Apparatus, system and method for actively monitoring interaction risks in client-provider communicated transactions

Abstract

A method for identifying potential future interaction risks between a client and a provider using a computer server is disclosed. Transactions between the client and the provider are conducted in association with one or more communication platforms and the method includes storing client data on the computer server received from a variety of data sources including client claims data, and storing agent data on the computer server received from a variety of data sources. The method further includes obtaining feedback data related to at least one of the client, the agent, and one of the transactions and analyzing the data to identify potential future transactional problems.

What is claimed is: 
     
         1 . A method for actively monitoring interaction risks potentially associated with transactions between a client and a provider using a computer, wherein the transactions between the client and provider are conducted in association with two or more communication platforms, including voice handlers, email servers, short message service servers, instant message servers and fax servers, the method comprising:
 accessing client claims data via the computer such that the client claims data is inaccessible to the provider, the client claims data having at least some data related to the client;   receiving risk guidelines for the provider on the computer;   receiving information on the computer identifying the client;   categorizing, by the computer, the client into a client risk category based on a computer analysis of the risk guidelines for the provider and the client claims data related to the client, the risk category of the client being inaccessible to the provider;   delivering functionality to the provider that automatically, without user intervention, captures communications involving the client and the provider on at least one of the two or more communication platforms and automatically reports on the captured communications, a frequency of capturing, reporting, or both being based on the provider-inaccessible client risk category of the client.   
     
     
         2 . The method of  claim 1  further comprises preventing an employee of the provider from completing at least one transaction between the client and the provider based at least in part on the provider-inaccessible client risk category associated with the client. 
     
     
         3 . The method of  claim 2 , wherein the provider has one or more agents, the method further comprises:
 accessing data regarding an agent of the provider via the computer;   delivering functionality to the provider that automatically, without user intervention, further captures communications involving the client and the agent of the provider on at least one of the two or more communication platforms and automatically reports on the further captured communications, a frequency of further capturing, reporting, or both being based on the data regarding the agent of the provider.   
     
     
         4 . The method of  claim 3 , further comprises delivering functionality to the provider that automatically, without user intervention, compares words in the communications with predetermined stop words, the frequency of further capturing, reporting, or both being further based on the presence of the predetermined stop words in the communications. 
     
     
         5 . The method of  claim 1 , wherein information identifying the client includes a telephone number associated with the client, the method further comprises using caller identification to identify communications involving the client. 
     
     
         6 . The method of  claim 1 , wherein the provider has one or more agents, the method further comprises:
 accessing data regarding an agent of the provider via the computer;   delivering functionality to the provider that automatically, without user intervention, captures further communications involving the client and the agent of the provider on at least one of the two or more communication platforms and automatically reports on the captured further communications, a frequency of further capturing, reporting, or both being based on the data regarding the agent of the provider.   
     
     
         7 . The method of  claim 6 , further comprises categorizing, by the computer, the agent into an agent risk category based on a computer analysis of the risk guidelines for the provider and the agent data. 
     
     
         8 . An apparatus for actively monitoring interaction risks potentially associated with transactions between a client and a provider, the transactions between the client and provider are conducted in association with two or more communication platforms, including voice handlers, email servers, short message service servers, instant message servers and fax servers, each of the two or more communication platforms being operably associated with a communication interface, the apparatus comprising:
 a non-transitory digital storage element;   a processor operably coupled to the communication interface and to the non-transitory digital storage element, the non-transitory digital storage element storing logic that when executed by the processor causes the processor to:   access client claims data such that the client claims data is inaccessible to the provider,
 the client claims data having at least some data related to the client; 
   receive risk guidelines for the provider;   receive information identifying the client;   categorize the client into a client risk category by comparing the risk guidelines for the provider with the client claims data related to the client, the risk category of the client being inaccessible to the provider;   automatically, without user intervention, cause the communication interface to capture communications involving the client and the provider on at least one of the two or more communication platforms; and   automatically, without user intervention, report on the captured communications, a frequency of capturing, reporting, or both being based on the provider-inaccessible client risk category of the client.   
     
     
         9 . The apparatus of  claim 8  wherein the logic stored by the non-transitory digital storage when executed by the processor further causes the processor to prevent an employee of the provider from completing at least one transaction between the client and the provider based at least in part on the provider-inaccessible client risk category associated with the client. 
     
