims Mfillment system 18 might also provide external services (added value) 38, trust service 40 and/or general directory services 42.
  • External services 38 might be, for example, logistics information, consumer information (i.e., comparisons of consumer goods), jewelry valuation services.
  • FIG. 5 represents only one of the many possible architectures and different types of services which might be implemented, and the present invention is not limited to this specific example.
  • various embodiments of the present invention wiU reduce claims leakage, reduce fraud and reduce procurement processing costs, as compared to traditional approaches to claims Mfillment.
EP01944645A 2000-06-21 2001-06-07 Automatisiertes schadensanspruchregulierungssystem Withdrawn EP1292896A4 (de)

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US59869300A 2000-06-21 2000-06-21
US598693 2000-06-21
PCT/US2001/040859 WO2001098914A1 (en) 2000-06-21 2001-06-07 Automated claims fulfillment system

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WO2001098914A1 (en) 2001-12-27
AU2001267033A1 (en) 2002-01-02

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