Patent Publication Number: US-2015081342-A1

Title: System and method to facilitate insurance workflow improvements

Description:
BACKGROUND 
     A claim professional working for an insurer may help process an insurance claim. For example, the claim professional might make a telephone call to discuss insurance coverage with a claimant and create a note in a claim file (e.g., an electronic record associated with the claim) that this step has been performed. Note that an insurance claim may be associated with a series of processing steps (e.g., a coverage determination, a liability assessment, a damages calculation, and an ultimate resolution) comprising a workflow. Moreover, a claim professional may notice potential improvement as he or she processes insurance claims. For example, a claim professional might realize that two similar steps could be combined into a single step to save time. It can be difficult, however, for an insurer to make use of such realizations in an efficient manner, especially when a relatively large number of claim professionals and/or processing locations are involved. In addition, the processing of insurance claims and other types of insurance activities may involve tens of thousands individual items and a large number of insurance entity employees, which can make even relatively minor improvements to an insurance workflow important. Moreover, different organizations within the insurer may have different workflows and/or different priorities with respect to implementing improvements. This can make it even more difficult to determine which potential improvements should be implemented by the insurer. It would therefore be desirable to provide systems and methods to facilitate insurance workflow improvements in an automated, efficient, and consistent manner. 
     SUMMARY OF THE INVENTION 
     According to some embodiments, systems, methods, apparatus, computer program code and means may provide a tool to facilitate insurance workflow improvements. In some embodiments, an indication of a suggested improvement to an insurance workflow may be received from a submitter&#39;s remote insurance claim processing terminal. A manager associated with the submitter may be automatically identified, and a message may be transmitted to the identified manager, the message including an identification of the submitter and information about the suggested improvement. Supplemental information associated with the suggested improvement may then be received from the manager and stored at a central workflow improvement platform along with the identification of the submitter and the indication of the suggested improvement. The indication of the suggested improvement and the supplemental information may then be automatically forwarded to one or more members comprising a suggestion review council. According to some embodiments, a potential sponsor for the suggested improvement may also be identified. 
     A technical effect of some embodiments of the invention is an improved and computerized method to facilitate insurance workflow improvements. With these and other advantages and features that will become hereinafter apparent, a more complete understanding of the nature of the invention can be obtained by referring to the following detailed description and to the drawings appended hereto. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is block diagram of a system according to some embodiments of the present invention. 
         FIG. 2  illustrates an insurance workflow improvement process according to some embodiments. 
         FIG. 3  illustrates a method that might be performed in accordance with some embodiments. 
         FIG. 4  illustrates an insurance workflow improvement submission interface according to some embodiments of the present invention. 
         FIG. 5  illustrates a submission view interface according to some embodiments of the present invention. 
         FIG. 6  illustrates a submission interface according to some embodiments of the present invention. 
         FIG. 7  illustrates a schedule for innovation counsel review interface according to some embodiments of the present invention. 
         FIG. 8  illustrates a submitted improvement interface according to some embodiments of the present invention. 
         FIG. 9  illustrates an insurance workflow improvement process according to some embodiments of the present invention. 
         FIG. 10  illustrates an insurance workflow improvement dashboard interface according to some embodiments of the present invention. 
         FIG. 11  illustrates an interface for a mobile device according to some embodiments of the present invention. 
         FIG. 12  illustrates an insurance workflow improvement process according to some embodiments of the present invention. 
         FIG. 13  is block diagram of an insurance workflow improvement tool or platform according to some embodiments of the present invention. 
         FIG. 14  is a tabular portion of a submitted workflow improvement database according to some embodiments. 
     
    
    
     DESCRIPTION 
     An insurance professional working for an insurer may help process an insurance claim, make underwriting decisions, etc. For example, a claim professional might send a letter to a claimant a pre-determined number of days after a claim is filed. Note that an insurance claim may be associated with a series of such processing steps (e.g., a coverage determination, a liability assessment, a damages calculation, and an ultimate resolution) comprising an insurance workflow. Moreover, a claim professional may notice a potential improvement as he or she processes insurance claims. For example, a claim professional might detect that a particular telephone prompt tends to confuse claimants. It can be difficult, however, for an insurer to make use of such realizations in an efficient manner, especially when a relatively large number of insurance items, claim professionals and/or processing locations are involved. 
