Claim adjustment quality review

Details Claim adjustment quality review Claim adjustment quality review

G - Physics

06

Q

G06Q 40/00 (2006.01)

Patent

CA 2560710

The present invention relates to a financial reinspection system that allows for efficient identification of financial issues regarding claim disbursements. One embodiment of the present invention is a database system in which all claims are tracked. Each tracked claim includes a plurality of characteristics or data items such as the identity of the claim adjuster, the identity of an assigned contractor, the location of the claim, the total claim amount, etc. The claims can be searched and sorted according to any one of the data items such that patterns or potential problems can easily be identified in an efficient manner. In addition, the system includes the ability to set rules which can be used to perform particular searches automatically in real time. The results generated from the rules can then be used to further identify financial problems. The specific process utilized by the system embodiment includes analyzing data items, formulating and processing rules in real time, and implementing reinspections based on the results generated by the rules. The analysis of data items includes identifying particular data items or combinations of data items which may be more likely to be associated with financial claim problems. The formulation and processing of rules in real time includes any type of real time search with one or more of the data items of the claims. And likewise, the implementation of reinspections includes any type of actions taken as a result of the information learned from the rule results.

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