A claim settlement risk control claim settlement rule updating method, device, equipment and readable medium

Abstract

Embodiments of the present disclosure disclose a claim settlement risk control claim settlement rule updating method and device, electronic equipment and computer readable medium. A specific embodiment of the method comprises: obtaining a claim settlement case set and a target claim settlement rule; splitting the claim settlement case set using the target claim settlement rule to obtain a case set affected by the claim settlement rule and a case set not affected by the claim settlement rule; generating a logic condition library according to the target claim settlement rule; determining a to-be-updated logic condition set from the logic condition library using the case set affected by the claim settlement rule and the case set not affected by the claim settlement rule; and updating the target claim settlement rule using the to-be-updated logic condition set. This embodiment can continuously maintain and optimize the claim settlement rule, so that the modified claim settlement rule can continue to identify risk situations that can be correctly identified before the modification, while identifying new situations that cannot be identified before the modification, and excluding situations that are incorrectly identified before the modification.

Description

TECHNICAL FIELD

[0001] Embodiments of the present disclosure relate to the technical field of computer technology, in particular to a claim settlement risk control claim settlement rule updating method and device, electronic equipment and computer readable medium. BACKGROUND

[0002] Applying a business claim settlement rule system to a vehicle insurance claim settlement process as a risk control scheme for vehicle insurance claim settlement is a means that can effectively control excessive damage assessment in vehicle insurance claim settlement business scenarios, resulting in increased claim settlement costs for insurance companies. The professional knowledge of automobile industry practitioners and vehicle insurance damage assessment personnel is concentrated in the claim settlement rule library in the form of business claim settlement rules. Business claim settlement rules specifically represent excessive damage assessment scenarios that exist in specific automobile accident and claim settlement processes, such as intentionally causing vehicle damage, collusion between repair shops and damage assessors to expand loss degree, etc. When an insurance company conducts vehicle insurance claim settlement business, the business rule uses claim settlement rules in the claim settlement rule library to match claim settlement business data. When there is a business claim settlement rule in the claim settlement rule library that can completely match the claim settlement business data, it is considered that the vehicle insurance claim case has the risk described by the claim settlement rule.

[0003] Currently, the main method for optimizing claim settlement rules in the vehicle insurance claim settlement industry is to use the artificial feedback-modification method. Insurance company vehicle insurance claim audit personnel, in actual business operations, judge whether the risk prompt given by the business claim settlement rule system is true or not according to the risk prompt given by the business claim settlement rule system combined with the specific case situation. As time goes by, new knowledge is generated and existing knowledge is invalidated. When the claim settlement rule cannot accurately describe the real case or situation, the claim settlement rule needs to be modified and adjusted. However, the main problem with modifying the claim settlement rule is to maintain the stability of the claim settlement rule. Claim settlement rule managers manually modify and adjust the claim settlement rule according to specific claim settlement cases. In the vehicle insurance claim settlement business risk control claim settlement rule, there is a problem of information silos. Due to the complexity and diversity of vehicle insurance claim settlement risk control, the number of claim settlement rules in the claim settlement rule library usually reaches tens of thousands, and the claim settlement rule itself is usually limited by the personal professional level and business experience of the person who writes it. SUMMARY

[0004] The summary portion of the present disclosure is used to introduce the concepts in a brief manner, which will be described in detail in the specific embodiments section. The summary portion of the present disclosure is not intended to identify key or essential features of the claimed technical solutions, nor is it intended to limit the scope of the claimed technical solutions.

[0005] Some embodiments of the present disclosure propose a claim settlement risk control claim settlement rule updating method, device, electronic equipment and computer readable medium to solve the technical problems mentioned in the background section.

[0006] In a first aspect, some embodiments of the present disclosure provide an updating method for claim settlement risk control claim settlement rules, the method comprising: obtaining a claim settlement case set and a target claim settlement rule; splitting the claim settlement case set using the target claim settlement rule to obtain a claim settlement rule-affected case set and a claim settlement rule-unaffected case set; generating a logical condition library according to the target claim settlement rule; determining a to-be-updated logical condition set from the logical condition library using the claim settlement rule-affected case set and the claim settlement rule-unaffected case set; and updating the target claim settlement rule using the to-be-updated logical condition set.

