Insurance claim forecasting system

Details Insurance claim forecasting system Insurance claim forecasting system

2008-06-24

2008-06-24

Thomas, Joseph (Department: 3626)

Data processing: financial, business practice, management, or co

Automated electrical financial or business practice or...

Insurance

C705S002000, C705S003000, C600S300000

Reexamination Certificate

active

07392201

ABSTRACT:
A computer-implemented process of developing a person-level cost model for forecasting future costs attributable to claims from members of a book of business, where person-level data are available for a substantial portion of the members of the book of business for an actual underwriting period, and the forecast of interest is for a policy period is disclosed. The process uses development universe data comprising person-level enrollment data, historical base period health care claims data and historical next period claim amount data for a statistically meaningful number of individuals. The process also provides at least one claim-based risk factor for each historical base period claim based on the claim code associated with the health care claim and provides at least one enrollment-based risk factor based on the enrollment data. The process also develops a cost forecasting model by capturing the predictive ability of the main effects and interactions of claim based risk factors and enrollment-based risk factors, with the development universe data through the application of an interaction capturing technique to the development universe data.

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