Automatic compensation method and device for claim settlement data, electronic equipment and storage medium

Abstract

The invention relates to the field of data processing, and discloses an automatic compensation method and device for claim settlement data, electronic equipment and a storage medium, and the method comprises the steps: obtaining the case data of a case to be subjected to claim settlement according to preset case information after a case auditing request submitted by a user is received; checking whether a preset type of claim settlement data is lacked in the case data, and if yes, supplementing the request text; judging whether the current time is within the working time period, if so, calling a first communication account to simulate a claim settlement specialist to send the repayment request text to a second communication account, and receiving target text data returned by the second communication account; and judging whether the target text data contains the missing preset type of claim settlement data or not, and if yes, storing the missing preset type of claim settlement data in the case data corresponding to the to-be-claimed case to complete the auditing request for the to-be-claimed case. According to the invention, full-process intelligentization of automatic supplementary collection of claim settlement data is realized, the workload of claim settlement specialists is reduced, and the efficiency of supplementary collection of data is improved.

Description

Technical Field

[0001] The present invention relates to the field of data processing, and in particular to a method, device, electronic equipment and storage medium for automatically collecting claim information. Background Art

[0002] In the insurance industry, claims settlement is an important link that is directly related to user satisfaction and service experience. However, during the claims review process, we often encounter problems such as incomplete or missing relevant information due to various reasons, which makes it impossible to quickly enter the settlement stage, thus prolonging the entire claims process.

[0003] At present, most insurance companies still use traditional manual methods to collect the information required for claims. Specifically, the process of manually collecting information is usually cumbersome, requiring claims personnel to contact users one by one and guide them to prepare and submit relevant materials. This process is not only time-consuming, but also prone to omissions or misunderstandings. It may result in the claims personnel contacting the user multiple times, but the collected information is still incomplete or does not meet the requirements, which in turn affects the claims process and reduces work efficiency.

[0004] Therefore, in the claims review process, how to reduce manual collection of supplementary documents and improve the efficiency of supplementary document collection is a technical problem that needs to be solved urgently. Summary of the invention

[0005] In view of the above content, it is necessary to provide a method for automatic collection of claims information, with the aim of realizing automatic collection of information by artificial intelligence during the claims review process, so as to improve the efficiency of collecting information.

[0006] The method for automatically collecting claim information provided by the present invention comprises:

[0007] After receiving a case review request submitted by a user containing preset case information of a pending claim case, obtaining case data of the pending claim case from a preset database according to the preset case information;

[0008] Check whether the acquired case data lacks preset type claim information. If the preset type claim information is missing, generate a corresponding supplementary request text for the missing preset type claim information according to the preset supplementary information speech script. The case data of the pending claim case includes the first communication account of the claim specialist responsible for the pending claim case and the second communication account of the user. The first communication account and the second communication account complete communication registration on the preset first server and realize mutual communication. The first communication account completes the call permission registration on the preset second server.

[0009] Determine whether the current time is within the working hours, and if so, call the first communication account to simulate the claims specialist to send the supplementary payment request text to the second communication account, and receive the target text data returned by the second communication account based on the supplementary payment request text;

[0010] Determine whether the target text data contains missing claims data of a preset type. If so, store the missing claims data of the preset type in the case data corresponding to the pending claims case to complete the review request for the pending claims case.

[0011] Optionally, the checking whether the acquired case data lacks a preset type of claim settlement information includes:

[0012] According to the type of the pending claim case, a list of inspection data corresponding to the pending claim case is obtained, wherein the list of inspection data includes various target data types corresponding to the pending claim case;

[0013] Check whether there is any claim data of the target data type that is not included in the case data;

[0014] If there is claim data of the target data type that is not included in the case data, it is determined that there is missing claim data of the preset type, and the claim data of the target data type that is not included in the case data is the missing claim data of the preset type.

