Patent Document ID: 9378527
Application ID: 12099388
Patent Flag: 1

Claim One:
1. A computer system comprising: a data storage module configured to receive, store, and provide access to indeterminate data and determinate data corresponding to historical claim transactions and to current claim transactions, and data indicative of categories of claims that are highly unlikely to be questionable; a computer processor configured to: receive determinate data corresponding to the historical claim transactions and the current claim transactions; receive raw indeterminate data corresponding to the historical claim transactions and the current claim transactions; extract, from the raw indeterminate data by an indeterminate data capture module, indeterminate data comprising at least one of claim handler notes, claim handler audio files, witness notes, witness audio files, claimant notes, and claimant audio files, the indeterminate data capture module including a natural language processing application to mine opinions from narrative text notes and a speech recognition application to analyze audio files to detect a speaker's state of mind; train, by a model training component, a predictive model component based on the determinate data and the extracted indeterminate data related to the historical claim transactions, thereby providing a trained predictive model component; adapt the predictive model component to changing patterns of questionable claim transactions by periodically updating the predictive model component based on new determinate data and new extracted indeterminate data; compare, by a screening module, a current claim transaction to the data indicative of categories of claims that are highly unlikely to be questionable and categorize, based on the comparing, each of said current claim transactions as one of a current claim suitable for predictive analysis when the current claim transaction does not correspond to the categories of claims that are highly unlikely to be questionable and a current claim not suitable for predictive analysis when the current claim transaction corresponds to at least one of the categories of claims that are highly unlikely to be questionable; determine, by the predictive model component coupled to the data storage module and based on the indeterminate data and the determinate data, whether to identify a one of said current claim transactions categorized as suitable for predictive analysis for referral to an investigation unit; an output device, coupled to the computer processor, configured to output an indication of whether said one of said current claim transactions should be referred to the investigation unit, said output generated in response to application of data for said one of said current claim transactions to the trained predictive model component and said screening module; and a routing module configured to direct workflow corresponding to said one of said current claim transactions based on the output from the output device, to one of an investigative analyst computer and a field investigator computer.