Communication of insurance claim data
Aspects of the invention are directed to methods and systems for efficiently communicating data between an insurer and a non-referral repair shop, e.g., vehicle repair shops that are normally not preapproved by the insurer to perform the estimating and repair work. The methods and systems described herein are particularly useful for insurers utilizing non-referral repair shops for servicing vehicles involved in insurance claims. According to aspects of this invention, the insured may be able to select a non-referral repair shop, not delegated or preapproved by the insurer, thereby generally allowing the insured to select any available vehicle repair shop.
1. A system comprising:
an insurance company data server coupled to a network; and
a vehicle insurance claim management application communicatively coupled, through the network, to the insurance company data server and a vehicle repair shop system of a vehicle repair shop, the vehicle insurance claim management application configured to:
receive work request data related to a vehicle and assignment data from the insurance company data server;
translate and change the assignment data into a format accepted by the vehicle repair shop system;
provide a real-time update to the vehicle repair shop system with at least one of the work request data or assignment data changes;
transmit and communicate the translated and changed assignment data to the vehicle repair shop system;
determine, if the vehicle repair shop is in a staffed market or a non-staffed market;
receive a vehicle repair estimate with estimate data associated with the work request data from the vehicle repair shop system;
responsive, at least in part to, not receiving the vehicle repair estimate before expiration of a time period and determining the vehicle repair shop is in the staffed market, assign a field estimate assignment to a field adjuster in the staffed market; and
responsive, at least in part, to not receiving the vehicle repair estimate before the expiration of the time period and determining the vehicle repair shop is in the non-staffed market, contact the vehicle repair shop.
2. The system of claim 1 , wherein the vehicle repair shop is a non-referral repair shop.
3. The system of claim 1 , wherein translating and changing the assignment data includes encrypting the assignment data.
4. The system of claim 1 , wherein the staffed market is associated with a market in which field adjusters are available and the non-staffed market associated with a market in which no field adjusters are available.
5. The system of claim 1 , the vehicle insurance claim management application further configured to:
determine the time period in which a repair estimate must be received from the vehicle repair shop system; and
determine, if the repair estimate was received before the expiration of the time period.
6. The system of claim 1 , wherein the vehicle insurance claim management application is further configured to:
receive the vehicle repair estimate with the estimate data from the vehicle repair shop system of the vehicle repair shop within the time period; and
responsive, at least in part, to receiving the vehicle repair estimate within the time period:
translate and change the estimate data into a format accepted by the vehicle insurance claim management application, wherein the translating includes encrypting the estimate data,
calculate a rules-based intelligence score based on an analysis and audit of the estimate data, wherein the rules-based intelligence score is related to an identification of anomalies in the estimate data and includes a statistically-based analysis of historical estimate data,
determine a 3-tier intervention level for the estimate data based on the rules-based intelligence score by comparing the rules-based intelligence score to one of a low-range, mid-range, or high-range threshold, wherein the 3-tier intervention level is one of a plurality of intervention levels, and wherein the low-range, mid-range, and high-range threshold is determined and adjusted by the vehicle insurance claim management application, and further wherein the low-range, mid-range, and high-range threshold is configurable,
provide real-time updates between the insurance company data server and the vehicle repair shop system when any information changes, and
transmit and communicate to the vehicle insurance claim management application, the real-time updates of any information changes.
7. The system of claim 6 , the vehicle insurance claim management application further configured to:
responsive to determining a low-range intervention level for the estimate data, automatically transmit an estimate approval notification to the vehicle repair shop system.
8. A system comprising:
an insurance company data server coupled to a network; and
a vehicle insurance claim management application communicatively coupled, through the network, to the insurance company data server, a first vehicle repair shop system of a first vehicle repair shop, and a second vehicle repair shop system of a second vehicle repair shop, the vehicle insurance claim management application configured to:
receive a first work request data related to a vehicle including first assignment data from the insurance company data server;
translate and change the first assignment data into a format accepted by the vehicle insurance claim management application;
provide a real-time update to the first vehicle repair shop system with at least one of the first work request data or assignment data changes,
transfer the translated first assignment data to the first vehicle repair shop system;
receive a first vehicle repair estimate with a first estimate data corresponding to a first vehicle from the first vehicle repair shop system;
translate and change the first estimate data into a format accepted by the vehicle insurance claim management application;
review the translated and changed first estimate data for compliance with contract-based conditions;
receive a second work request and second assignment data relating to a second vehicle from the insurance company data server;
translate and change the second assignment data into a format accepted by the vehicle insurance claim management application;
transfer the translated and changed second assignment data to the second vehicle repair shop system;
determine if the second vehicle repair shop is in a staffed market or a non-staffed market;
responsive, at least in part to, not receiving a second vehicle repair estimate before expiration of a time period and determining the second vehicle repair shop is in the staffed market, assign a field estimate assignment to a field adjuster in the staffed market and transmit and communicate to the second vehicle repair shop system in real-time, through the vehicle insurance claim management application, an updated assignment data corresponding to the assigned field estimate assignment; and
responsive, at least in part, to not receiving the second vehicle repair estimate before the expiration of the time period and determining the second vehicle repair shop is in the non-staffed market, contact the first vehicle repair shop.