[0007] In a second aspect, some embodiments of the present disclosure provide an updating apparatus for claim settlement risk control claim settlement rules, the apparatus comprising: an obtaining unit configured to obtain a claim settlement case set and a target claim settlement rule; a splitting unit configured to split the claim settlement case set using the target claim settlement rule to obtain a claim settlement rule-affected case set and a claim settlement rule-unaffected case set; a generating unit configured to generate a logical condition library according to the target claim settlement rule; a determining unit configured to determine a to-be-updated logical condition set from the logical condition library using the claim settlement rule-affected case set and the claim settlement rule-unaffected case set; and an updating unit configured to update the target claim settlement rule using the to-be-updated logical condition set.

[0008] In a third aspect, an electronic device is provided, which includes one or more processors; a storage device storing one or more programs; and when the one or more programs are executed by the one or more processors, the one or more processors implement the method described in any of the implementations of the first aspect.

[0009] In a fourth aspect, a computer readable medium is provided, which stores a computer program, and when the computer program is executed by a processor, the method described in any of the implementations of the first aspect is implemented.

[0010] One of the above-mentioned embodiments of the present disclosure has the following beneficial effects: using a statistical analysis method to analyze claim settlement rules in a claim settlement rule library, the claim settlement rules can be continuously maintained and optimized, so that the modified claim settlement rules can continue to identify risk situations that can be correctly identified before modification, while new situations that cannot be identified before modification can be identified, and situations that are incorrectly identified before modification can be excluded. BRIEF DESCRIPTION OF DRAWINGS

[0011] The above and other features, advantages, and aspects of the embodiments of the present disclosure will become more apparent by describing in detail some embodiments thereof with reference to the attached drawings in which: like reference numerals refer to like elements throughout. It should be understood that the drawings are schematic and elements and features are not necessarily to scale.

[0012] Figure 1 is a schematic diagram of an application scenario of an updating method of a claim settlement risk control claim settlement rule according to some embodiments of the present disclosure;

[0013] Figure 2 is a flowchart of some embodiments of an updating method of a claim settlement risk control claim settlement rule according to the present disclosure;

[0014] Figure 3 is a structural schematic diagram of some embodiments of an updating apparatus of a claim settlement risk control claim settlement rule according to the present disclosure;

[0015] Figure 4 is a structural schematic diagram of an electronic device suitable for implementing some embodiments of the present disclosure. DETAILED DESCRIPTION

[0016] Embodiments of the present disclosure will be described below in greater detail with reference to the accompanying drawings. Although some embodiments of the present disclosure are shown in the drawings, it should be understood that the present disclosure can be implemented in various forms, and should not be interpreted as being limited to the embodiments set forth herein. On the contrary, these embodiments are provided so as to more thoroughly and completely understand the present disclosure. It should be understood that the drawings and embodiments of the present disclosure are merely for exemplary purposes, and are not intended to limit the scope of protection of the present disclosure.

[0017] It should also be noted that, for ease of description, only parts related to the present application are shown in the drawings. The embodiments in the present disclosure and the features in the embodiments can be combined with each other without conflict.

[0018] It should be noted that the terms “first”, “second”, and the like mentioned in the present disclosure are merely used to distinguish different devices, modules or units, and are not intended to limit the order or interdependence of the functions performed by these devices, modules or units.

[0019] It should be noted that the terms “one”, “multiple” mentioned in the present disclosure are illustrative and not restrictive, and those skilled in the art should understand that, unless otherwise explicitly stated in the context, it should be understood as “one or more”.

[0020] The names of the messages or information exchanged between the devices in the embodiments of the present disclosure are merely for illustrative purposes, and are not intended to limit the scope of the messages or information.

