Chatbot for reviewing insurance claims complaints

Patent metadata

Field	Value
Publication number	US-12567115-B2
Application number	US-202318234472-A
Country	US
Kind code	B2
Filing date	Aug 16, 2023
Priority date	Jun 6, 2023
Publication date	Mar 3, 2026
Grant date	Mar 3, 2026

Abstract

The following relates generally to AI-based review of insurance claims complaints. In some embodiments, one or more processors: (1) receive, via a chatbot, an insurance claim complaint; (2) categorize, via the chatbot, the insurance claim complaint by determining a category of the insurance claim complaint, the category comprising a tone category or a policy category; (3) build, via the chatbot, a complaint report including information of the insurance claim complaint and an indication of the category; and/or (5) send, via the chatbot, the complaint report to an insurance complaint administrator computing device.

First claim

What is claimed:

1 . A computer-implemented method for reviewing insurance claims complaints, comprising:
training, using one or more processors, a chatbot of the one or more processors by: (i) receiving a prompt, (ii) generating a plurality of output responses based upon the prompt, (iii) ranking respective output responses of the plurality of output responses, and (iv) training the chatbot of the one or more processors based upon the ranked output responses; receiving, using the chatbot of one or more processors, an insurance claim complaint, wherein the chatbot includes a generative pre-trained transformer (GPT), and/or long-short-term-memory (LSTM); categorizing, using the chatbot, the insurance claim complaint by determining a category of the insurance claim complaint, the category comprising a tone category or a policy category; building, using the chatbot, a complaint report including information of the insurance claim complaint and an indication of the category; and sending, using the chatbot, the complaint report to an insurance complaint administrator computing device.

2 . The computer-implemented method of claim 1 , wherein:
the tone category comprises tone subcategories comprising: (i) rudeness of a claims adjuster; (ii) length of time it took a claims adjuster to respond to an insurance customer; and/or (iii) difficulties with an application (app) and/or website; and the policy category comprises policy subcategories comprising: (i) insurance policy did not cover damage or loss; (ii) deductible was too high; and/or (iii) subsequent increase in insurance policy premium.

3 . The computer-implemented method of claim 1 , wherein:
the receiving the insurance claim complaint comprises receiving a plurality of insurance claims complaints including the insurance claim complaint; and the complaint report includes a subreport of only tone category insurance claims complaints, and/or a subreport of only policy category insurance claims complaints.

4 . The computer-implemented method of claim 1 , wherein:
the receiving the insurance claim complaint comprises receiving a plurality of insurance claims complaints including the insurance claim complaint; and the complaint report comprises a table including indications of if the insurance complaints are tone category insurance claims complaints or policy category insurance claims complaints.

5 . The computer-implemented method of claim 1 , wherein:
the receiving the insurance claim complaint comprises receiving a plurality of insurance claims complaints including the insurance claim complaint, and wherein insurance claims complaints of the plurality of insurance claims complaints include dates and/or times of insurance claims; and the method further comprises determining a trend in the insurance claims based upon the dates and/or times.

6 . The computer-implemented method of claim 5 , wherein the trend comprises an increase or decrease in the insurance claims:
corresponding to a type of insurance policy associated with the insurance claim complaints, the type of insurance policy comprising a homeowners insurance policy, a renters insurance policy, an auto insurance policy, a life insurance policy and/or a disability insurance policy; in a particular geographic area; and/or due to a cause of damage, the cause of damage including: hail damage, fire damage, frozen pipe damage, flood damage, and/or wind damage.

7 . The computer-implemented method of claim 1 , further comprising:
determining, using the chatbot, a type of insurance policy associated with the insurance claim complaint, the type of insurance policy comprising a homeowners insurance policy, a renters insurance policy, an auto insurance policy, a life insurance policy and/or a disability insurance policy; and receiving, using the chatbot, from the insurance complaint administrator computing device, a selection of a type of insurance policy; wherein the building of the complaint report includes building the complaint report to include only insurance complaints with the selected type of insurance policy.

8 . The computer-implemented method of claim 1 , wherein the building of the complaint report includes building the complaint report to include an indication of if an insurance customer of the insurance claims complaint left an insurance company of the insurance claim.

9 . The computer-implemented method of claim 1 , further comprising:
determining, via the one or more processors, a website with the insurance claim complaint; and scraping, via the one or more processors, the insurance claim complaint from the website.

10 . The computer-implemented method of claim 1 , further comprising training the chatbot with a historical dataset comprising: (i) historical insurance claims complaints, and/or (ii) historical complaint reports.

11 . The computer-implemented method of claim 1 , wherein the information of the insurance claim complaint includes:
an indication of a type of insurance policy associated with the insurance claim complaint, the type of insurance policy comprising a homeowners insurance policy, a renters insurance policy, an auto insurance policy, a life insurance policy and/or a disability insurance policy; a quotation from correspondence between an insurance customer of the insurance claim complaint and an employee of a insurance company, wherein the employee of the insurance company is a claims adjustor or an insurance agent; a summary of the insurance claim complaint; dates and/or times of one or more correspondences between the insurance customer and the employee; and/or imagery data corresponding to the insurance claim complaint including imagery data of an insured item of an insurance claim of the insurance claim complaint.

12 . A computer system for reviewing insurance claim complaints, the computer system comprising one or more processors configured to:
train a chatbot by: (i) receiving a prompt, (ii) generating a plurality of output responses based upon the prompt, (iii) ranking respective output responses of the plurality of output responses, and (iv) training the chatbot based upon the ranked output responses; receive, using the chatbot, an insurance claim complaint, wherein the chatbot includes a generative pre-trained transformer (GPT), and/or long-short-term-memory (LSTM); categorize, using the chatbot, the insurance claim complaint by determining a category of the insurance claim complaint, the category comprising a tone category or a policy category; build, using the chatbot, a complaint report including information of the insurance claim complaint and an indication of the category; and send, using the chatbot, the complaint report to an insurance complaint administrator computing device.

13 . The computer system of claim 12 , wherein:
the one or more processors are configured to receive the insurance claim complaint by receiving a plurality of insurance claims complaints including the insurance claim complaint; and the complaint report includes a subreport of only tone category insurance claims complaints, and/or a subreport of only policy category insurance claims complaints.

14 . The computer system of claim 12 , wherein the computer system further comprises a display device, and wherein the one or more processors are further configured to display the complaint report on the display device.

15 . A computer system for reviewing insurance claims complaints, the computer system comprising:
one or more processors; and one or more memories; the one or more memories having stored thereon computer-executable instructi

Assignees

• State Farm Mutual Automobile Insurance Co

Inventors

• Brannan Joseph Robert
• King Vicki
• Fields Brian Mark
• Tofte Nathan L

Classifications

• G06Q10/44

  Identification of trends within social networks, e.g. identification of trending topics · CPC title

• G06Q10/40 Primary

  Business processes related to social networking or social networking services · CPC title

• G06Q40/08

  Insurance · CPC title

• G06Q40/084

  by insurance claims processing · CPC title

• H04L51/02

  using automatic reactions or user delegation, e.g. automatic replies or chatbot-generated messages · CPC title