9. The system of claim 8 , wherein the first vehicle repair shop is a direct repair vehicle repair shop.
10. The system of claim 8 , wherein the second vehicle repair shop is a non-referral vehicle repair shop.
11. The system of claim 8 , wherein translating and changing the first assignment data and the second assignment data includes encrypting the first assignment data and the second assignment data.
12. The system of claim 8 , wherein the staffed market is associated with a market in which field adjusters are available and the non-staffed market associated with a market in which no field adjusters are available.
13. The system of claim 8 , wherein the vehicle insurance claim management application is further configured to:
receive the second vehicle repair estimate with a second estimate data from the second vehicle repair shop system within the time period; and
responsive, at least in part, to receiving the second vehicle repair estimate within the time period:
translate and change the second estimate data into a format accepted by the vehicle insurance claim management application, wherein the translating includes encrypting the second estimate data,
calculate a rules-based intelligence score based on an analysis and audit of the second estimate data, wherein the rules-based intelligence score is related to an identification of anomalies in the second estimate data and includes a statistically-based analysis of historical estimate data,
determine a 3-tier intervention level for the second estimate data based on the rules-based intelligence score by comparing the rules-based intelligence score to one of a low-range, mid-range, or high-range threshold, wherein the 3-tier intervention level is one of a plurality of intervention levels, and wherein the low-range, mid-range, and high-range threshold is determined and adjusted by the vehicle insurance claim management application, and further wherein the low-range, mid-range, and high-range threshold is configurable,
provide real-time updates between the insurance company data server and the second vehicle repair shop system when any information changes, and
transmit and communicate to the vehicle insurance claim management application, the real-time updates of any information changes.
14. The system of claim 13 , the vehicle insurance claim management application further configured to:
responsive to determining a low-range intervention level for the second estimate data, automatically transmit an estimate approval notification to the second vehicle repair shop system.
15. A system comprising:
an insurance company data server coupled to a network; and
a vehicle insurance claim management application in communication with, through the network, the insurance company data server and a vehicle repair shop system of a vehicle repair shop that causes the vehicle insurance claim application to:
receive a first work request data related to a vehicle and first assignment data from the insurance company data server;
translate and change the first assignment data into a format accepted by the vehicle insurance claim management application;
provide a real-time update to the vehicle repair shop system with at least one of the first work request data or assignment data changes,
transfer the translated and changed first assignment data to the vehicle repair shop system;
receive a first vehicle repair estimate with a first estimate data corresponding to a first vehicle from the vehicle repair shop system;
translate and change the first estimate data into a format accepted by the vehicle insurance claim management application;
review the translated and changed first estimate data for compliance with contract-based conditions;
receive a second work request and second assignment data corresponding to the first vehicle from the insurance company data server;
translate and change the second assignment data into a format accepted by the vehicle insurance claim management application;
transfer the translated and changed second assignment data to the vehicle repair shop system;
determine, if the vehicle repair shop is in a staffed market or a non-staffed market;
determine, if a second vehicle repair estimate was received before expiration of a time period;
responsive, at least in part to, not receiving the second vehicle repair estimate within the time period and determining the vehicle repair shop is in the staffed market, assign a field estimate assignment to a field adjuster in the staffed market and transmit and communicate to the vehicle repair shop system in real-time, through the vehicle insurance claim management application, an updated assignment data corresponding to the assigned field estimate assignment; and
responsive, at least in part, to not receiving the second vehicle repair estimate within the time period and determining the vehicle repair shop is in the non-staffed market, contact the vehicle repair shop.
16. The system of claim 15 , wherein the vehicle repair shop is a non-referral repair shop.
17. The system of claim 15 , wherein translating and changing the first assignment data and the second assignment data includes encrypting the first assignment data and the second assignment data.
18. The system of claim 15 , wherein the staffed market is associated with a market in which field adjusters are available and the non-staffed market associated with a market in which no field adjusters are available.
19. The system of claim 15 , wherein the vehicle insurance claim management application is further configured to:
receive the second vehicle repair estimate with a second estimate data from the vehicle repair shop system within the time period; and
responsive, at least in part, to receiving the second vehicle repair estimate within the time period:
translate and change the second estimate data into a format accepted by the vehicle insurance claim management application, wherein the translating includes encrypting the second estimate data,
calculate a rules-based intelligence score based on an analysis and audit of the second estimate data, wherein the rules-based intelligence score is related to an identification of anomalies in the second estimate data and includes a statistically-based analysis of historical estimate data,
determine a 3-tier intervention level for the second estimate data based on the rules-based intelligence score by comparing the rules-based intelligence score to one of a low-range, mid-range, or high-range threshold, wherein the 3-tier intervention level is one of a plurality of intervention levels, and wherein the low-range, mid-range, and high-range threshold is determined and adjusted by the vehicle insurance claim management application, and further wherein the low-range, mid-range, and high-range threshold is configurable,
provide real-time updates between the insurance company data server and the vehicle repair shop system when any information changes, and
transmit and communicate to the vehicle insurance claim management application, the real-time updates of any information changes.
20. The system of claim 19 , the vehicle insurance claim management application further configured to:
responsive to determining a low-range intervention level for the second estimate data, automatically transmit an estimate approval notification to the vehicle repair shop system.