[0015] Optionally, the checking whether the acquired case data lacks a preset type of claim settlement information includes:

[0016] Using a preset optical character recognition technology to identify data type keywords corresponding to various claim data in the case data, and obtaining a data type keyword set;

[0017] According to the type of the pending claim case, a preset keyword inspection list corresponding to the pending claim case is obtained, and whether there are keywords in the preset keyword inspection list that are not included in the data type keyword set;

[0018] If any keyword in the preset keyword check list is not included in the data type keyword set, it is determined that preset type claim data is missing, and the data type corresponding to the keyword not included in the data type keyword set is the data type of the missing claim data.

[0019] Optionally, the generating of a corresponding supplementary payment request text for the missing preset type of claim settlement information according to the preset supplementary collection information script includes:

[0020] According to the type of the missing claim information of the preset type, the script for collecting supplementary information corresponding to the missing claim information of the preset type is obtained from the preset database;

[0021] Extracting user personal information from the case data and obtaining basic information of missing preset types of claims data;

[0022] The user personal information and the basic information are filled into the corresponding blank items in the basic template of the supplementary information collection script to generate the supplementary submission request text.

[0023] Optionally, the method further includes:

[0024] When it is determined that the current time is not within the working time period, a delayed sending task alarm is set according to the supplementary submission request text;

[0025] The delayed sending task alarm is used to automatically call the first communication account within the next working time period to simulate the claims specialist sending the supplementary payment request text to the second communication account.

[0026] Optionally, the communication account includes an email account, and the calling of the first communication account simulates the claims specialist sending the supplementary payment request text to the second communication account, including:

[0027] According to the first communication account, the calling authority registration is completed on the preset second server, and the email account of the claims specialist is called on the second server to log in to the mail client or web mailbox service of the first server;

[0028] In the email client or the webmail service, call the email account of the claims specialist to create a new email, and set the recipient to the email account of the user;

[0029] The supplementary submission request text is input into the body of the new email and sent.

[0030] Optionally, the communication account includes an instant messaging software account, and the calling of the first communication account simulates the claims specialist sending the supplementary payment request text to the second communication account, including:

[0031] The calling permission registration is completed on the preset second server according to the first communication account, and the instant messaging software account of the claims specialist is called on the second server to log in to the instant messaging software of the first server;

[0032] Open the chat window corresponding to the instant messaging software account of the user in the instant messaging software, input the supplementary payment request text in the chat window and send it.

[0033] In order to solve the above problems, the present invention also provides a device for automatically collecting claims information, the device comprising:

[0034] A submission module, configured to, after receiving a case review request submitted by a user containing preset case information of a pending claim case, obtain case data of the pending claim case from a preset database according to the preset case information;

[0035] A verification module is used to verify whether the acquired case data lacks preset type claim information. If the preset type claim information is missing, a corresponding supplementary request text is generated for the missing preset type claim information according to a preset supplementary information speech script. The case data of the pending claim case includes a first communication account of a claim specialist responsible for the pending claim case and a second communication account of the user. The first communication account and the second communication account complete communication registration on a preset first server and realize mutual communication. The first communication account completes call permission registration on a preset second server.

[0036] The sending module is used to determine whether the current time is within the working time period. If so, the first communication account is called to simulate the claims specialist to send the supplementary payment request text to the second communication account, and receive the target text data returned by the second communication account based on the supplementary payment request text;

[0037] The judgment module is used to judge whether the target text data contains missing preset type claim data. If so, the missing preset type claim data is stored in the case data corresponding to the pending claim case to complete the review request for the pending claim case.

[0038] In order to solve the above problem, the present invention further provides an electronic device, the electronic device comprising:

[0039] at least one processor; and,

[0040] a memory communicatively connected to the at least one processor; wherein,

[0041] The memory stores a claim data automatic collection program that can be executed by the at least one processor. The claim data automatic collection program is executed by the at least one processor so that the at least one processor can execute the above-mentioned claim data automatic collection method.