     It would therefore be desirable to provide systems and methods to facilitate insurance workflow improvements in an automated, efficient, and consistent manner.  FIG. 1  is block diagram of a system  100  according to some embodiments of the present invention. In particular, the system  100  includes an insurance workflow improvement platform  150  that receives automobile insurance claim data from an insurance professional  110 . According to some embodiments, the insurance workflow improvement platform  150  may also receive information, such as an electronic file, from a client, an employee, or insurance agent. The insurance professional  110 , such as a claim handler, may transmit to the insurance workflow improvement platform  150  information about a suggest improvement to an insurance workflow which may then be stored in an improvement database  140 . The insurance workflow improvement platform  150  might be, for example, associated with a Personal Computers (PC), laptop computer, an enterprise server, a server farm, and/or a database or similar storage devices. The insurance workflow improvement platform  150  may, according to some embodiments, be associated with a business organization or an insurance provider. 
     According to some embodiments, an “automated” insurance workflow improvement platform  150  may facilitate insurance claim workflow improvements using a Graphical User Interface (“GUI”)  152 . As used herein, the term “automated” may refer to, for example, actions that can be performed with little or no human intervention. The insurance professional  110  may interact with the graphical user interface  152  to submit a suggested insurance workflow improvement and information about the suggestion may be provided to other parties  160 , such as a manager or members of an innovation council. According to some embodiments, an engine  154  may facilitate the processing of a suggested improvement. The insurance workflow improvement platform  150  might also transmit information to an external automated system  170 , such as a report generator, workflow application, or email notification system. 
     As used herein, devices, including those associated with the insurance workflow improvement platform  150  and any other device described herein, may exchange information via any communication network which may be one or more of a Local Area Network (LAN), a Metropolitan Area Network (MAN), a Wide Area Network (WAN), a proprietary network, a Public Switched Telephone Network (PSTN), a Wireless Application Protocol (WAP) network, a Bluetooth network, a wireless LAN network, and/or an Internet Protocol (IP) network such as the Internet, an intranet, or an extranet. Note that any devices described herein may communicate via one or more such communication networks. 
     The insurance workflow improvement platform  150  may store information into and/or retrieve information from the improvement database  140 . The improvement database  140  may be locally stored or reside remote from the insurance workflow improvement platform  150 . Although a single insurance workflow improvement platform  150  is shown in  FIG. 1 , any number of such devices may be included. Moreover, various devices described herein might be combined according to embodiments of the present invention. For example, in some embodiments, the claim insurance workflow improvement platform  150  and improvement database  140  might be co-located and/or may comprise a single apparatus. 
     The elements of the system  100  may be used to implement a workflow improvement program. For example,  FIG. 2  illustrates an insurance workflow improvement program or process  200  according to some embodiments. The process begins with the generation of an idea  210  to improve insurance workflow. For example, a claim professional might identify an opportunity to update Medicare data more efficiently. The idea and solution may also undergo further development  220  with a fast track handler and/or a team leader to map out details and describe the solution. 
     The idea may be submitted  230  to an improvement tool  240  that will facilitate review and implementation  250  of the idea. In particular, an innovation process owner review  260  may finalize development of the idea/solution to present to an innovation council for review  270 . The innovation council may approve and prioritize ideas and the process  200  may then conclude with implementation of the solution  280 . 
       FIG. 3  illustrates a method that might be performed by some or all of the elements of the system  100  described with respect to  FIG. 1  and/or the process  200  of  FIG. 2 . The flow charts described herein do not imply a fixed order to the steps, and embodiments of the present invention may be practiced in any order that is practicable. Note that any of the methods described herein may be performed by hardware, software, or any combination of these approaches. For example, a computer-readable storage medium may store thereon instructions that when executed by a machine result in performance according to any of the embodiments described herein. 
