Intelligent policy covery gap discovery and policy coverage optimization
AssigneeInternational Business Machines Corporation
InventorsTheodora Brisimi, Vanessa Lopez Garcia, Valentina Rho, John Segrave-Daly
Life of this patent
Estimating the term…
Abstract
Various embodiments are provided for providing intelligent policy coverage optimization in a computing environment by a processor. One or more policy coverage gaps in one or more operational rules defined by one or more rules, policies, or a combination thereof and associated with one or more non-compliant policy claims associated with the one or more policy coverage gaps may be identified. The one or more policy coverage gaps may be ranked according to one or more selected criteria.
Claims20
A method for providing intelligent policy coverage optimization in a computing environment by a processor comprising:
- executing machine learning logic to generate a policy model using eligibility standards of an insurance policy as input data, wherein the eligibility criteria is modeled as one or more operational rules within the policy model;
- identifying, using the policy model, one or more policy coverage gaps in the one or more operational rules defined by one or more rules, policies, or a combination thereof and corresponding to one or more non-compliant policy claims associated with the one or more policy coverage gaps, wherein the one or more policy coverage gaps are deficiencies in the one or more operational rules that preclude enforcement of collection with respect to the one or more non-compliant policy claims previously remunerated to a claimant;
- ranking the one or more policy coverage gaps according to one or more selected criteria;
- displaying the ranked one or more policy coverage gaps on a user interface (UI):
- and receiving feedback data associated with an accuracy of the ranked one or more policy coverage gaps, wherein the feedback data is used to iteratively update the policy model to enhance the accuracy in identifying future policy coverage gaps over time.
A system for providing intelligent policy coverage optimization in a computing environment, comprising:
- one or more processors with executable instructions that when executed cause the system to:
- execute machine learning logic to generate a policy model using eligibility standards of an insurance policy as input data, wherein the eligibility criteria is modeled as one or more operational rules within the policy model;
- identify, using the policy model, one or more policy coverage gaps in the one or more operational rules defined by one or more rules, policies, or a combination thereof and corresponding to one or more non-compliant policy claims associated with the one or more policy coverage gaps, wherein the one or more policy coverage gaps are deficiencies in the one or more operational rules that preclude enforcement of collection with respect to the one or more non-compliant policy claims previously remunerated to a claimant;
- rank the one or more policy coverage gaps according to one or more selected criteria, display the ranked one or more policy coverage gaps on a user interface (UI);
- and receive feedback data associated with an accuracy of the ranked one or more policy coverage gaps, wherein the feedback data is used to iteratively update the policy model to enhance the accuracy in identifying future policy coverage gaps over time.
A computer program product for, by one or more processors, providing intelligent policy coverage optimization in a computing environment, the computer program product comprising a non-transitory computer-readable storage medium having computer-readable program code portions stored therein, the computer-readable program code portions comprising:
- an executable portion that executes machine learning logic to generate a policy model using eligibility standards of an insurance policy as input data, wherein the eligibility criteria is modeled as one or more operational rules within the policy model;
- an executable portion that identifies, using the policy model, one or more policy coverage gaps in the one or more operational rules defined by one or more rules, policies, or a combination thereof and corresponding to one or more non-compliant policy claims associated with the one or more policy coverage gaps, wherein the one or more policy coverage gaps are deficiencies in the one or more operational rules that preclude enforcement of collection with respect to the one or more non-compliant policy claims previously remunerated to a claimant;
- an executable portion that ranks the one or more policy coverage gaps according to one or more selected criteria;
- an executable portion that displays the ranked one or more policy coverage gaps on a user interface (UI);
- and an executable portion that receives feedback data associated with an accuracy of the ranked one or more policy coverage gaps, wherein the feedback data is used to iteratively update the policy model to enhance the accuracy in identifying future policy coverage gaps over time.
Dependencies are inferred from the claim text.