Abstract: A system and method for automated claims data auditing. The system may include a memory device configured to store a plurality of audit questions associated with audit question metadata, to store a plurality tasks associated with task metadata, to store a plurality workflows associated with workflow metadata and to store a plurality surveys associated with survey metadata. The system may include a processor configured to generate an audit template based on at least a subset of the plurality of surveys and the plurality of tasks. The processor may further be configured to generate a copy of the audit template for use in a project. The system may include a receiver configured to receive assignment instructions associated with the project, wherein the assignment instructions assign resources to the project.

Abstract: A computer system for processing data related to a group benefit insurance policy issued to a policyholder to extend coverage to individual insureds who are members of a group and having a critical illness benefit includes a data storage device storing data indicative of: a plurality of categories of medical diagnoses; a plurality of diagnoses associated with each of the categories; a first occurrence value; a second occurrence value; and history of insureds related to the critical illness benefit by the insured. The system is configured for payment of a claim in the first occurrence value for a first diagnosis of an insured in a category, and the second occurrence value, which may be not more than the first occurrence value, for a second diagnosis of the insured in the same category.

Abstract: A method and system for converting XML files to and from files in a data format based on hierarchies in real-time. A method for converting from XML to the data format based on hierarchies includes: applying a stylesheet to at least one XML file thereby generating at least one data record in an intermediate format and including information included in the at least one XML file; and, translating the at least one record in the intermediate format to the data format based on hierarchies. A method for converting from a data format based on hierarchies to XML includes: translating at least one record including information stored in the file format based on hierarchies to an intermediate format; and, applying a stylesheet to the at least one record in the intermediate format thereby generating at least one XML file being indicative of the information and suitable for transmission.

Abstract: A computer system for processing data related to a group benefit insurance policy issued to a policyholder to extend coverage to individual insureds who are members of a group and having a critical illness benefit includes a data storage device storing data indicative of: a plurality of categories of medical diagnoses; a plurality of diagnoses associated with each of the categories; a first occurrence value; a second occurrence value; and history of insureds related to the critical illness benefit by the insured. The system is configured for payment of a claim in the first occurrence value for a first diagnosis of an insured in a category, and the second occurrence value, which may be not more than the first occurrence value, for a second diagnosis of the insured in the same category.

Abstract: The invention relates generally to data analysis, and to systems and methods for the computation of the volatility of a loss. The system comprises a module for receiving a data parameter, a database for storing the parameter, a computerized predictive model, and a business logic processor for executing the predictive model. The volatility is used to, among other things, determine an appropriate work flow for handling the loss.

Abstract: A computer system or network of computer systems is configured to administer investment accounts issued by an issuer. The investment accounts include equity based investments having associated guarantees, such as variable annuities during the accumulation phase. The investment accounts further include fixed income investments with a guarantee, such as a guaranteed minimum accumulation benefit. The fixed income accounts may sell may sell equity put spreads to the variable annuity accounts, and the variable annuity accounts may sell equity all spreads to the fixed income accounts. An independent pricing service may determine pricing for non-traded instruments.

Abstract: A computer-implemented method for determining payroll related insurance premiums includes receiving at a server computer first payroll data relating to a first employer in a first data format from a first source and second payroll data in a second data format from a second source. At least one of the first source and the second source includes an employer payroll computer system at an employer location. The received data is read and extracted by a utility program at the employer location. The method further includes conditioning the received payroll data into uniform format payroll data; filtering by at least one of the utility program and the server computer the payroll data to remove non-premium related data; applying by inclusion and exclusion rules from a rules engine to determine payroll data items to consider in calculating a payroll-based insurance premium; and calculating payroll-based insurance premiums.

Abstract: In insurance and related industries, service providers perform assignments such as repairing smoke or water damage. Service provider performance data reflects how well service providers perform their assigned tasks, and may contain subjective or qualitative values. A number of performance criteria may be analyzed, such as quality of service criterion, cycle time, and customer satisfaction. Performance data related to the selected criteria may be aggregated and quantitative values may be generated from subjective or qualitative values. A vendor quality index (VQI) based on the quantified data may be generated. The generated quantitative values and VQI may be rendered on a display device or printed on a printer to facilitate objective comparisons between different service providers. Based on the generated quantitative values and VQI, parameters may be adjusted that affect how the VQI is determined, initiate electronic debits or credits to accounts corresponding to service providers, and/or generate user alerts.

