Computer system for applying proactive referral model to long term disability claims

A computer system comprising:

• a data storage unit for receiving, storing and providing access to historical claim data and current claim data, the historical claim data representing historical long term disability (LTD) claims, the current claim data representing current LTD claims;
• a computer processor in communication with the data storage unit;
• and
• a program memory, coupled to the computer processor, for storing at least one application program, the at least one application program including program instruction steps for execution by the computer processor, the at least one application program including:
• a proactive referral model that has been trained on and verified with the historical claim data and that controls the computer processor to analyze the current claim data in the data storage unit and to provide a respective output for each current claim represented by the current claim data, the respective output indicating whether said each current claim should be referred to an investigation unit;
• and
• a routing component, responsive to the respective output for each of the current claims, for selectively routing ones of the current claims to the investigation unit;
• wherein said proactive referral model is based on a plurality of variables, the variables including at least two of:
• (a) a variable that indicates that a claimant's diagnosis has changed;
• (b) a variable that indicates that the one of said current claims was brought under any-occupation coverage;
• (c) a variable that reflects a market segment for a policy under which the one of said current claims was brought;
• (d) a variable that has a value based on a state in which the claimant resides;
• and (e) a variable that represents an amount of experience of a claims handler who handled the one of said current claims.

A method of operating a computer system, the method comprising:

• storing historical claim data in the computer system, the historical claim data representing historical long term disability (LTD) claims;
• processing the historical claim data to generate values for a derived variable, the derived variable indicative of whether a non-derived variable has changed in value for a given LTD claim;
• building a proactive referral model using the derived variable;
• verifying by computer the proactive referral model with a subset of the historical claim data;
• storing current claim data in the computer system, the current claim data representing current LTD claims;
• processing the current claim data to generate values of the derived variable with respect to the current LTD claims;
• applying the trained and verified proactive referral model to the current claim data and to the values of the derived variable generated with respect to the current LTD claims, to generate a respective output for each of the current LTD claims;
• and
• selectively routing ones of the current LTD claims to an investigative unit based on the outputs generated by the proactive referral model.