[0021] The present disclosure will be described in detail below with reference to the accompanying drawings and in conjunction with the embodiments.

[0022] Figure 1 is a schematic diagram of an application scenario of an updating method of a claim settlement risk control claim settlement rule according to some embodiments of the present disclosure; is a schematic diagram of an application scenario of an updating method of a claim settlement risk control claim settlement rule according to some embodiments of the present disclosure;

[0023] As shown in Figure 1 , the server 101 can obtain a claim case set 102 and a target claim rule 103, split the claim case set 102 by using the target claim rule 103 to obtain a claim rule affected case set 104 and a non-claim rule affected case set 105, then generate a logic condition library 106 according to the target claim rule 103, subsequently determine a to-be-updated logic condition set 107 from the logic condition library 106 by using the claim rule affected case set 104 and the non-claim rule affected case set 105, and finally update the target claim rule 103 by using the to-be-updated logic condition set 107.

[0024] It can be understood that the claim risk control claim rule updating method can be executed by a terminal device, or can also be executed by the server 101. The execution subject of the method can also include a device integrated by the terminal device and the server 101 through a network, or can also be executed by various software programs. The terminal device can be various electronic devices with information processing capabilities, including but not limited to smart phones, tablet computers, e-book readers, laptop computers, desktop computers, and the like. The execution subject can also be embodied as a server 101, software, etc. When the execution subject is software, it can be installed in the above-mentioned electronic devices. It can be implemented as multiple software or software modules for providing distributed services, or as a single software or software module. No specific limitation is made here.

[0025] It should be understood that Figure 1 the number of servers in the above-mentioned server is only illustrative. According to the needs of implementation, there can be any number of servers.

[0026] With reference to Figure 2 , flow 200 of some embodiments of the claim risk control claim rule updating method according to the present disclosure is shown. The claim risk control claim rule updating method includes the following steps:

[0027] Step 201, obtaining a claim case set and a target claim rule.

[0028] In some embodiments, the execution subject (such as the server shown in Figure 1 ) of the claim risk control claim rule updating method can obtain the claim case set and the target claim rule through wired connection or wireless connection. It should be noted that the wireless connection can include but is not limited to 3G / 4G connection, WiFi connection, Bluetooth connection, WiMAX connection, Zigbee connection, UWB (ultra wideband) connection, and other now known or future developed wireless connection methods.

[0029] In particular, the target claim settlement rule mentioned above generally refers to a pre-selected claim settlement rule. The claim settlement rule is essentially a computerized embodiment of relevant professional knowledge. The claim settlement rule is composed of a set of logical (Boolean) conditions, each of which can be considered as a specific knowledge point. When a specific case meets all the logical (Boolean) conditions in a single claim settlement rule, it is considered that the conclusion (or feature) represented by the claim settlement rule is established in the specific case. In the context of vehicle insurance claim settlement risk control, it specifically means that the vehicle insurance claim case exists in the risk situation represented by the claim settlement rule.

[0030] Step 202: Split the claim case set using the target claim settlement rule to obtain a claim settlement rule-affected case set and a claim settlement rule-unaffected case set.

[0031] In some embodiments, the execution subject can split the claim case set using the target claim settlement rule to obtain a claim settlement rule-affected case set and a claim settlement rule-unaffected case set.

[0032] Here, the claim settlement rule-affected case set generally refers to a case set whose claim settlement result is affected by the target claim settlement rule. The claim settlement rule-unaffected case set generally refers to a case set whose claim settlement result is not affected by the target claim settlement rule. The specific splitting standard is determined according to the risk situation described by the claim settlement rule. For example, (claim settlement rule-affected case): the risk situation described by the claim settlement rule is that XXX accessories are suspected of intentionally causing loss risk. If the business operator verifies that the risk is true, the XXX accessories will be removed from the claim list. For another example, (claim settlement rule-unaffected case): the risk situation described by the claim settlement rule is that XXX accessories are suspected of intentionally causing loss risk. If the business operator verifies that the risk is not true, the XXX accessories will not be removed from the claim list.

