CLIAMS:We claim:
1. A method for optimizing processing of insurance claims, the method comprising:
examining, by an insurance data processing apparatus, completeness of information in an insurance application form to avail insurance claims for an insured patient;
segmenting, by the insurance data processing apparatus, the information contained in the insurance application form into at least one of medical data and behavioural data of the insured patient;
classifying, by the insurance data processing apparatus, one or more diseases from the medical data into a medical group and behavioural parameters from the behavioural data into a behavioural group, wherein the classification is performed using predefined one or more ontologies comprising medical ontologies and behavioural ontologies; and
verifying, by the insurance data processing apparatus, a relevancy of the insurance claims associated to the insured patient based on the classification of the one or more diseases and the behavioural parameters.

2. The method as claimed in claim 1 further comprises alerting by the insurance data processing apparatus, incompleteness of the information in the insurance application form.

3. The method as claimed in claim 1, wherein the predefined medical ontologies are generated based on relationship between different types of diseases, factors causing the diseases, severity factors of the diseases and symptoms of the diseases.

4. The method as claimed in claim 1, wherein the predefined behavioural ontologies are generated based on relationship between different behaviour of the patient along with symptoms of the behaviours, mental status of the patient, basis of occurrence of behaviour in the patient and circumstance of occurrence of behaviour in the patient.

5. The method as claimed in claim 1 further comprises evaluating by the insurance data processing apparatus, severity level of the one or more diseases suffering by the insured patient, stamina level of the insured patient, and immunity level of the insured patient using at least one of the medical ontology and historical medical information of the insured patient.

6. The method as claimed in claim 5 further comprises evaluating by the insurance data processing apparatus, recovery period of the insured patient using at least one of the predefined one or more ontologies, historical behavioural information and the historical medical information of the insured patient.

7. The method as claimed in claim 1 further comprises retrieving by the insurance data processing apparatus, behavioural parameters from one or more data sources selected from at least one of social blogs, social media, Customer Relationship Management (CRM) based data sources associated to an insurance provider, data sources associated to medical service providers, and data sources related to behavioural examiner.

8. The method as claimed in claim 1 further comprises identifying fraud, by the insurance data processing apparatus, by performing:
retrieving reports comprising at least one of the information, the medical data, the behaviour data, historical medical information, behavioural parameters, and historical information related to availing of insurance claims; and
mapping the reports to the at least one of the classification of the one or more diseases and the behavioural parameters and the predefined one or more ontologies to examine the correctness of availing of the insurance claims.
9. An insurance data processing apparatus for optimizing processing of insurance claims, comprising:
a processor;
a memory communicatively coupled to the processor, wherein the memory stores processor-executable instructions, which, on execution, cause the processor to:
examine completeness of information in an insurance application form to avail the insurance claims for an insured patient;
segment the information contained in the insurance application form into at least one of medical data and behavioural data of the insured patient;
classify one or more diseases from the medical data into a medical group and behavioural parameters from the behavioural data into a behavioural group, said classification is performed using predefined one or more ontologies comprising medical ontologies and behavioural ontologies; and
verify a relevancy of the insurance claims associated to the insured patient based on the classification of the one or more diseases and the behavioural parameters.

10. The insurance data processing apparatus as claimed in claim 9 is further configured to alert incompleteness of the information in the insurance application form.

11. The insurance data processing apparatus as claimed in claim 9, wherein the predefined medical ontologies are generated based on relationship between different types of diseases, factors causing the diseases, severity factors of the diseases and symptoms of the diseases

12. The insurance data processing apparatus as claimed in claim 9, wherein the predefined behavioural ontologies are generated based on relationship between different behaviour of the patient along with symptoms of the behaviours, mental status of the patient, basis of occurrence of behaviour in the patient and circumstance of occurrence of behaviour in the patient.

13. The insurance data processing apparatus as claimed in claim 9 is further configured to evaluate severity level of the one or more diseases suffering by the insured patient, stamina level of the insured patient, and immunity level of the insured patient using at least one of the medical ontology and historical medical information of the insured patient.

14. The insurance data processing apparatus as claimed in claim 13 is further configured to evaluate recovery period of the insured patient using at least one of the predefined one or more ontologies, historical behavioural information and the historical medical information of the insured patient.

15. The insurance data processing apparatus as claimed in claim 9 further configured to retrieve behavioural parameters from one or more data sources selected from at least one of social blogs, social media, Customer Relationship Management (CRM) based data sources associated to an insurance provider, data sources associated to medical service providers, and data sources related to behavioural examiner. .

16. The insurance data processing apparatus as claimed in claim 9 is further configured to identify fraud by performing:
retrieve reports comprising at least one of the information, the medical data, the behaviour data, historical medical information, behavioural parameters, and historical information related to availing of insurance claims; and
map the reports to the at least one of the classification of the one or more diseases and the behavioural parameters and the predefined one or more ontologies to examine the correctness of availing of the insurance claims.
17. A non-transitory computer readable medium including instructions stored thereon that when processed by a processor cause an insurance data processing apparatus to perform acts of:
examining completeness of information in an insurance application form to avail the insurance claims for an insured patient;
segmenting the information contained in the insurance application form into at least one of medical data and behavioural data of the insured patient;
classifying one or more diseases from the medical data into a medical group and behavioural parameters from the behavioural data into a behavioural group, said classification is performed using predefined one or more ontologies comprising medical ontologies and behavioural ontologies; and
verifying a relevancy of the insurance claims associated to the insured patient based on the classification of the one or more diseases and the behavioural parameters.

Dated this 10th day of November, 2014

SHWETHA A CHIMALGI
OF K & S PARTNERS
AGENT FOR THE APPLICANT
,TagSPECI:TECHNICAL FIELD
The present subject matter is related, in general to data processing system and more particularly, but not exclusively to a method and an insurance data processing apparatus for optimizing processing of insurance claims of the insured patient.