Abstract: A data analytics system may include a first risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a first risk relationship provider. Similarly, a second risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a second risk relationship provider. A back-end application computer server may include a data mining engine that analyzes a set of electronic records in the first and second risk relationship data stores to identify flags corresponding to risk drivers. A predictive analytics engine may then calculate a risk score associated with the set of electronic records based on the associated entity attribute values and the identified flags corresponding to risk drivers. An insight platform may automatically generate a recommended action for the enterprise to lower the calculated risk score.

Abstract: A data analytics system may include a first risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a first risk relationship provider. Similarly, a second risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a second risk relationship provider. A back-end application computer server may include a data mining engine that analyzes a set of electronic records in the first and second risk relationship data stores to identify flags corresponding to risk drivers. A predictive analytics engine may then calculate a risk score associated with the set of electronic records based on the associated entity attribute values and the identified flags corresponding to risk drivers. An insight platform may automatically generate a recommended action for the enterprise to lower the calculated risk score.

Abstract: A data analytics system may include a first risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a first risk relationship provider. Similarly, a second risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a second risk relationship provider. A back-end application computer server may include a data mining engine that analyzes a set of electronic records in the first and second risk relationship data stores to identify flags corresponding to risk drivers. A predictive analytics engine may then calculate a risk score associated with the set of electronic records based on the associated entity attribute values and the identified flags corresponding to risk drivers. An insight platform may automatically generate a recommended action for the enterprise to lower the calculated risk score.

Abstract: A data analytics system may include a first risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a first risk relationship provider. Similarly, a second risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a second risk relationship provider. A back-end application computer server may include a data mining engine that analyzes a set of electronic records in the first and second risk relationship data stores to identify flags corresponding to risk drivers. A predictive analytics engine may then calculate a risk score associated with the set of electronic records based on the associated entity attribute values and the identified flags corresponding to risk drivers. An insight platform may automatically generate a recommended action for the enterprise to lower the calculated risk score.

Abstract: A data analytics system may include a first risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a first risk relationship provider. Similarly, a second risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a second risk relationship provider. A back-end application computer server may include a data mining engine that analyzes a set of electronic records in the first and second risk relationship data stores to identify flags corresponding to risk drivers. A predictive analytics engine may then calculate a risk score associated with the set of electronic records based on the associated entity attribute values and the identified flags corresponding to risk drivers. An insight platform may automatically generate a recommended action for the enterprise to lower the calculated risk score.

Abstract: A segmentation platform is interposed between an intake server and remote user-accessible computers. The segmentation platform includes a model training computer processor configured to generate a predictive model for determining a segment corresponding to received data sets based upon claim segment rules and historical data sets stored in data storage devices. The segmentation platform may be configured to dynamically update workload data corresponding to a plurality of users, and responsive to that updating and based upon application of the predictive model, segment the received current data sets and transmit electronic claim files to respective remote user-accessible computing devices. The predictive model is continually adapted through activation of the model training component to update the predictive model with new current claim data sets.

Abstract: A data analytics system may include a first risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a first risk relationship provider. Similarly, a second risk relationship data store containing electronic records that represent a plurality of risk relationships between the enterprise and a second risk relationship provider. A back-end application computer server may include a data mining engine that analyzes a set of electronic records in the first and second risk relationship data stores to identify flags corresponding to risk drivers. A predictive analytics engine may then calculate a risk score associated with the set of electronic records based on the associated entity attribute values and the identified flags corresponding to risk drivers. An insight platform may automatically generate a recommended action for the enterprise to lower the calculated risk score.

Abstract: The present application is directed to systems and methods adapted to automatically analyze insurance claim records, automatically identify risk drivers, automatically identify how these risk drivers affect insurance claim outcomes and automatically provide risk mitigation strategies that improve insurance claim outcomes.

Abstract: A segmentation platform is interposed between an intake server and remote user-accessible computers. The segmentation platform includes a model training computer processor configured to generate a predictive model for determining a segment corresponding to received data sets based upon claim segment rules and historical data sets stored in data storage devices. The segmentation platform may be configured to dynamically update workload data corresponding to a plurality of users, and responsive to that updating and based upon application of the predictive model, segment the received current data sets and transmit electronic claim files to respective remote user-accessible computing devices. The predictive model is continually adapted through activation of the model training component to update the predictive model with new current claim data sets.

Abstract: A segmentation platform is interposed between an intake server and remote user-accessible computers. The segmentation platform may include a model training computer processor configured to generate a predictive model for determining a segment corresponding to received data sets based upon claim segment rules and historical data sets stored in data storage devices. The segmentation platform may be configured to dynamically update workload data corresponding to a plurality of users, and responsive to that updating and based upon application of the predictive model, segment the received current data sets and transmit electronic claim files to respective remote user-accessible computing devices. The predictive model is continually adapted through activation of the model training component to update the predictive model with new current claim data sets.

Abstract: Detailed resource information, including a resource preference indication, may be stored for a set of potentially available resource units. The system may store, for each resource unit, at least one performance metric score value. For each resource unit, a back-end application computer server may automatically access the performance metric score value in a resource performance metric computer store. Based on the at least one performance metric score value, the back-end application computer server may automatically update a state of the resource preference indication in an available resource computer store and automatically arrange to adjust at least one output parameter in accordance with the updated state of the resource preference indication. According to some embodiments, a diagnosis grouping platform groups similar claims handled by the panel of medical service providers, and a rating platform reviews performance of each medical service provider in the panel based on groups of similar claims.

Abstract: A segmentation platform is interposed between an intake server and remote user-accessible computers. The segmentation platform may include a model training computer processor configured to generate a predictive model for determining a segment corresponding to received data sets based upon claim segment rules and historical data sets stored in data storage devices. The segmentation platform may be configured to dynamically update workload data corresponding to a plurality of users, and responsive to that updating and based upon application of the predictive model, segment the received current data sets and transmit electronic claim files to respective remote user-accessible computing devices. The predictive model is continually adapted through activation of the model training component to update the predictive model with new current claim data sets.

Abstract: According to some embodiments, a triage platform may receive data indicative of a disability insurance claim submitted in connection with a disability insurance policy, including at least one claim characteristic. The triage platform may determine, based on the claim characteristic, a claim segment to be associated with the disability insurance claim. A claim handler may be assigned to the disability insurance claim in accordance with the determined claim segment. Information about the disability insurance claim may then be automatically routed to the assigned claim handler.