[0033] Step 203: Generate a logical condition library according to the target claim settlement rule.

[0034] In some embodiments, the execution subject can generate a logical condition library according to the target claim settlement rule.

[0035] In particular, the claim settlement rule is disassembled, as described above, the claim settlement rule is composed of a set of logical (Boolean) conditions, and the disassembled single logical (Boolean) condition represents a knowledge point in the business in the actual business scenario.

[0036] In some optional implementations of some embodiments, the execution subject can disassemble the claim settlement rule to obtain a logical condition set; for each logical condition in the logical condition set, the logical condition is subjected to claim settlement rule boundary removal and de-duplication processing to obtain a logical condition library of the claim settlement rule.

[0037] Specifically, the claim settlement rule splitting includes the following steps:

[0038] First, the claim settlement rule is disassembled, and the claim settlement rule is composed of a set of logical (Boolean) conditions. A single Boolean condition represents a knowledge point in the business in the actual business scenario.

[0039] Second, all individual logical (Boolean) conditions are removed from the boundaries of the claim settlement rule, and after deduplication, the overall logical (Boolean) condition library (or knowledge base) is formed.

[0040] Step 204, using the above-mentioned claim settlement rule affected case set and the non-claim settlement rule affected case set to determine the to-be-updated logical condition set from the above-mentioned logical condition library.

[0041] In some embodiments, the above-mentioned execution subject can determine the to-be-updated logical condition set from the above-mentioned logical condition library using the above-mentioned claim settlement rule affected case set and the non-claim settlement rule affected case set.

[0042] As an example, if the number of cases in the non-claim settlement rule affected case set of a logical condition is much larger than the claim settlement rule affected case set, it can be considered that the logical condition needs to be updated.

[0043] In some optional implementations of some embodiments, the above-mentioned execution subject can determine the frequency of the above-mentioned logical condition in the above-mentioned claim settlement rule affected case set and the non-claim settlement rule affected case set for each logical condition in the above-mentioned logical condition library, obtaining the claim settlement rule affected case set appearance frequency and the non-claim settlement rule affected case set appearance frequency of the above-mentioned logical condition; from the above-mentioned logical condition library, determine the logical condition whose frequency difference between the claim settlement rule affected case set appearance frequency and the non-claim settlement rule affected case set appearance frequency reaches a threshold, to obtain the to-be-updated logical condition set.

[0044] Specifically, all logical (Boolean) conditions (or part of selected conditions) in the logical (Boolean) condition library can be used to test the cases in the claim settlement rule affected case set and the non-claim settlement rule affected case set, respectively, to count the frequency of each logical (Boolean) condition appearing in the two sets, respectively.

[0045] Specifically, the execution subject can calculate the absolute value of the frequency difference of each logical (Boolean) condition in the two sets. The frequency is calculated in percentage, and the absolute value of the frequency difference is in the interval [0%-100%], the greater the frequency difference, the greater the difference in the knowledge point represented by the logical (Boolean) condition in the two set samples. For example: the logical condition (vehicle value < 15 million), when the frequency difference is large, it means that in one set, most of the vehicle values are less than 15 million, while in the other set, most of the vehicle values are higher than 15 million.

[0046] According to the preset frequency difference threshold, for example, 80%, collect all logical (Boolean) conditions whose frequency difference exceeds the threshold to obtain a set of to-be-updated logical conditions.

[0047] Step 205, updating the target claim settlement rule by using the set of to-be-updated logical conditions.

[0048] In some embodiments, the execution subject can update the target claim settlement rule by using the set of to-be-updated logical conditions.