     At S 310 , a communication device may receive, from a submitter&#39;s remote insurance processing terminal, an indication of a suggested improvement to an insurance workflow. The received indication of a suggested improvement to the insurance workflow might, for example, include one or more of: (i) an explanation of opportunity, (ii) an estimated impact of problem, (iii) a proposed solution, (iv) a primary improvement area, (v) an indication of involved individuals, (vi) a site, and (vii) a remote worker indication. 
     At S 320 , a manager associated with the submitter may be automatically identified. For example, an employee identifier of the submitter may be used to look up the manager&#39;s identifier in an employee database. As used herein, the term “manager” may refer to any person or entity that may provide additional information about a suggestion, including a boss, team leader, or supervisor. At S 330 , a message may be automatically transmitted to the identified manager, the message including an identification of the submitter and information about the suggested improvement. For example, an email message might be transmitted to the manager, and the email message might include a link that, when activated by the manager, causes a display of a workflow improvement application. 
     At S 340 , supplemental information associated with the suggested improvement may be received from the manager. For example, the manager might indicate whether or not he or she thinks the suggested improvement is feasible. At S 350 , the supplemental information may be stored at a central workflow improvement platform along with the identification of the submitter and the indication of the suggested improvement. Note that, according to some embodiments, the submitter is able to access a first portion of the supplemental information without being able to access a second portion (e.g., the information submitted by his or her manager). Such an approach may, for example, encourage a manager to provide honest feedback about a suggested improvement. 
     According to some embodiments, a process owner may be assigned to the suggested improvement. The process owner might, for example, provide one or more of: (i) a benefits calculation, (ii) a review date, (iii) an implementation date, (vi) a date of decline, (vii) action item descriptions, (viii) a sponsor identifier, (ix) a business lead, (x) a claims organization selection, (xi) a field department selection, (xii) a status, (xiii) a reason for closing, and (xiv) recognitions (e.g., recognizing and/or rewarding the submitter). 
     At S 360 , the indication of the suggested improvement and the supplemental information may be automatically forwarded or routed to a plurality of members comprising a suggestion review council. After the suggestion review council considers the suggested improvement (along with other improvements), an indication of approval (or disapproval) may be received from the suggestion review council. If approved, the insurance workflow may then be adjusted in accordance with the suggested improvement. According to some embodiments, this process might include identifying a potential sponsor at S 370  for the suggested improvement. As used herein, the term “sponsor” might refer to any person or entity who may help implement and/or pay for the suggested improvement. Some embodiments further comprise retrieving the supplemental information at the central workflow improvement platform along with the identification of the submitter the indication of the suggested improvement, and transmitting the indication of the suggested improvement and the supplemental information to the sponsor. The sponsor may, for example, oversee and/or fund implementation of an approved suggestion. 
     According to some embodiment, a plurality of submitted improvements may be automatically analyzed to identify potentially related submitted improvements. For example, the analysis may look for redundant suggested improvements, categorized suggested improvements, and/or alternate suggested improvements (e.g., two different ways to solve the same problem in the insurance claim workflow). 
     Some or all of the steps in improvement process may be implemented via one or more GUIs. For example,  FIG. 4  illustrates an insurance workflow improvement submission interface  400  according to some embodiments of the present invention. The interface  400  includes an opportunity text input area  402  that may be used by a claim professional to define the problem he or she is trying to solve. The interface  400  may also include an estimate impact of problem text input area  404  that may be used to explain the scope of the problem (e.g., the problem causes a 30 minute delay in the processing of 2% of all claims that are received). A proposed solution text input area  406  may be used to define how the problem should be solved (e.g., an additional question should be included in a questionnaire given to claimants). The interface might further include selections  408  associated with the primary improvement area, other individuals that are involved, a site (e.g., a claims processing site in Tennessee), a supervisor, and/or whether or not a remote worker is involved. When the information is completed, the claims professional may select “OK” to submit the suggestion or cancel to stop the process. 
     Such an approach may engage and empower claim professionals in the process of identifying problems and developing and contributing to solutions. The best ideas may come from the people who execute a workflow on a daily basis and therefore have experience and insight that maybe key to finding lasting, sustainable improvements for an insurance organization. 
