[0038] The present invention will be described in detail below in conjunction with specific embodiments. The following examples will help those skilled in the art to further understand the present invention, but do not limit the present invention in any form. It should be pointed out that for those of ordinary skill in the art, a number of modifications and improvements can be made without departing from the concept of the present invention. These all belong to the protection scope of the present invention.
[0039] In this embodiment, the artificial intelligence adjustment system provided by the present invention includes a CHC system module, an insurance information module, an adjustment information display terminal, an insurance applicant entry module, an adjustment information display terminal, and an adjustment database;
[0040] The insurance information module is configured to search for insurance information in the adjustment database through the CHC system module and the adjustment information processing module in turn;
[0041] The adjustment information processing module is configured to interact with the adjustment information database and send the insurance information to the adjustment information display terminal for display;
[0042] The insured person entry module is used to receive the insured person information and transfer the insured person information to the CHC system module;
[0043] The adjustment information display terminal is used to display the insurance information and insurance applicant information;
[0044] The CHC system module is configured to read the query data input by the insurance information module for searching insurance information and send the insurance applicant information entered by the insurance applicant input module to the adjustment database;
[0045] The adjustment database is used to store insurance information and insurance applicant information.
[0046] The insurance information module includes an insurance company query module, an insurance type query module, an insurance policy number query module, and an insurance company query module; wherein the insurance company query module is used to sequentially pass through the CHC system module and the adjustment information The processing module searches for insurance company information in the adjustment database; the insurance type query module is used to search for insurance type information in the adjustment database through the CHC system module and the adjustment information processing module in turn; the insurance policy number The query module is used to search the policy number information in the adjustment database through the CHC system module and the adjustment information processing module in turn; the insurance company query module is used to search through the CHC system module and the management information processing module in turn The calculation information processing module searches for insurance company information in the adjustment database; the insurance information includes insurance company information, insurance type information, policy number information, and insurance company information.
[0047] The artificial intelligence adjustment system provided by the present invention also includes an underwriting condition addition module, an underwriting condition editing module, and an attribute setting module; the underwriting condition addition module is used to create a new underwriting condition plan, and the adjustment information processing module The underwriting condition plan is submitted to the adjustment information database and sent to the adjustment information display terminal for display; the underwriting condition plan includes underwriting items, expense items, insured amount, premiums, compensation ratio, deductible, deductible days, Limit, time limit, time limit, waiting period, type of insurance and remarks; the underwriting condition editing module is used to modify the underwriting condition plan; the attribute setting module is used to set the claim standard and claim ratio to limit the underwriting conditions New module and underwriting data in the underwriting conditions editing module.
[0048] The artificial intelligence adjustment system provided by the present invention further includes a claim settlement module, a claim entry module, and a claim review module; the claim settlement module is used to obtain information on the insured person whose claim has been settled in the adjustment information database, and The insured person information is transferred to the claim entry module; the claim entry module is used to receive the insured person information and transmit the insured person information to the claim review module; the claim review module is used to receive The insured person information sent by the claim input module is reviewed and verified, and the insured person information is transmitted to the automatic adjustment module after the review. The automatic adjustment module is used to receive the information of the insured person approved by the claim review module and calculate the adjustment result according to the underwriting condition plan in the insured information and transmit the adjustment result to the adjustment database through the adjustment information processing module And sent to the adjustment information display terminal for display. The adjustment result includes the claim number, the policy number, the calculation formula and the amount, the treatment items, the insurance type and the claim number.
[0049] After selecting the insurance company, insurance type, policy number and insurance company in the insurance information module, enter the insurance company information provided by the insurance company in the new underwriting conditions module, and then create new underwriting projects through the underwriting conditions plan. For the medical item information of the insured person in the insurance company, the insured person's information will be encrypted through the adjustment information processing module to generate encrypted information, and the encrypted information and the insured person's information will be stored in the adjustment information database; when the insured person finishes the consultation According to the medical expenses information provided by the insurance company for the insured personnel, enter the new module of underwriting conditions, and then transmit the medical expenses information to the adjustment information database.