[0049] In some optional implementations of some embodiments, the execution subject can add the logical condition to the target claim settlement rule in response to determining that the frequency of the logical condition in the claim settlement rule-affected case set is greater than the frequency in the non-claim settlement rule-affected case set for each logical condition in the set of to-be-updated logical conditions; and add the negation of the logical condition as a supplementary condition to the target claim settlement rule in response to determining that the frequency of the logical condition in the claim settlement rule-affected case set is less than the frequency in the non-claim settlement rule-affected case set for each logical condition in the set of to-be-updated logical conditions.

[0050] Specifically, if the logical (Boolean) condition appears frequently in the affected business set, the logical (Boolean) condition should be supplemented to the current claim settlement rule individual; if the logical (Boolean) condition appears frequently in the non-affected set, the negation of the logical (Boolean) condition should be added as a supplementary condition to the current claim settlement rule individual.

[0051] In addition, the execution subject can also determine the relevance of the semantics represented by the logical (Boolean) condition to the description of the current claim settlement rule individual, and if the relevance is low, the logical (Boolean) condition can be used as a clue for the claim settlement rule writer to derive new rules.

[0052] In some optional implementations of some embodiments, the execution subject can generate an update report on the target claim settlement rule and send the update report to a target user, where the update report includes the claim settlement rule-affected case set, the non-claim settlement rule-affected case set, the logic condition library, the frequency of the logic conditions in the logic condition library in the claim settlement rule-affected case set and the non-claim settlement rule-affected case set, the set of logic conditions to be updated, the target claim settlement rule, and the updated target claim settlement rule.

[0053] Specifically, the execution subject can display the update report to a claim settlement rule manager for review and optimization of the claim settlement rule.

[0054] By combining the manual confirmation of the business claim settlement rule manager to analyze the claim settlement rule individuals and the historical business case data set in the claim settlement rule library, and presenting the analysis results to the claim settlement rule manager, the possible problems of the claim settlement rule can be warned and the guidance and clues for the claim settlement rule modification can be provided.

[0055] One of the embodiments of the above-mentioned embodiments of the present disclosure has the following beneficial effects: using a statistical analysis method to analyze the claim settlement rule in the claim settlement rule library can continuously maintain and optimize the claim settlement rule, so that the modified claim settlement rule can continue to identify the risk situations that can be correctly identified before modification, while identifying new situations that cannot be identified before modification, and excluding the situations that are incorrectly identified before modification.

[0056] Further reference Figure 3 , as an implementation of the method shown in the above-mentioned figures, the present disclosure provides some embodiments of an update device for claim settlement risk control claim settlement rules, which device embodiments correspond to the method embodiments shown in Figure 2 , and the device can be applied in various electronic devices.

[0057] As Figure 3As shown, the updating device 300 of the claim settlement risk control claim settlement rule of some embodiments comprises: an acquisition unit 301, a splitting unit 302, a generation unit 303, a determination unit 304, and an updating unit 305. The acquisition unit 301 is configured to acquire a claim case set and a target claim settlement rule; the splitting unit 302 is configured to split the claim case set by using the target claim settlement rule to obtain a case set affected by the claim settlement rule and a case set not affected by the claim settlement rule; the generation unit 303 is configured to generate a logical condition library according to the target claim settlement rule; the determination unit 304 is configured to determine a to-be-updated logical condition set from the logical condition library by using the case set affected by the claim settlement rule and the case set not affected by the claim settlement rule; and the updating unit 305 is configured to update the target claim settlement rule by using the to-be-updated logical condition set.

[0058] It can be understood that the units recorded in the device 300 correspond to the respective steps in the method described with reference to Figure 2 The operations, features and beneficial effects described above with respect to the method also apply to the device 300 and the units contained therein, and will not be described here again.

[0059] One of the above-mentioned embodiments of the present disclosure has the following beneficial effects: using a statistical analysis method to analyze the claim settlement rules in the claim settlement rule library can continuously maintain and optimize the claim settlement rules, so that the modified claim settlement rules can continue to identify the risk situations that can be correctly identified before modification, can identify new situations that cannot be identified before modification, and can exclude situations that are incorrectly identified before modification.