[0042] In order to solve the above problems, the present invention also provides a computer-readable storage medium, on which a program for automatically collecting claims information is stored. The program for automatically collecting claims information can be executed by one or more processors to implement the above-mentioned method for automatically collecting claims information.

[0043] Compared with the prior art, the present invention, after receiving a case review request submitted by a user containing preset case information of a pending claim case, obtains the case data of the pending claim case from a preset database according to the preset case information; checks whether the acquired case data lacks preset type claim information, and if so, generates a corresponding supplementary submission request text for the missing preset type claim information according to a preset supplementary information speech script, the case data of the pending claim case includes a first communication account of a claims specialist responsible for the pending claim case and a second communication account of the user, the first communication account and the second communication account are in the preset The first server completes communication registration and realizes mutual communication. The first communication account completes the calling permission registration on the preset second server; determines whether the current time is within the working time period. If so, calls the first communication account to simulate the claims specialist to send the supplementary payment request text to the second communication account, and receives the target text information returned by the second communication account based on the supplementary payment request text; determines whether the target text information contains the missing preset type claim information. If so, stores the missing preset type claim information in the case data corresponding to the pending claim case to complete the review request for the pending claim case.

[0044] The present invention checks whether the claim case information is complete in an automated manner, and uses the first communication account of the claim specialist to simulate the claim specialist to notify the user to supplement the missing information, thereby reducing the steps of manual inspection and manual notification and speeding up the claim process. BRIEF DESCRIPTION OF THE DRAWINGS

[0045] Figure 1 A schematic diagram of a process flow of a method for automatically collecting claims information provided by an embodiment of the present invention;

[0046] Figure 2 A schematic diagram of a module of a device for automatically collecting claims information provided by an embodiment of the present invention;

[0047] Figure 3 A schematic diagram of the structure of an electronic device for implementing a method for automatically collecting claim settlement information provided by an embodiment of the present invention;

[0048] The purpose, features and advantages of the present invention will be further described with reference to the accompanying drawings in conjunction with the embodiments. DETAILED DESCRIPTION

[0049] In order to make the purpose, technical scheme and advantages of the present invention more clearly understood, the present invention is further described in detail below in conjunction with the accompanying drawings and embodiments. It should be understood that the specific embodiments described herein are only used to explain the present invention and are not intended to limit the present invention. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without making creative work are within the scope of protection of the present invention.

[0050] It should be noted that the descriptions of "first", "second", etc. in the present invention are only used for descriptive purposes and cannot be understood as indicating or implying their relative importance or implicitly indicating the number of the indicated technical features. Therefore, the features defined as "first" and "second" may explicitly or implicitly include at least one of the features. In addition, the technical solutions between the various embodiments can be combined with each other, but they must be based on the ability of ordinary technicians in the field to implement them. When the combination of technical solutions is contradictory or cannot be implemented, it should be deemed that such a combination of technical solutions does not exist and is not within the scope of protection required by the present invention.

[0051] Reference Figure 1 FIG. 1 is a flow chart of a method for automatically collecting claim information provided by an embodiment of the present invention. The method is executed by an electronic device.

[0052] In this embodiment, the method for automatically collecting claim information includes:

[0053] S1. After receiving a case review request submitted by a user containing preset case information of a pending claim case, the case data of the pending claim case is obtained from a preset database according to the preset case information.

[0054] In this embodiment, the insurance company or the claims processing platform's claims system receives a case review request submitted by a user containing preset case information of a pending claim case. For example, the preset case information includes a case number, user identity information, a case report number, etc. The preset case information is key information used to uniquely identify the pending claim case.

[0055] The case data of the pending claim case is obtained from the preset database according to the preset case information. For example, the preset type of claim information refers to the specific type of documents or information that must be submitted by the insurance company. Taking the car damage claim as an example, the preset type of claim information may include the photo of the reporter's ID card, the photo of the driver's license, the photo of the damaged part of the car, etc.).

