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Method and device for evaluating risk claim settlement

A risky and pre-set technology, applied in the field of data processing, can solve the problems of insurance companies’ economic losses and high-risk cases that are easy to miss

Inactive Publication Date: 2018-04-03
PING AN TECH (SHENZHEN) CO LTD
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  • Abstract
  • Description
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Problems solved by technology

[0004] In view of this, the present invention provides a method and device for assessing risk claims, the main purpose of which is to solve the problem that the existing loss verification personnel may easily miss some high-risk cases through manual review when reviewing claim cases, which is harmful to insurance companies. cause some economic loss

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  • Method and device for evaluating risk claim settlement
  • Method and device for evaluating risk claim settlement
  • Method and device for evaluating risk claim settlement

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Embodiment Construction

[0055] Exemplary embodiments of the present disclosure will be described in more detail below with reference to the accompanying drawings. Although exemplary embodiments of the present disclosure are shown in the drawings, it should be understood that the present disclosure may be embodied in various forms and should not be limited by the embodiments set forth herein. Rather, these embodiments are provided for more thorough understanding of the present disclosure and to fully convey the scope of the present disclosure to those skilled in the art.

[0056] The embodiment of the present invention provides an assessment method for risk claims, such as figure 1 As shown, the method includes:

[0057] 101. Obtain the claim settlement information and historical policy information of the insured in the claim settlement case.

[0058] Among them, the insured refers to the person who has the right to claim insurance money after the occurrence of the insured event according to the eff...

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Abstract

The invention discloses a method and a device for evaluating a risk claim settlement, relates to the technical field of data processing and mainly solves the problem that the economic loss is broughtto an insurance company when existing loss-evaluating personnel checks a claim settlement case and easily misses high-risk cases through manual check. A main technical scheme of the method comprises the steps of acquiring claim settlement information and historical insurance policy information of an insured in the claim settlement case; analyzing to-be-evaluated logic parameters in the claim settlement information and the historical insurance policy information, wherein the logic parameters are used for reflecting the situation that the insured participates in medical programs in the claim settlement case; and matching the logic parameters and preset evaluation logics, counting an evaluation result of the claim settlement case corresponding to the logic parameters, wherein the preset evaluation logics are used for reflecting a relation between different logic parameters and different evaluation scores. The method and the device are mainly used for evaluating the risk claim settlement.

Description

technical field [0001] The invention relates to the technical field of data processing, in particular to an evaluation method and device for risk claims. Background technique [0002] After an insurance claim case occurs, the underwriters in the insurance industry need to verify and proofread the claim case in order to accurately settle the claim and reduce the claim risk brought by the claim case. Among them, in the process of assessing the claims case, the underwriters include loss assessment and loss verification. After the loss assessment, the loss assessment personnel will review their work results. If there is no doubt, they will agree with the result. If there is any objection, It will be returned to prevent fraudulent insurance. [0003] At present, when the existing loss verification personnel review claims cases, they manually check the insurance information of the insured and the loss assessment information. However, for manual proofreading and review, each loss ...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06Q40/08
CPCG06Q40/08
Inventor 蔡宁和婷
Owner PING AN TECH (SHENZHEN) CO LTD
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