Patent ID: 7769624
Filing Date: 2010-08-03
Classification: G06Q

Abstract:
1. A computer implemented method for providing virtual mentoring to an insurance claim professional of an insurance organization, comprising: electronically storing insurance based knowledge data relating to mentoring an insurance claim professional in a computer knowledge database determined by: electronically storing data obtained from conducting discussions with designated leaders of multiple disciplines and advisory entities within the organization about knowledge relating to the mentoring; electronically storing data determined from identifying various insurance based Quality Management (QM) results and outcomes considered by the organization based on the discussions; and electronically storing data from converting the insurance based QM results and outcomes into the knowledge data for storing in the computer knowledge database; electronically storing insurance based expert data determined from consulting experts on the identified insurance based QM results and outcomes within the organization to obtain each expert's individual experience and intellectual capital on the identified insurance based QM results and outcomes, and converting the expert's individual experience and intellectual capital into the expert data; electronically storing additional insurance based knowledge data relating to the mentoring determined through an exchange or extraction of information on designated topics that are presented in designated communications with members of the organization, and converting the exchanged or extracted information into the additional knowledge data for storing in the knowledge database; retrieving the stored insurance based knowledge data from the computer knowledge database, the stored insurance based expert data, and the stored additional insurance based knowledge data and compiling detailed functional insurance based best practices and techniques of top functional experts based on the obtained individual experiences and intellectual capital, on the identified insurance based QM results/outcomes, and on the additional insurance knowledge data; data mining and retrieving, by a computer, insurance based claim data of a plurality of claims of the insurance organization relating to the insurance based knowledge data and the additional insurance based knowledge data; performing, by the computer, predictive modeling of the insurance based claim data, to implement at least one of identifying claims with potential for opportunity to improve outcomes, identifying which customers of the insurance organization will have the potential for increased future medical costs, targeting specialized interventions to improve health care, reducing future health care costs, and providing efficient and effective referrals for specialty resource reviews, wherein the predictive modeling comprises at least one model that is updatable based on additions or modifications to the stored insurance based claim data; determining, by the computer, an experience of the insurance claim professional within the organization when present, wherein the experience is determined by at least one of a skill set, an area of expertise, a mob code, a length of service, a position, a level of expertise, a level experience and an exposure to insurance claims; and based on the experience of the insurance claim professional, providing, by the computer, the mentoring for the insurance claim professional by interactively guiding the insurance claim professional to process an identified claim responsive to at least one of the insurance based claim data, the insurance based knowledge data, the insurance based expert data, the additional insurance based knowledge data, predictive logic, the insurance based QM results and outcomes, and the insurance based functional best practices, to provide training information to the insurance claim professionals of the organization.