[0056] A user is an individual or entity who files a claim with an insurance company. Specifically, users can refer to the following roles: Policyholder: The person who purchases an insurance contract, usually a party to the insurance contract and the party who pays the premium. Insured: The person covered by the insurance contract. In some cases, the insured may be the policyholder himself or another person designated by the policyholder. Claimant: The person who files a claim. The claimant may be the insured or another person who has the authority to file a claim on behalf of the insured (for example, an agent or legal heir).

[0057] Claims cases are those that have been reported to the insurance company by the user but have not yet completed the entire review and processing process. In other words, this is a case that is in the early or middle stages of the claims process and has not yet been finalized and the claims result has not been reached.

[0058] The preset database refers to a database that is pre-set and maintained in the claims system to store various information and data related to claims. The database contains various standard information and rules required to process claims cases to support the automation and standardization of the claims process.

[0059] S2. Check whether the acquired case data is missing any preset type of claim information. If any preset type of claim information is missing, generate a corresponding supplementary request text for the missing preset type of claim information according to the preset supplementary information script. The case data of the pending claim case includes the first communication account of the claims specialist responsible for the pending claim case and the second communication account of the user. The first communication account and the second communication account complete communication registration on the preset first server and realize mutual communication. The first communication account completes the call permission registration on the preset second server.

[0060] In this embodiment, after receiving a case review request, the claims system checks whether the obtained case data related information and materials are complete according to preset inspection rules. If the case data related information and materials are complete, the claims case is directly reviewed.

[0061] If it is found that any preset type of claim information is missing, the claim system will generate a supplementary submission request text according to the pre-set script for collecting supplementary information to inform the user which documents are missing and guide the user on how to submit these missing documents in order to continue processing the claim application.

[0062] The supplementary document collection script is a standard language template used to guide staff or the claims system on how to communicate with users when it is found that the application materials submitted by users are incomplete or lack necessary documents in claims or other business scenarios. The supplementary document collection script includes how to politely and clearly inform users which documents they are missing and guide them on how to correctly supplement these materials.

[0063] The purpose of the design of the supplementary document collection script is to ensure that communication with users is both professional and efficient, while reducing misunderstandings and unnecessary delays. It can also assist staff or automated claims systems. By using the supplementary document collection script, insurance companies can maintain consistency and high standards of user service while also helping to simplify internal workflows.

[0064] The case data of pending claims includes the first communication account of the claims specialist responsible for the pending claims and the second communication account of the user. The claims specialist refers to a professional in the insurance company who is responsible for handling pending claims. The main responsibility of the claims specialist is to review and process the user's claim request and ensure that the claim process complies with the company's policies and laws and regulations.

[0065] A communication account refers to an account or identifier used for communication, allowing a claims specialist and a user to exchange information through a specific server. In the present invention, communication account types include but are not limited to:

[0066] 1. Instant messaging software accounts: For example, accounts of instant messaging software such as WeChat, QQ, WhatsApp, and Telegram. These accounts allow claims specialists and users to communicate through instant messaging and send text, pictures, files, and other information.

[0067] 2. Email account: such as Gmail, Outlook, corporate mailbox, etc. Email is suitable for sending detailed claim information, formal claim notice and other important documents.

[0068] 3. Mobile phone number: Mobile phone number can be used to send text messages, pictures or make calls. It is an important contact method in emergency situations or when direct voice communication is required.

[0069] 4. Social media accounts: Although not common, in some cases, social media accounts (such as Facebook, Linked In, etc.) can also be used as a communication channel.

[0070] The first communication account and the second communication account complete communication registration on the preset first server and realize mutual communication. The first communication account and the second communication account need to be registered on a specific server (the preset first server can be WeChat or QQ) so that they can recognize and communicate with each other. Communication registration involves configuring network connection information, verifying the identity of the account, and setting necessary communication parameters.

[0071] In addition to registering the communication function on the first server, the first communication account also needs to register its permission information on another server (the preset second server can be the insurance company's server). That is, the second server can use the first communication account to perform certain operations on the first server or access specific data and services.

