Determination method and device of mutual exclusion information of insurance claim settlement cases

A technology for mutually exclusive information and determination methods, which is applied in the field of determination methods and devices for mutually exclusive information in insurance claim cases, and can solve the problems of reducing audit efficiency, prone to loopholes, wrong judgments, and missed judgments

Inactive Publication Date: 2018-04-13
PING AN TECH (SHENZHEN) CO LTD
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

[0004] In view of this, the present invention provides a method and device for determining mutually exclusive information in an insurance claim case. , Vulnerabilities are prone to occur during manual review. For example, the judgment of whether there is mutually exclusive information in past medical history, surgical records, joint insurance relationship, and blacklist will vary from person to person, resulting in wrong judgments or missed judgments in the review, increasing the risk of claim settlement , and manual review also wastes a lot of human resources and reduces the efficiency of review

Method used

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  • Determination method and device of mutual exclusion information of insurance claim settlement cases
  • Determination method and device of mutual exclusion information of insurance claim settlement cases
  • Determination method and device of mutual exclusion information of insurance claim settlement cases

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Embodiment Construction

[0042] 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.

[0043] An embodiment of the present invention provides a method for determining mutually exclusive information in an insurance claim case, such as figure 1 As shown, the method includes:

[0044] 101. Obtain the claim settlement data of the insured in the claim settlement case.

[0045]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 ...

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Abstract

The invention discloses a determination method and device of mutual exclusion information of insurance claim settlement cases and relates to the technical field of data processing. The main objectiveof the invention is to solve problems that loopholes easily occur in manual checking, error judgment and leaked judgment of the checking are caused, claim settlement risks are increased, a large number of human resources are wasted in manual checking and checking efficiency is reduced in determination about whether there is mutual exclusion in specific claim settlement items and treatment items inclaim settlement cases. The method comprises steps of acquiring claim settlement data of an insured person in a claim settlement case; according to a preset mutual exclusion rule, judging whether there is mutual exclusion information in the claim settlement data, wherein the preset mutual exclusion rule is used for reflecting the mutual exclusion relation in the claim settlement data; and if there is mutual exclusion information, marking the mutual exclusion information.

Description

technical field [0001] The invention relates to the technical field of data processing, in particular to a method and device for determining mutually exclusive information of an insurance claim case. 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 order to ensure the accuracy of the claims, the underwriters need to manually check each claim item in the claims and judge whether there is any abnormal phenomenon in the claims. [0003] At present, the review of existing claims cases is manually reviewed by underwriters, and it is necessary to review whether there are some unreasonable situations in the insurance application information and loss assessment information of the insured. However, for the specific claim items and Whether there is an unreasonable situation...

Claims

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Application Information

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