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Claim settlement customer risk identification method and system

A risk identification and customer technology, applied in the field of insurance services, can solve the problems of infringing the interests of the insured and the public interests, lack of scientific identification methods for medical insurance fraud, and inability to effectively reflect the risk characteristics of different groups, so as to improve the automation rate of claims, Support development and pricing, the effect of accurate risk characterization

Pending Publication Date: 2018-10-23
PING AN HEALTH INSURANCE CO LTD
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AI Technical Summary

Problems solved by technology

This method cannot effectively reflect the risk characteristics of different groups of people and cannot support differentiated pricing
[0003] In addition, there are currently a considerable amount of medical insurance fraud, and the existing technology lacks effective scientific identification methods for medical insurance fraud, which seriously affects the balance of income and expenditure of the medical insurance fund, and violates the interests of the majority of insured people and even the public interest

Method used

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  • Claim settlement customer risk identification method and system
  • Claim settlement customer risk identification method and system
  • Claim settlement customer risk identification method and system

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Embodiment Construction

[0051] Below, the implementation of the technical solution will be further described in detail in conjunction with the accompanying drawings.

[0052] Those skilled in the art can understand that although the following description involves many technical details related to the embodiments of the present invention, this is only an example for illustrating the principle of the present invention, and does not imply any limitation. The present invention can be applied to occasions other than the technical details exemplified below, as long as they do not deviate from the principle and spirit of the present invention.

[0053] In addition, in order to avoid making the description in this manual limited to redundant, in the description in this manual, some technical details that can be obtained in the existing technical documents may be omitted, simplified, modified, etc. understandable to human beings, and this does not affect the adequacy of the disclosure of this specification. ...

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Abstract

The invention relates to a claim settlement customer risk identification method and system. The method comprises a data preparation stage, a model training stage and a model implementation stage. Thedata preparation stage comprises the following steps of obtaining data related to a claim settlement customer risk from medical claim settlement big data, wherein the data comprises personal information and doctor-seeing information of a claim settlement customer, and the doctor-seeing information includes doctor-seeing expense information; and extracting characteristics required for training a GBM model from the data to form a data set. The model training stage comprises the following steps of taking part of the data in the data set as a training set to be input to a trainer of the GBM modelfor performing training; and generating a trained GBM model. The model implementation stage comprises the following steps of collecting current claim settlement data of the claim settlement customer,and extracting the characteristics required by the GBM model; and inputting the characteristics to the GBM model to generate an identification result, wherein the identification result comprises a doctor-seeing expense possibly generated in the future by the claim settlement customer.

Description

technical field [0001] The invention relates to the technical field of insurance services based on Internet applications, in particular to a risk identification method and system for claims settlement customers. Background technique [0002] At present, the pricing method of health insurance products is relatively simple, mainly relying on industry benchmarking, reinsurance quotations, combined with simple macro risk analysis. This method cannot effectively reflect the risk characteristics of different groups of people and cannot support differentiated pricing. [0003] In addition, there are a considerable number of medical insurance frauds at present, and the existing technology lacks effective scientific identification methods for medical insurance fraud, which seriously affects the balance of income and expenditure of medical insurance funds, and violates the interests of the majority of insured people and even the public interest. [0004] Therefore, in order to achiev...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06Q10/06G06Q40/08
CPCG06Q10/0635G06Q40/08
Inventor 冯晓俊夏如雪夏天羿然
Owner PING AN HEALTH INSURANCE CO LTD
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