     Since a relatively large number of suggestions might be received from a substantial number of claim professionals, some embodiments provide for the generation and/or display a report associated with a plurality of suggested improvements based at least in part on: (i) suggested improvement status, (ii) claims site, (iii) line of business, (iv) submitter, (v) date, and/or (vi) importance. For example,  FIG. 5  illustrates one example of a submission view interface  500  according to some embodiments of the present invention. In this case, a claim professional, manager, promoter, sponsor, etc. might view submissions based on identifier  502 , submitter  504 , submission date  506 , claim center site  508 , and/or claims organization  510  (e.g., group benefits claims or automobile claims). 
     After a claim professional submits a suggested improvement, a manager or process owner may provide additional information about the idea. For example,  FIG. 6  illustrates a submission interface  600  according to some embodiments of the present invention. Such a display  600  might be provided, for example, in an automatic email asking for manager comments  602 , process owner comments  604 , and/or a benefits calculation  606  (e.g., the idea will take few resources to implement and will result in substantial quality improvements). 
     After an initial review is complement by a manager and/or process owner, the submission may be schedule to be reviewed by an innovation council. For example,  FIG. 7  illustrates a schedule for innovation counsel review interface  700  according to some embodiments of the present invention. A first area  702  of the interface  700  may list multiple submitted ideas (e.g., an identifier and title). When one of the ideas is selected, a second area  704  of the interface  700  may be used to enter an innovation council review date. At this point, an indication of the review date might be automatically transmitted to the submitter in an email. 
     During the review process, a sponsor may be assigned, the council might approve or decline submission, and  FIG. 8  illustrates a submitted improvement interface  800  that may be used to track information about a submitted idea according to some embodiments of the present invention. In particular, the interface  800  includes selections  802  indicating the date a process owner began to review the idea, the date of a council decision, the current status, whether or not the submitter has be recognized and/or rewarded, etc. The interface  800  also includes a text input area  804  that may be used to keep tract of action items associated with the submitted idea (e.g., contact the Information Technology group to determine if the submitted idea can even be implemented). 
     The interface  800  of  FIG. 8 , or any of the other interfaces described herein, may be used to search for previously submitted improvements. For example, someone considering entering a new idea or a potential sponsor might search a database to locate submissions using keywords, tags, categories, and other advanced search features to text, video, audio, and other types of data associated with his or her search. 
       FIG. 9  illustrates an insurance workflow improvement process  900  according to some embodiments of the present invention. During idea development and submission  910 , an employee may identify an opportunity, measure the impacts, hypothesize a solution or root cause, engage his or her manager and/or site champion for feedback, and eventually submit the idea in accordance with any of the embodiments described here. During innovation process owner review  920 , a manager may review the submission and provide comments to determine if this is a unique opportunity (not a duplicate idea) and has the necessary detail to be brought forward to the innovation committee for review. In some cases, the manager might ask the original submitted to provide additional details about the problem and/or solution. 
     The innovation council  930  may review the submission during a bi-weekly meeting to determine if the submission should move forward for implementation, be declined, or if the idea requires additional analysis and/or details. If the idea should move forward, pursuing sponsorship  940  may include identifying and engaging a sponsor for the idea. Sponsorship might involve supporting the idea through resources, funding, guidance and/or endorsement of the suggested improvement to the workflow. The idea may then be implemented  950  by having the process owner track the progress of the idea as it progresses. A business lead may be identified and a scope statement associated with the changes may be developed. 
     Thus, a submitted improvement to an insurance workflow will progress through various stages during the insurance workflow improvement process  900 . To help track submissions,  FIG. 10  illustrates an insurance workflow improvement dashboard interface  1000  according to some embodiments of the present invention. The dashboard interface  1000  displays, for a number of different processing sites, how many ideas have been submitted, are scheduled for innovation council review, have been approved by the innovation council, sponsored, and eventually implemented. Some embodiments, such as the dashboard interface  1000 , have been described herein as being accessed via a PC or laptop computer. Note, however, that embodiments may be implemented using any device capable of executing the disclosed functions and steps. For example,  FIG. 11  illustrates an interface  1100  for a mobile device in accordance with some embodiments described herein. In particular, the display  1100  includes a graphical user interface including information about suggested improvements to an insurance claim workflow. 