[0072] For example, both the claims specialist account and the user account need to be registered on WeChat, and ensure that both parties can identify and communicate with each other through WeChat. The claims specialist account also needs to complete the permission registration on the insurance company's server, so that the claims system can send a request for additional information to the user by calling the claims specialist account, and can receive the additional information sent back by the user through WeChat.

[0073] In one embodiment, the checking whether the acquired case data lacks the preset type of claim settlement information includes:

[0074] The inspection is to determine whether the acquired case data lacks the preset type of claim information, including:

[0075] According to the type of the pending claim case, a list of inspection data corresponding to the pending claim case is obtained, wherein the list of inspection data includes various target data types corresponding to the pending claim case;

[0076] Check whether there is any claim data of the target data type that is not included in the case data;

[0077] If there is claim data of the target data type that is not included in the case data, it is determined that there is missing claim data of the preset type, and the claim data of the target data type that is not included in the case data is the missing claim data of the preset type.

[0078] According to the type of claim case to be settled (such as traffic accident, health insurance claim, etc.), a list of inspection materials related to the type of claim case to be settled is obtained from predefined rules or databases. The list of inspection materials contains various standard claim materials required to process the type of claim case to be settled.

[0079] Check the pending claims to confirm that the pending claims data includes each type of claim information listed in the inspection information list. This is a one-by-one verification process to ensure that no necessary documents or information are missing.

[0080] Through such steps, we can ensure that every claim case has complete information, thereby ensuring the accuracy and efficiency of the claims process. If missing information is found, further measures can be taken, such as generating a supplementary request text and notifying the customer to submit the supplementary information.

[0081] In one embodiment, the checking whether the acquired case data lacks the preset type of claim settlement information includes:

[0082] Using a preset optical character recognition technology to identify data type keywords corresponding to various claim data in the case data, and obtaining a data type keyword set;

[0083] According to the type of the pending claim case, a preset keyword inspection list corresponding to the pending claim case is obtained, and whether there are keywords in the preset keyword inspection list that are not included in the data type keyword set;

[0084] If any keyword in the preset keyword check list is not included in the data type keyword set, it is determined that preset type claim data is missing, and the data type corresponding to the keyword not included in the data type keyword set is the data type of the missing claim data.

[0085] Use OCR software or tools to scan and read documents in case data. OCR technology can convert text in paper documents or images into editable and searchable electronic text, that is, obtain a set of data type keywords.

[0086] The claims system will have a preset keyword list, which contains specific words or phrases related to claims. According to the preset keyword verification list, check whether these keywords are included in the data type keyword set obtained through OCR, so as to determine whether all types of claims data are included in the case data. For example, such as "date", "amount", "accident location", "doctor's signature", etc. The presence or absence of these keywords can help the claims system determine whether the corresponding claims data has been correctly submitted and identified.

[0087] If all preset keywords are found in the data type keyword set, then the case data can be considered complete, at least there is no missing claim data of the preset type within the scope of the keyword coverage. If some keywords fail to match, it may indicate that some claim data is missing and needs further verification or supplementation.

[0088] By using optical character recognition technology to identify each type of claim information in the case data, a large number of claim applications can be processed automatically, which can greatly improve efficiency and reduce the workload of manual review.

[0089] In one embodiment, the method of generating a corresponding supplementary payment request text for the missing preset type of claim settlement information according to the preset supplementary collection information script includes:

[0090] According to the type of the missing claim information of the preset type, the script for collecting supplementary information corresponding to the missing claim information of the preset type is obtained from the preset database;

[0091] Extracting user personal information from the case data and obtaining basic information of missing preset types of claims data;

[0092] The user personal information and the basic information are filled into the corresponding items in the basic template of the supplementary information collection script to generate the supplementary submission request text.

[0093] A series of supplementary document collection scripts are stored in the preset database. According to the type of missing claim documents of preset types, an appropriate basic template is selected from the series of supplementary document collection scripts. These basic templates may be designed for different situations, such as missing identity documents, medical reports, accident scene photos, etc.