[0050] The new insured amount function in the new module of underwriting conditions is based on the project cost provided by the insurance company, the operator enters the insured amount into the insured item, and then stores the insured amount in the adjustment message database.
[0051] The new premium function in the new underwriting condition module is the same as described above. Among them, the insured amount, premium, and compensation ratio in the new underwriting condition module can establish a parent-child relationship based on the cost item function. Among them, the establishment of parent-child association is as follows:
[0052] After selecting the cost items under the plan, select the sum assured and premium to establish a parent-child relationship. After the parent-child relationship is established, a level number will be automatically generated and sent to the adjustment information database through the adjustment information processing module, and then the adjustment information database passes the adjustment The information display terminal displays.
[0053] The deductible function under the newly added module of underwriting conditions can support annual deductibles based on the amount of money, daily deductibles based on the amount of money, and single deductibles based on the amount of money. After the operator selects the data, the adjustment is passed The information processing module is automatically transferred to the adjustment information database. The deductible days function under the newly added module of underwriting conditions can support annual deductibles based on how many days per year and sub-deductibles based on how many days each year. After selecting the data, it will be automatically sent to the adjustment information through the adjustment information processing module In the database.
[0054] The limit function under the new module of underwriting conditions can support sub-limit, daily limit, sub-fix and daily fix according to the amount. After selecting the data, it will be automatically transmitted to the adjustment information database through the adjustment information processing module. The limit function under the newly added module of underwriting conditions can be carried out according to the number of times provided, the limit of how many times per year and how many times of quarters, after selecting the data, it will be automatically sent to the adjustment through the adjustment information processing module. Information database. The limited time function under the newly added module of underwriting conditions can be carried out according to the number of days provided, and the limit of how many days are there every year and how many times. After selecting the data, it will be automatically sent to the adjustment information database through the adjustment information processing module. . The waiting period function under the newly added module of underwriting conditions refers to the number of waiting days after the claim settlement application is automatically transferred to the adjustment information database through the adjustment information processing module after the operator selects the data.
[0055] In this embodiment, when using the artificial intelligence adjustment system provided by the present invention, the operator enters after logging into the system, and it will automatically import the insurance company module, insurance type module, insurance policy number module and insurance company module in the CHC system module The CHC system module requests the adjustment information processing module and then the adjustment processing module requests the adjustment information database to be transmitted to the CHC system module. The CHC system module is then displayed through the adjustment information display terminal. The operator selects The designated insurance company, insurance type, policy number and insurance company can view all underwriting conditions plans under the current designated insurance company. After selecting the designated insurance company, insurance type, policy number, and insurance company, the operator enters the insurance company information provided by the insurance company in the new mode of underwriting conditions, and then builds new underwriting items through the underwriting plan. The underwriting items refer to the applicant The personal information of the insured’s medical item information will be encrypted by the adjustment information processing module, and the encrypted information will be stored in the adjustment information database together with the insured’s information. After the insured has completed the treatment in the hospital, the operator will automatically transmit the cost item to the adjustment information database through the insurance company’s provision of the insured’s medical expenses in the new module of underwriting conditions.
[0056] After the operator has established the underwriting condition plan, the insured person information is entered in the insured person entry module, and the insured person information is transmitted to the adjustment information database through the CHC system module for storage, and the claim settlement module is obtained through the adjustment information processing module In the adjustment information database, all users who have a claim settlement are displayed through the adjustment information display terminal. The operator selects the insurance applicant to be adjusted in the claim settlement module, and the system automatically transmits the selected data to the claim case after selection Input module, after receiving the data, the compensation input module transmits the data to the audit module. If the data is approved, the data will be sent to the automatic adjustment module for adjustment. If the audit fails, the system will automatically transfer the data Return to the compensation entry module. After the automatic adjustment module receives the audited data, it automatically calculates the adjustment amount of the data according to the formula. After the adjustment is completed, the adjustment result will generate a new data and send it to the adjustment information database through the adjustment information processing module Stored in and displayed through the adjustment information display terminal.
[0057] The specific embodiments of the present invention have been described above. It should be understood that the present invention is not limited to the above specific embodiments, and those skilled in the art can make various deformations or modifications within the scope of the claims, which does not affect the essence of the present invention.
