Patent ID: 8010391
Filing Date: 2011-08-30
Classification: G06Q

Abstract:
1. A method of processing insurance claims relating to an insured, comprising: a computer system receiving at least one notice of an event or condition that gives rise to a claim for payment under a first insurance policy covering the insured; creating a node hierarchy, wherein creating the node hierarchy comprises: the computer system creating a claim management case node relating to the insured at a claim management case level; the computer system creating one or more policy nodes at a policy level separate from and below the claim management case level, each of at least one of the policy nodes corresponding to an insurance policy covering the insured; the computer system creating one or more coverage nodes at a coverage level separate from and below the policy level, each of at least one of the coverage nodes corresponding to an insurance base coverage or a rider under one of the insurance policies covering the insured; the computer system attaching at least one of the coverage nodes at the coverage level to the at least one of the policy nodes at the policy level; the computer system creating two or more benefit nodes at a benefit level, each of at least two of the benefit nodes corresponding to a benefit under at least one of the insurance policies associated with the claim management case or corresponding to a benefit under at least one of the insurance base coverages or riders associated with one of the insurance policies; and the computer system attaching at least a first one of the benefit nodes to at least one of the policy nodes of the policy level and attaching at least a second one of the benefit nodes to at least one of the coverage node of the coverage level, wherein the level of the node to which each of the first one of the benefit nodes and the second one of the benefit nodes is attached depends on whether the benefit corresponding to the benefit node pertains to a policy as a whole or pertains to a particular base coverage or a rider under one of the policies; the computer system performing, at a claim management case level, using the claim management case node, at least one process for the claim management case, wherein the at least one process performed at the claim management case level applies to all of the policies and all of the coverages associated with the claim management case; the computer system performing, at the policy level or the coverage level, using at least one of the policy nodes or one of the coverage nodes, at least one process for the claim management case, wherein the at least one process performed at the policy level or at the coverage level applies to only one of the policies associated with the claim management case or to only one of the coverages associated with the claim management case; the computer system performing, at the benefit level, using at least one of the benefit nodes, at least one process for the claim management case, wherein the at least one process performed at the benefit level applies to only one of the benefits associated with the claim management case; the computer system performing at least one rendezvous, wherein at least one rendezvous comprises: a queued item waiting for a response from a policy administration system; the queued item receiving response data from the policy administration system; the computer system comparing the response data from the policy administration system to expected data; and the computer system determining that a rendezvous is effective based on a match of the response data and the expected data; and adjudicating at least one claim under one or more of the policies.