Abstract: A computer system for processing and presentation of employee absence data includes an absence data management and storage system configured to receive data relating to a plurality of absences in a plurality of absence types from a plurality of data sources, and storing data relating to the plurality of absences, the stored data including, associated with one or more of the absences, absence type, employee identification, employer identification, employer unit identification and absence start date; and a data presentation server configured to receive user requests for data, access data from the absence data management and storage system and furnish data for display on user devices responsive to the request.

Abstract: This invention relates generally to a computer system and method for integrating insurance policy underwriting. In one aspect it integrates the older legacy insurance policy generating systems to on line systems where users access the system through browsers. The computer system to perform the process of underwriting, rating, quoting, binding, and booking an insurance policy includes browsers, data bases, processors and a dispatcher that parses the information to select an insurance process. Suitable software programs review messages received from users to determine if certain messages are less than a prescribed limit. If a message is greater than the limit, then the message is parsed into a header information and one or more data fields whereby the header information is provided to a legacy processor and to policy generation software for further creation of policy related information and documentation.

Abstract: Systems and methods are discussed for providing sensor enhanced safety, recovery, and activity evaluation systems. Sensors that monitor user activity and behavior are worn by a user and/or placed in the user environment. Data from the sensors are processed to obtain a safety, recovery, and/or activity evaluation. Based on the evaluation, recommendations or adjustments to the terms of an insurance policy covering the user, the user's employer, or a facility providing health care to the user to accurately reflect the risks associated with the user, employer, and/or facility.

Abstract: A system and method are disclosed herein for maintaining an inventory of assets located at an insured property covered under an insurance policy based on data received from IP-addressable devices located at the property. The system includes an inventory database for storing inventory information about assets located at an insured property, a communication interface for receiving registration and operational data associated with an IP-addressable device, and a business logic computer. The business logic computer creates a data structure for storing inventory information about assets located at the insured property in the inventory database for each insured property. The business logic computer determines, for the insured property, the inventory information about the insured property's assets based on registration and operational data received from its IP-addressable devices located at the property.

Abstract: Systems and methods are disclosed herein for identifying potential insurance prospects. The potential customers or prospects are identified by determining prospect underwriting affinity scores, prospect affinity scores, and prospect context scores with predictive models. The scores are then combined into a combined prospect score, which is used to adjust insurance underwriting, workflow, and premium determination processes for the prospects.

Abstract: A computerized system and computer-implemented method for enabling insurance vendor self-audits that receives referral data from a vendor, samples the referrals, assigns audit questions to each referral within the sample of referrals, presents the audit questions to the vendor and receives answers from the vendor, scores the answers based on rules, and reports the audit scores.

Abstract: A computer system for administering applications for term life insurance has a processor and a memory storage device in communication with the processor. The processor is configured to receive data indicative of application data and data indicative of a health of a proposed insured; based on the received data, determine whether the proposed insured is eligible, and generate an output signal to cause a policy to be generated and comprehensive underwriting to commence, the life insurance policy providing for a first premium rate for a first period after issue, and a second premium rate for a second period commencing on expiration of the first period, at least one of the second premium rate being determined based on data indicative of a result of comprehensive underwriting. Upon completion of comprehensive underwriting, data is generated for notification of results of comprehensive underwriting and the second premium rate to the insured.

Abstract: A computer system accesses payroll-related insurance premium data at an individual employee level and provides the data at the individual employee level, including cost of insurance at the individual employee level, on a client device. A computer system compares stored data with payroll data and identifies employees lacking occupation classification information for payroll-based premium determination. The computer system provides a fillable form on a user device for the user to provide occupation classification data, and receives the occupation classification data. The computer system provides fillable forms on a user device for a user to provide payroll data for receipt by the system, runs business rules on the received payroll data, determines premiums for payroll-based insurance coverage.