Hartford Fire Insurance Compnay

Joseph D Pagano

Jonathan Kaleb Adams

Ryan A Gawel

William J Bohn

Robert E Bonner

According to some embodiments, historical claim data may be stored in a computer storage unit. The historical claim data may be used to train and verify a predictive model, the predictive model being associated with an evaluation of claim transactions to determine whether to refer each claim transactions to a nurse intervention program. Data for current claim transactions may be processed, and the trained and verified predictive model may be applied to the data for the current claim transactions to generate a respective output for each of the current claim transactions. Some of the current claim transactions may be selectively routed to a case management center associated with the nurse intervention program based on the outputs generated by the predictive model.

Computer system and method for processing data relating to nurse intervention program decisions

A system and method are provided for determining a composition of a service provider network for providing services according to a workers' compensation insurance plan. The system and method acquires claim information, which describes workers' compensation claims and medical service providers, and determines a metric value for each of the medical service providers, adjusts the metric values, assigns scores based on the adjusted metric values, determines an average of the assigned scores, and generates results data based on the assigned scores. The results data indicates, for each of the medical service providers, whether the medical service provider should be included in the service provider network. The service provider metrics include a metric that relates to an amount paid per claim and a percentage of claims that involved lost time.

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Wallingford, CT, United States of America

Joseph D Pagano