     Thus, embodiments may provide claim professionals with the tools they need to improve workflows. As a result, the quality of claim processing may be improved and/or productivity may be increased. Note that embodiments may help reduce different types of waste in an insurance workflow, including defects (e.g., data errors), transportation (moving physical files), motion (switching been applications), over-processing (multiple unneeded sign-offs), over-production (reports that go unread), inventory (filing cabinets filled with old documents), delay (waiting for return telephone calls), and/or behavioral (conflicting goals and objectives). 
       FIG. 12  illustrates an insurance workflow improvement process  1200  according to some embodiments of the present invention. At  1212 , an innovation process owner may work with a submitter to prepare an idea to be reviewed. At  1214 , the innovation process owner brings the idea forward to the innovation council, and the council may then review and discuss the idea at  1222 . If the idea is not recommended by the council at  1224 , the innovation process owner explains the decision to the submitter at  1216  and the process  1200  ends. 
     If the idea is recommended by the council at  1224 , the council works to identify a sponsor for the idea at  1226 . At  1218 , the innovation process owner communicates with the improvement sponsor who may then decide how to implement the idea at  1232 . The improvement sponsor may assign a project team to lead implementation of the idea at  1234 , and the innovation may track progress and communicate with the original submitter at  1250  until the idea is implemented (and the insurance workflow has been improved). 
     The embodiments described herein may be implemented using any number of different hardware configurations. For example,  FIG. 13  is block diagram of an insurance workflow improvement tool or platform  1300  that may be, for example, associated with the system  100  of  FIG. 1 . The insurance workflow improvement platform  1300  comprises a processor  1310 , such as one or more commercially available Central Processing Units (CPUs) in the form of one-chip microprocessors, coupled to a communication device  1320  configured to communicate via a communication network (not shown in  FIG. 13 ). The communication device  1320  may be used to communicate, for example, with one or more remote devices (e.g., associated with claim professionals, managers, and/or members of an innovation council). The insurance workflow improvement platform  1300  further includes an input device  1340  (e.g., a mouse and/or keyboard to enter and adjust information about a submitted idea) and an output device  1350  (e.g., a computer monitor to display a graphical user interface and/or reports). 
     The processor  1310  also communicates with a storage device  1330 . The storage device  1330  may comprise any appropriate information storage device, including combinations of magnetic storage devices (e.g., a hard disk drive), optical storage devices, mobile telephones, and/or semiconductor memory devices. The storage device  1330  stores a program  1312  and/or an insurance workflow improvement engine  1314  for controlling the processor  1310 . The processor  1310  performs instructions of the programs  1312 ,  1314 , and thereby operates in accordance with any of the embodiments described herein. For example, the processor  1310  may receive an indication of a suggested improvement to an insurance claim workflow from a submitter&#39;s remote insurance claim processing terminal. A manager associated with the submitter may be automatically identified, and the processor  1310  may transmit a message to the identified manager, including an identification of the submitter and information about the suggested improvement. The processor  1310  may then receive supplemental information associated with the suggested improvement from the manager to be stored along with the identification of the submitter and the indication of the suggested improvement. The indication of the suggested improvement and the supplemental information may then be automatically forwarded by the processor  1310  to a plurality of members comprising a suggestion review council. 
     The programs  1312 ,  1314  may be stored in a compressed, uncompiled and/or encrypted format. The programs  1312 ,  1314  may furthermore include other program elements, such as an operating system, clipboard application a database management system, and/or device drivers used by the processor  1310  to interface with peripheral devices. 
     As used herein, information may be “received” by or “transmitted” to, for example: (i) the insurance workflow improvement platform  1300  from another device; or (ii) a software application or module within the insurance workflow improvement platform  1300  from another software application, module, or any other source. 
