Rule based Claims Verification

Control €xpert is a service provider in the damage and quality management for a variety of businesses such as insurance companies, car manufacturers, fleet and leasing companies. On their behalf, Control €xpert verifies cost estimates, invoices and expert reports, trying to identify cost-saving opportunities. Aim of the project was the development of a rule-based claim checking and verification system for a newly opened business segment.

Specifically for this task, we developed a new and now generally available functional unit for the kenroadsDesigner. Our "Rules Engine" allows to define an unlimited number of rules and associated actions, which can be applied to analyse, flag, manipulate or filter arbitrary data stores.

The application developed for Control €xpert supports the whole process from data entry by the business specialist through to generating the final report. The actual verification is done at the push of a button. According to the triggered rules, invoice items are automatically flagged and, if defined so in the rules, an adjustment value will be suggested. The business specialist receives detailed background information about the proposed adjustments and other helpful hints, so that he may add additional modifications or make manual readjustments. Eventually a consolidated report is generated, summarising the identified savings potential and listing all suggested adjustments, which then is to be send to the respective client.

Control €xpert's reasons for choosing kenroadsDesigner as development platform were not only economic aspects (faster development at less costs). In addition, they valued this easy to use development environment, because it will give them greater flexibility in maintenance and further development and provide additional sourcing options.

Already planned enhancements will include automatic capturing of invoice data via OCR scanning and subsequent batch processing as well as transition of the application into a web environment.