Claim settlement risk control method and device and computer readable storage medium

Abstract

The invention discloses a claim settlement risk control method and device and a computer readable storage medium, and belongs to the field of insurance claim settlement, and the method comprises the steps: judging whether a claim settlement request is a normal request or not according to a preset risk control rule after receiving the claim settlement request; if the claim settlement request is a normal request, extracting a plurality of features from information carried by the claim settlement request; inputting the plurality of features into a pre-trained risk control model for prediction toobtain a risk probability of the claim settlement request; and assessing the risk level of the claim settlement request at least based on the risk probability of the claim settlement request. According to the embodiment of the invention, the risk control accuracy of the claim settlement case can be improved, the controllability of the risk control cost is improved, the Internet insurance company is effectively assisted to reduce the loss, and the claim settlement efficiency is improved.

Description

technical field [0001] The present invention relates to the field of insurance claims, in particular to a method, device and computer-readable storage medium for risk control of claims. Background technique [0002] With the continuous development of Internet technology, traditional insurance companies and Internet giants have deployed Internet insurance. Internet insurance does not require the participation of insurance agents when users apply for insurance, and relies on the information submitted by users for underwriting. While improving the user experience, the insurance company also introduces greater risks. Claims risk control is essential for the business development of insurance companies link. [0003] At present, insurance companies face more than 30 kinds of problems when processing insurance claims, such as: accidents during the waiting period, repeated claims, incomplete submission of documents, special needs of departments or foreign guests, and insurance frau...

AI Technical Summary

Problems solved by technology

Most insurance companies adopt the method of risk control rules combined with manual review. This method of claim risk control has certain defects.

First of all, due to the diversity of factors such as insurance products, user diseases, hospitals visited, and the amount of expenses, the combined situation is very intricate, and mistakes are prone to occur in both manual review and rule definition.

Secondly, when judging abnormalities such as abnormal amounts and days of hospitalization, the traditional compensation method is relatively extensive in setting abnormal thresholds, which are mostly obtained from the experience of claimants. Different claimants have different experiences and standards for compensation , with subjectivity

Furthermore, the combination of risk control rules and manual review makes the work efficiency of insurance claims adjusters low and the workload is heavy, which affects the quality of insurance services

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