     In some embodiments (such as shown in  FIG. 13 ), the storage device  1330  further stores an insurance workflow improvements database  1400 , templates  1360  (e.g., templates of how a benefits analysis should be formatted), and duplicate rules  1370  (e.g., rules that define when a submitted idea should be flagged as being the same as a previously submitted idea based on tags, keywords, language analysis, etc.). An example of a database that may be used in connection with the insurance workflow improvement platform  1300  will now be described in detail with respect to  FIG. 14 . Note that the database described herein is only one example, and additional and/or different information may be stored therein. Moreover, various databases might be split or combined in accordance with any of the embodiments described herein. For example, the templates  1360  and/or duplicate rules  1370  might be combined and/or linked to each other within the program  1312  and/or insurance workflow improvement engine  1314 . 
     Referring to  FIG. 14 , a table is shown that represents the insurance workflow improvements database  1400  that may be stored at the insurance workflow improvement platform  1300  according to some embodiments. The table may include, for example, entries identifying workflow improvement ideas submitted by claim professionals. The table may also define fields  1402 ,  1404 ,  1406 ,  1408 ,  1410  for each of the entries. The fields  1402 ,  1404 ,  1406 ,  1408 ,  1410  may, according to some embodiments, specify: a workflow improvement identifier  1402 , a title  1404 , a date  1406 , a submitter identifier  1408 , a manager identifier  1410 , and a status  1412 . The insurance workflow improvements database  1400  may be created and updated, for example, based on information received from claim professionals, managers, and/or members of an innovation council. 
     The workflow improvement identifier  1402  may be, for example, a unique alphanumeric code identifying an idea to improve insurance claim processing. The title  1404  may describe the idea and the date  1406  may indicate when the idea was submitted. The submitter identifier  1408  may identify the claim profession who submitted the idea and the manager identifier  1410  may indicate his or her supervisor (who may, according to some embodiments, be asked to provide supplemental information about the suggested improvement). The status  1412  may indicate the current state of the submitted idea as it flows through the insurance workflow improvement program (e.g., the submitted idea might be pending, under review by the innovation council, implemented, denied, etc.). 
     Thus, embodiments described herein may provide insurance professionals with the ability to submit new ideas to improve an insurance workflow. Moreover, the submitted ideas can be reviewed, tracked, and/or prioritized in an automated and efficient manner. 
     The following illustrates various additional embodiments of the invention. These do not constitute a definition of all possible embodiments, and those skilled in the art will understand that the present invention is applicable to many other embodiments. Further, although the following embodiments are briefly described for clarity, those skilled in the art will understand how to make any changes, if necessary, to the above-described apparatus and methods to accommodate these and other embodiments and applications. 
     Although specific hardware and data configurations have been described herein, note that any number of other configurations may be provided in accordance with embodiments of the present invention (e.g., some of the information associated with the databases described herein may be combined or stored in external systems). 
     Applicants have discovered that embodiments described herein may be particularly useful in connection with insurance claim processing workflows. Note, however, that other types of insurance workflows may also benefit from the invention (e.g., underwriting decisions). 
     According to some embodiments, an insurer may set forth a goal or “challenge” to a group of employees (e.g., to reduce claim processing time by ten minutes on average). The employees may then submit suggestions, review suggestions made by other employees, and/or provide comments (e.g., assign a rating) and/or changes to suggestions made by other employees. In this way, a collaborative approach may be employed to eventually identify one or more potential solutions and/or improvements. 
     According to other embodiments, employees of an insurer who deal with customers may have the ability to “flag” or otherwise mark points in an insurance process workflow when difficulties arise. For example, if a customer becomes confused by an explanation given during a telephone call, the employee can click an icon to indicate that interaction did not go smoothly (and perhaps provide a brief description of the problem). The insurer can collect and analyze these indications over a period of time to determine where an insurance workflow process may be improved. 
     The present invention has been described in terms of several embodiments solely for the purpose of illustration. Persons skilled in the art will recognize from this description that the invention is not limited to the embodiments described, but may be practiced with modifications and alterations limited only by the spirit and scope of the appended claims.