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Method and device for identifying high fraud risk

A high-risk and risky technology, applied in the field of medical insurance information processing, can solve the problems of inability to improve the identification rate of high-risk customers, compress the profit space of short-term accident insurance and health insurance, and poor quality, so as to reduce insurance risks and reduce Claims risk and the effect of increasing profits

Inactive Publication Date: 2019-05-21
TAIKANG LIFE INSURANCE CO LTD +1
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

Specifically, facing the poor quality of external data, it is impossible to improve the discrimination rate of identifying high-risk customers, and the introduction of a large amount of external data will reduce the profit margin of short-term accident insurance and health insurance

Method used

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  • Method and device for identifying high fraud risk
  • Method and device for identifying high fraud risk
  • Method and device for identifying high fraud risk

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Embodiment Construction

[0020] In order to better understand the spirit of the present invention, it will be further described below in conjunction with some preferred embodiments of the present invention.

[0021] In order to enable one of ordinary skill in the art to make and use the embodiments of the invention, the following description is for a particular application and its conditions. Various modifications to the embodiments of the present invention will be apparent to those skilled in the art. However, the general principles defined herein may be applied to other implementations and applications without departing from the spirit and scope of the embodiments of the present invention. Therefore, the embodiments of the present invention are not limited to the shown embodiments, but are obtained in the widest scope consistent with the principles and characteristics disclosed herein.

[0022] figure 1 A flowchart showing a method 100 for identifying high fraud risks according to an embodiment of...

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Abstract

The invention provides a method and a device for identifying a high fraud risk, a computer system and a computer readable medium. The method for identifying the high fraud risk comprises the steps ofobtaining claim settlement case data; Calculating a regional case number, a regional classification condition case number, a regional classification condition average hospitalization day number and aregional classification condition hospitalization day number standard deviation according to the claim settlement case data; Determining a high-risk region; Determining a high-risk classification condition corresponding to the high-risk region; Setting a high-risk judgment threshold value; And determining high-risk cases from the insured clients according to the high-risk regions and the high-riskclassification conditions.

Description

technical field [0001] The invention relates to a medical insurance information processing method, in particular to a method, device, computer system and computer readable medium for identifying high fraud risks. Background technique [0002] Under the current combination of the Internet and insurance, the biggest challenge for Internet insurance companies is to do a good job in dual-core risk control, reduce high loss ratios, and enhance profitability. Specifically, facing the poor quality of external data, it is impossible to improve the discrimination rate of identifying high-risk customers, and the introduction of a large amount of external data will reduce the profit margin of short-term accident insurance and health insurance. In this case, how Internet insurance companies can use the accumulated claims data of past customers to efficiently identify high-risk customers, and take corresponding risk control measures to reduce the risk of claims, control operating expense...

Claims

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Application Information

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IPC IPC(8): G06Q40/08
Inventor 李庆云陈佩崔蓝艺徐生梅周国平
Owner TAIKANG LIFE INSURANCE CO LTD
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