[0094] Obtain the user's specific personal information (such as the user's name) and the basic information of the missing information (for example, the basic information includes the specific file name, parameters, specifications, etc. that need to be supplemented), fill the user's personal information and basic information into the corresponding items in the basic template of the supplementary information script, and generate a supplementary request text. This personalized supplementary request text will be sent to the user to inform what information needs to be supplemented in order to continue processing the claim application.

[0095] In one embodiment, the present invention uses a large language model (LLM) to achieve automated customer service by collecting a large number of historical conversation records between different users and claims adjusters, including but not limited to email exchanges, chat records, and telephone recordings converted to text, etc. The language model is trained using the historical conversation records, and these conversation records are analyzed using NLP technology to extract the voice tone, text style or expression style unique to the claims adjusters. This includes an assessment of factors such as politeness, formality, and tone intensity. Based on the above analysis results, a large language model (LLM) is developed that can imitate the writing style of a specific claims adjuster.

[0096] When the claims system needs to generate a new supplementary payment request, it will refer to the previously established language model, adjust the supplementary information collection script according to the specific situation, and generate the corresponding supplementary payment request text. The generated supplementary payment request text not only contains the required specific information, but also maintains the original style of the claims adjuster as much as possible, making the user feel like communicating directly with the claims adjuster.

[0097] Generate corresponding supplementary submission request texts for missing preset types of claim documents according to preset supplementary document scripts, which can ensure that all supplementary submission request texts follow consistent professional standards and clearly convey the required information. At the same time, it also simplifies the workflow of claim processing personnel and improves efficiency.

[0098] S3. Determine whether the current time is within the working hours. If so, call the first communication account to simulate the claims specialist to send the supplementary payment request text to the second communication account, and receive the target text information returned by the second communication account based on the supplementary payment request text.

[0099] In this embodiment, the claim system first checks the current time to determine whether it is within the working hours. For example, the working time period can be defined as 8 am to 6 pm (8:00-18:00), and the specific time can be determined according to the actual situation of the insurance company.

[0100] If the current time is indeed within the working hours, the claims system will send the supplementary payment request text to the user's second communication account through the claims specialist's first communication account. Waiting to receive the target text information based on the supplementary payment request text reply from the user. The user's reply may include information about the missing preset type of claims information, or inquiries about how to provide the missing preset type of claims information.

[0101] The above process ensures that users are contacted at the appropriate time and avoids disturbing users during non-working hours. It also improves communication efficiency and ensures that users can receive notifications of the need to supplement preset types of claims information in a timely manner and can respond in a timely manner. This can speed up the claims process and improve user satisfaction.

[0102] In one embodiment, the method further comprises:

[0103] When it is determined that the current time is not within the working time period, a delayed sending task alarm is set according to the supplementary submission request text;

[0104] The delayed sending task alarm is used to automatically call the first communication account within the next working time period to simulate the claims specialist sending the supplementary payment request text to the second communication account.

[0105] When it is detected that a message needs to be sent during non-working hours, the sending action will not be executed immediately, but a delayed task will be set. This task will be automatically triggered during the next working hour to complete the sending of the message. The specific steps are as follows:

[0106] The claims system will check whether the current time falls within the predefined working time period (e.g. 8:00-18:00). If the current time is not within the set working hours (e.g. evening or weekends), the claims system will not send the information immediately but will create a reminder or task. This reminder will be activated at the beginning of the next working time period. When the next working time period is reached, this reminder or task will be triggered. Then the claims system will call the first communication account (e.g. corporate email or a specific instant messaging tool account) to send the supplementary payment request text to another designated receiving account (ie "second communication account").

[0107] Setting a delayed task alarm helps maintain time boundaries for professional communication, ensuring that users are not disturbed during non-working hours, while also ensuring that important information can be conveyed at the right time.

