Individual risk pricing method and system
A risk and risk-level 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 of people. 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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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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[0059] Below, the implementation of the technical solution will be further described in detail in conjunction with the accompanying drawings.
[0060] 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.
[0061] 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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The disclosure relates to an individual risk pricing method and system. An individual is an existing or potential claim customer. The method includes a data preparation phase, a model training phase and a model implementation phase. The data preparation phase includes the following steps: obtaining data, which are related to claim customer risks, from medical claim big-data, wherein the data include individual information and doctor seeing information of claim customers, and the doctor seeing information includes doctor seeing fee information; and extracting features, which are needed for training a GBM (Gradient Boosting Machine) model, from the data to form a data set. The model training phase includes the following steps: using partial data in the data set as a training set, and inputting the same to a trainer of the GBM model for training; and generating a GBM model of which training is completed. The model implementation phase includes the following steps: collecting current claimdata of a claim customer, and extracting features needed by the GBM model; and inputting the features to the GBM model to generate a recognition result, wherein the recognition result includes a doctor seeing fee which is of the claim customer and may be generated in the future.
Description
technical field [0001] The invention relates to the technical field of insurance services based on Internet applications, in particular to a personal risk pricing method and system. 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 achieve individual differentiated se...
Claims
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Patent Timeline
Login to View More IPC IPC(8): G06Q10/06G06Q30/02G06Q40/08
CPCG06Q10/0635G06Q30/0278G06Q30/0283G06Q40/08
Inventor 冯晓俊夏如雪夏天
Owner PING AN HEALTH INSURANCE CO LTD