[0060] Reference is made below to Figure 4 which shows a structural schematic diagram of an electronic device (for example Figure 1 a server) 400 suitable for implementing some embodiments of the present disclosure. Figure 4 The electronic device shown is merely an example and should not impose any limitation on the functions and use range of the embodiments of the present disclosure.

[0061] As shown in Figure 4 , the electronic device 400 can include a processing device (for example, a central processor, a graphics processor, etc.) 401, which can perform various appropriate actions and processes according to programs stored in a read-only memory (ROM) 402 or loaded into a random access memory (RAM) 403 from a storage device 408. In the RAM 403, various programs and data required for the operation of the electronic device 400 are also stored. The processing device 401, the ROM 402, and the RAM 403 are connected to each other through a bus 404. An input / output (I / O) interface 405 is also connected to the bus 404.

[0062] In general, the following devices can be connected to the I / O interface 405: input devices 406, including, for example, a touch screen, a touch pad, a keyboard, a mouse, a camera, a microphone, an accelerometer, a gyroscope, and the like; output devices 407, including, for example, a liquid crystal display (LCD), a speaker, a vibrator, and the like; storage devices 408, including, for example, a magnetic tape, a hard disk, and the like; and communication devices 409. The communication devices 409 can allow the electronic device 400 to communicate wirelessly or via a wire with other devices to exchange data. Although Figure 4 The electronic device 400 is shown with various devices, but it is understood that all of the shown devices are not required to be implemented or present. More or fewer devices can alternatively be implemented or present. Figure 4 Each block shown in the flowcharts can represent a device or multiple devices as needed.

[0063] In particular, the processes described above with reference to the flowcharts can be implemented as a computer software program according to some embodiments of the present disclosure. For example, some embodiments of the present disclosure include a computer program product comprising a computer program carried on a computer readable medium, the computer program containing program code for executing the methods shown in the flowcharts. In some such embodiments, the computer program can be downloaded and installed from a network through the communication devices 409, or installed from the storage devices 408, or installed from the ROM 402. When the computer program is executed by the processing devices 401, the above-mentioned functions defined in the methods of some embodiments of the present disclosure are performed.

[0064] Note that the computer-readable medium or media used to provide the computer program sequence to the computer system can be embedded in a computer program product, which comprises all the respective features, which are provided with the computer program sequence, and which are enumerated above. It is understood that the computer-readable medium or media described herein are included in the computer program product, or are a component of the computer program product. In some embodiments of the disclosure, the computer-readable storage medium can be, for example but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or any suitable combination of the foregoing. More specific examples of a computer-readable storage medium can include, but are not limited to, an electrical connection having one or more wires, a portable computer diskette, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), an optical fiber, a portable compact disc read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing. In some embodiments of the disclosure, a computer-readable storage medium can be any tangible medium that contains, or stores a program for use by or in connection with an instruction execution system, apparatus, or device. In some embodiments of the disclosure, a computer-readable signal medium can include a computer-readable storage medium in baseband or propagated as a carrier wave in a propagated data signal, which contains a computer-readable program code. Such a propagated signal can take a wide variety of forms, including, but not limited to, electro-magnetic, optical, or any suitable combination thereof. A computer-readable signal medium can also be any computer-readable medium that is not a computer-readable storage medium and that can communicate, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device. Program code embodied on a computer-readable medium can be transmitted using any appropriate medium, including but not limited to wireless, wire line, optical fiber cable, RF, etc., or any suitable combination of the foregoing.

[0065] In some embodiments, the client, server, or both can communicate using any current known or future developed network protocol, such as HTTP (HyperText Transfer Protocol), and can be interconnected with any form or medium of digital data communication (e.g., a communication network). Examples of communication networks include local area networks ("LAN"), wide area networks ("WAN"), the Internet, and peer-to-peer networks (e.g., ad hoc peer-to-peer networks), as well as any current known or future developed networks.