[0108] In one embodiment, the method further comprises:

[0109] After sending the supplementary submission request text to the second communication account, if the target text material is not received within the first time period, editing the supplementary submission request text to obtain a re-request text;

[0110] The first communication account is called to simulate the claims specialist sending the re-request text to the second communication account, so as to receive the target text data returned by the second communication account based on the re-request text.

[0111] After the claim system sends a notification asking the user to submit a supplementary request text, if no response is received from the user within the specified time (e.g. within 10 minutes), the claim system will take further measures to ensure that the information can be effectively transmitted. The specific steps are as follows:

[0112] Wait for a period of time (e.g. 10 minutes) to see if the target text data can be received from the user. This period of time is called the "first time period". If the target text data of the user's reply is not received within the first time period, the claims system will edit the original "supplementary request text" and generate a new re-request text. The re-request text usually contains some additional prompts or reminders to encourage the user to reply as soon as possible.

[0113] The first communication account of the claims specialist is called again to simulate the voice tone, text style or expression style of the claims specialist to send the edited "re-request text" to the user's second communication account so that the user can receive the updated reminder information.

[0114] For example, suppose the claims system sends a message to the user through the claims specialist's corporate WeChat account. The content may be: "Dear XX, your claim case lacks the accident responsibility determination form. Please submit it as soon as possible."

[0115] If no reply is received within 10 minutes, the claims system will edit the original message and generate a new "re-request text", which may read: "Dear XX, your claim case lacks an accident liability determination letter. Please submit it as soon as possible. Failure to submit it in time may affect the claims progress." The edited message will be sent to the user again through the claims specialist's corporate WeChat account, and the system will wait for the user's reply again.

[0116] The present invention can ensure that even if the first attempt is unsuccessful, the information can be conveyed to the user through further reminders, thereby increasing the probability of user response and speeding up the claim process.

[0117] In one embodiment, the method further comprises:

[0118] If the target text data is not received within the third time period, a task for collecting supplementary data is generated according to the missing preset type of claim data;

[0119] The task of collecting supplementary information is sent to the claims specialist so that the claims specialist can collect the missing preset type of claims information for the user.

[0120] If the claims system does not receive the target text information from the user within the specified time (such as 60 minutes) after sending the re-request text, the claims system will automatically create a supplementary information collection task based on the previously confirmed missing preset type of claims information. This supplementary information collection task is set up to ensure that the user can eventually submit all the required claims information.

[0121] After creating the task of collecting supplementary documents, the claims system will send this task to the claims specialist responsible for the case. This means that the claims specialist will receive a notification or a new item in the task list, indicating that they need to manually follow up on the user's situation.

[0122] After receiving the task of collecting supplementary information, the claims specialist will proactively contact the user to help them complete the submission process of the missing claims information. This may involve direct telephone communication, emails, text messages or other methods to remind and assist the user.

[0123] When the claims system is unable to resolve a problem, it can automatically create a task to collect additional information for the claims specialist to ensure that no case is neglected.

[0124] In one embodiment, the communication account includes an email account, and the calling of the first communication account simulates the claims specialist sending the supplementary payment request text to the second communication account, including:

[0125] According to the first communication account, the calling authority registration is completed on the preset second server, and the email account of the claims specialist is called on the second server to log in to the mail client or web mailbox service of the first server;

[0126] In the email client or the webmail service, call the email account of the claims specialist to create a new email, and set the recipient to the email account of the user;

[0127] The supplementary submission request text is input into the body of the new email and sent.

[0128] According to the preset call permission registration, the claims system uses the claims specialist's email account to log in to the corresponding email client or webmail service. This step ensures that the email is sent in the identity of the claims specialist, maintaining professionalism and formality.

[0129] After successful login, the claims system uses the claims specialist's email account to create a new email, which is specially created for this communication. In the new email, the claims system sets the user's email account as the recipient to ensure that the email can be accurately sent to the user's mailbox. Enter the previously prepared supplementary payment request text into the body of the new email and complete the sending operation.