     
         10 . The apparatus of  claim 9 , wherein the provider has one or more agents, the logic stored by the non-transitory digital storage when executed by the processor further causes the processor to:
 access data regarding an agent of the provider;   automatically, without user intervention, further capture communications involving the client and the agent of the provider on at least one of the two or more communication platforms; and   automatically, without user intervention, report on the further captured communications, a frequency of further capturing, reporting, or both being based on the data regarding the agent of the provider.   
     
     
         11 . The apparatus of  claim 10 , wherein the logic stored by the non-transitory digital storage when executed by the processor further causes the processor to automatically, without user intervention, compare words in the communications with predetermined stop words, the frequency of further capturing, reporting, or both being further based on the presence of the predetermined stop words in the communications. 
     
     
         12 . The apparatus of  claim 8 , wherein information identifying the client includes a telephone number associated with the client, the logic stored by the non-transitory digital storage when executed by the processor further causes the processor to use caller identification to identify communications involving the client. 
     
     
         13 . The apparatus of  claim 8 , wherein the provider has one or more agents, the logic stored by the non-transitory digital storage when executed by the processor further causes the processor to:
 access data regarding an agent of the provider;   automatically, without user intervention, capture further communications involving the client and the agent of the provider on at least one of the two or more communication platforms; and   automatically, without user intervention, report on the captured further communications, a frequency of further capturing, reporting, or both being based on the data regarding the agent of the provider.   
     
     
         14 . The apparatus of  claim 13 , the logic stored by the non-transitory digital storage when executed by the processor further causes the processor to categorize the agent into an agent risk category based on an analysis of the risk guidelines for the provider and the agent data. 
     
     
         15 . An system for actively monitoring interaction risks potentially associated with transactions between a client and a provider, the transactions between the client and provider are conducted in association with two or more communication platforms, including voice handlers, email servers, short message service servers, instant message servers and fax servers, each of the two or more communication platforms being operably associated with a communication interface, the system comprising:
 a server having a first non-transitory digital storage element and a first processor operably coupled to the first non-transitory digital storage element, the first non-transitory digital storage element storing logic that when executed by the first processor causes the server to:   receive client claims data from a data source such that the client claims data is inaccessible to the provider, the client claims data having at least some data related to the client;   store risk guidelines for the provider;   receive information identifying the client;   categorize the client into a client risk category by comparing the risk guidelines for the provider with the client claims data related to the client, the risk category of the client being inaccessible to the provider;   a client having a second non-transitory digital storage element and a second processor operably coupled to the second non-transitory digital storage element, the second non-transitory digital storage element storing logic that when executed by the second processor causes the client to automatically, without user intervention:   cause the communication interface to capture communications involving the client and the provider on at least one of the two or more communication platforms; and   report on the captured communications, a frequency of capturing, reporting, or both being based on the provider-inaccessible client risk category of the client.   
     
     
         16 . The system of  claim 15  wherein the logic stored by the second non-transitory digital storage when executed by the second processor further causes the client to prevent an employee of the provider from completing at least one transaction between the client and the provider based at least in part on the provider-inaccessible client risk category associated with the client. 
     
     
         17 . The system of  claim 16 , wherein the provider has one or more agents and the risk guidelines contain agent related risk policies, the logic stored by the first non-transitory digital storage when executed by the first processor further causes the server to:
 access data regarding an agent of the provider;   categorize the agent into an agent risk category by comparing the risk guidelines for the provider with the agent data; and   the logic stored by the second non-transitory digital storage when executed by the second processor further causes the client to automatically, without user intervention:   further capture communications involving the client and the agent of the provider on at least one of the two or more communication platforms; and   report on the further captured communications, a frequency of further capturing, reporting, or both being based on the agent risk category of the agent.   
     
     
         18 . The system of  claim 17 , wherein the logic stored by the second non-transitory digital storage when executed by the second processor further causes the client to automatically, without user intervention, compare words in the communications with predetermined stop words, the frequency of further capturing, reporting, or both being further based on the presence of the predetermined stop words in the communications. 
     
     
         19 . The system of  claim 18 , wherein information identifying the client includes a telephone number associated with the client, the logic stored by the second non-transitory digital storage when executed by the second processor further causes the client to use caller identification to identify communications involving the client and send the client identification to the server. 
     
     
         20 . The system of  claim 15 , wherein information identifying the client includes a telephone number associated with the client, the logic stored by the second non-transitory digital storage when executed by the second processor further causes the client to use caller identification to identify communications involving the client and send the client identification to the server.