[0066] The computer readable medium can be included in the electronic device; or can exist separately from the electronic device. The computer readable medium can carry one or more programs which, when executed by the electronic device, cause the electronic device to acquire a claim settlement case set and a target claim settlement rule; split the claim settlement case set by using the target claim settlement rule to obtain a case set affected by a claim settlement rule and a case set not affected by the claim settlement rule; generate a logical condition library according to the target claim settlement rule; determine a to-be-updated logical condition set from the logical condition library by using the case set affected by the claim settlement rule and the case set not affected by the claim settlement rule; and update the target claim settlement rule by using the to-be-updated logical condition set.

[0067] Computer program code for carrying out operations of some embodiments of the present disclosure can be written in any combination of one or more programming languages, including an object oriented programming language such as Java, Smalltalk, C++ or the like, and conventional procedural programming languages, such as the "C" programming language or similar programming languages. The program code can execute entirely on the user's computer, partly on the user's computer, as a stand-alone software package, partly on the user's computer and partly on a remote computer or entirely on the remote computer or server. In the latter scenario, the remote computer can be connected to the user's computer through any type of network, including a local area network (LAN) or a wide area network (WAN), or the connection can be made to an external computer (for example, through the Internet using an Internet Service Provider).

[0068] The flow diagrams and the block diagrams in the drawings are illustrations of architectures, functionalities, and operations of possible implementations of systems, methods, and computer program products according to various embodiments of present disclosure. In this regard, each block in the flow diagrams or block diagrams can represent a module, a procedure, or a part of code, which comprises one or more executable instructions for implementing the specified logical functions. It should also be noted that in some alternative implementations, the functions noted in the blocks can occur in a different order than that noted in the figures. For example, two blocks noted in succession can in fact be executed substantially concurrently or in the opposite order, depending on the functionality involved. It is also noted that each block in the block diagrams and / or flow diagrams, and combinations of blocks in the block diagrams and / or flow diagrams, can be implemented by dedicated hardware-based systems that perform the specified functions or operations, or can be implemented by a combination of dedicated hardware and computer instructions.

[0069] The units described in some embodiments of the present disclosure can be implemented in the form of software, or can be implemented in the form of hardware. The described units can also be arranged in a processor, for example, can be described as: a processor includes an acquisition unit, a splitting unit, a generating unit, a determining unit and an updating unit. Among them, the name of these units does not constitute a limitation to the unit itself in some cases, for example, the acquisition unit can also be described as "a unit of acquiring the claim case set and the target claim rule".

[0070] The functions described above in the present document can be performed at least in part by one or more hardware logic components. For example, non-limiting, exemplary types of hardware logic components that can be used include: field programmable gate arrays (FPGAs), application specific integrated circuits (ASICs), application specific standard products (ASSPs), system on a chip (SOCs), complex programmable logic devices (CPLDs), etc.

[0071] The above description is merely some preferred embodiments of the present disclosure and a description of the principles of the technology used. Those skilled in the art should understand that the scope of the application involved in the embodiments of the present disclosure is not limited to the technical solutions formed by the specific combinations of the above technical features, and should also cover other technical solutions formed by any combination of the above technical features or their equivalent features without departing from the above inventive concept. For example, the above features are replaced with each other to form a technical solution with similar functions disclosed in the embodiments of the present disclosure (but not limited to).

Claims

1. A method for updating claims risk control and claims rules, comprising: Obtain a collection of claims cases and target claims rules; The set of claims cases is split using the target claims rules to obtain a set of cases affected by the rules for accepting claims and a set of cases affected by the rules for not accepting claims. A logical condition library is generated based on the target claims rules; The set of logical conditions to be updated is determined from the logical condition library using the case set affected by the acceptance rules and the case set affected by the non-acceptance rules, wherein; For each logical condition in the logical condition library, determine the frequency of occurrence of the logical condition in the case set affected by the acceptance rule and the case set affected by the non-acceptance rule, and obtain the frequency of occurrence of the logical condition in the case set affected by the acceptance rule and the case set affected by the non-acceptance rule. From the logical condition library, determine the logical condition where the frequency difference between the occurrence frequency of the case set affected by the acceptance rule and the occurrence frequency of the case set affected by the non-acceptance rule reaches a threshold, and obtain the logical condition set to be updated; The target claims rule is updated using the set of logical conditions to be updated.

2. The method according to claim 1, wherein, The step of generating a logical condition library based on the target claims rules includes: The claims rules are broken down to obtain a set of logical conditions; For each logical condition in the set of logical conditions, the claims rule boundaries are removed and duplicates are deduplicated to obtain the logical condition library of the claims rules.

3. The method according to claim 2, wherein, The step of updating the target claims rule using the set of logical conditions to be updated includes: For each logical condition in the set of logical conditions to be updated, in response to determining that the frequency of the case set affected by the acceptance rule of the logical condition is greater than the frequency of the case set affected by the non-acceptance rule, the logical condition is added to the target claims rule; For each logical condition in the set of logical conditions to be updated, in response to determining that the frequency of the case set affected by the acceptance rule of the logical condition is less than the frequency of the case set affected by the non-acceptance rule, the negative value of the logical condition is added as a supplementary condition to the target claims rule.

4. The method according to claim 3, wherein, The method further includes: Generate an update report on the target claims rule and send the update report to the target user. The update report includes the case set affected by the accepted claims rule, the case set affected by the unaccepted claims rule, the logic condition library, the frequency of occurrence of the logic condition in the logic condition library in the case sets affected by the accepted claims rule and the unaccepted claims rule, the logic condition set to be updated, the target claims rule, and the updated target claims rule.

5. An apparatus for updating claims risk control and claims rules, comprising: The acquisition unit is configured to acquire a set of claims cases and target claims rules; The splitting unit is configured to split the claims case set using the target claims rules to obtain a case set affected by the acceptance rules and a case set affected by the non-acceptance rules; The generation unit is configured to generate a logical condition library based on the target claims rules; The determining unit is configured to determine a set of logical conditions to be updated from the logical condition library using the set of cases affected by the acceptance rules and the set of cases affected by the non-acceptance rules. Specifically, for each logical condition in the logical condition library, the frequency of occurrence of the logical condition in the set of cases affected by the acceptance rules and the set of cases affected by the non-acceptance rules is determined to obtain the frequency of occurrence of the logical condition in the set of cases affected by the acceptance rules and the set of cases affected by the non-acceptance rules. The unit then determines logical conditions from the logical condition library where the frequency difference between the frequency of occurrence of the logical condition in the set of cases affected by the acceptance rules and the set of cases affected by the non-acceptance rules reaches a threshold, thereby obtaining the set of logical conditions to be updated. The update unit is configured to update the target claims rule using the set of logical conditions to be updated.

6. The apparatus according to claim 5, wherein, The generation unit is further configured to: The claims rules are broken down to obtain a set of logical conditions; For each logical condition in the set of logical conditions, the claims rule boundaries are removed and duplicates are deduplicated to obtain the logical condition library of the claims rules.

7. The apparatus according to claim 5, wherein, The update unit is further configured to: For each logical condition in the logical condition library, determine the frequency of occurrence of the logical condition in the case set affected by the acceptance rule and the case set affected by the non-acceptance rule, and obtain the frequency of occurrence of the logical condition in the case set affected by the acceptance rule and the case set affected by the non-acceptance rule. From the logical condition library, determine the logical condition where the frequency difference between the occurrence frequency of the case set affected by the acceptance rule and the occurrence frequency of the case set affected by the non-acceptance rule reaches a threshold, and obtain the logical condition set to be updated.

8. An electronic device, comprising: One or more processors; Storage device, on which one or more programs are stored, When the one or more programs are executed by the one or more processors, the one or more processors implement the method as described in any one of claims 1-4.

9. A computer-readable medium having a computer program stored thereon, wherein, When the program is executed by the processor, it implements the method as described in any one of claims 1-4.

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