[0130] In one embodiment, the communication account includes an instant messaging software account, and the calling of the first communication account simulates the claims specialist sending the supplementary payment request text to the second communication account, including:

[0131] The calling permission registration is completed on the preset second server according to the first communication account, and the instant messaging software account of the claims specialist is called on the second server to log in to the instant messaging software of the first server;

[0132] Open the chat window corresponding to the instant messaging software account of the user in the instant messaging software, enter the supplementary payment request text in the chat window and send it.

[0133] According to the preset call permission registration, the claims system uses the claims specialist's instant messaging software account to log in to the corresponding instant messaging software. This step ensures that the message is sent in the identity of the claims specialist, maintaining the professionalism and formality of the communication.

[0134] After successful login, the claims system will open the chat window of the user's instant messaging software account. This means that the claims system has found the user's chat history or contacts and is ready to communicate with them. In the user's chat window, enter the text of the supplementary payment request to be sent into the chat box and complete the sending operation.

[0135] S4. Determine whether the target text data contains missing claims data of a preset type. If so, store the missing claims data of the preset type into the case data corresponding to the pending claims case to complete the review request for the pending claims case.

[0136] In this embodiment, it is necessary to check whether the target text data replied by the user contains the preset type of claim data required to be supplemented before. If it does, the claim system will extract the missing preset type of claim data from the reply and store it in the pending claim case, thereby completing the inspection of the pending claim case.

[0137] In one embodiment, the step of determining whether the target text data contains missing claims data of a preset type includes:

[0138] Extracting the target text data from the first communication account, wherein the target text data includes graphic data;

[0139] Using a preset optical character recognition technology to identify keywords contained in the graphic data;

[0140] Determine whether the graphic data is the missing preset type of claim settlement information based on the keyword.

[0141] The target text information replied by the user is extracted from the first communication account of the claims specialist. The claims system automatically determines whether the target text information submitted by the user contains the preset type of claims information previously required to be supplemented. The target text information includes graphic data, such as photos or scanned copies sent by the user via email, instant messaging software or text messages.

[0142] Use preset optical character recognition (OCR) technology to recognize graphic data. OCR technology can convert the text in the graphic data into editable text form, so that the claims system can further process the text information.

[0143] After OCR technology converts the text in the image data into text, it searches for keywords in the text. Keywords may be specific words or phrases related to the missing preset type of claim information, such as "accident liability determination letter", "medical expense invoice", etc.

[0144] The identified keywords are used to determine whether the graphic data is the required preset type claim information. If the graphic data contains the required keywords, the graphic data is considered to be the missing preset type claim information submitted by the user; otherwise, the graphic data is considered not to be the required preset type claim information.

[0145] The present invention verifies whether the claim case information is complete in an automated manner, and uses the first communication account of the claim specialist to simulate the claim specialist to notify the user to supplement the missing information. It can handle multiple cases at the same time without waiting for a claim specialist to review them one by one, thereby greatly shortening the time of the entire claim process. The automated system reduces the demand for claim specialists, especially in handling routine supplementary payment requests, which can save the insurance company's labor costs. By simulating the tone and style of the claim specialist, the supplementary payment request text generated by the claim system is more professional and polite, which improves user satisfaction.

[0146] In summary, by simulating the automated system of claims adjusters, we can not only improve work efficiency and reduce costs, but also ensure that every user can get a high-quality service experience. This not only helps to improve customer satisfaction, but also reduces the steps of manual inspection and manual notification, and speeds up the claims process.

[0147] like Figure 2 , which is a schematic diagram of a module of a device for automatically collecting claims information provided by an embodiment of the present invention.

[0148] The automatic claim information collection device 100 of the present invention can be installed in an electronic device. According to the functions to be implemented, the automatic claim information collection device 100 can include a submission module 110, a verification module 120, a sending module 130 and a judgment module 140. The module of the present invention can also be called a unit, which refers to a series of computer program segments that can be executed by a processor of an electronic device and can complete fixed functions, which are stored in the memory of the electronic device.

[0149] In this embodiment, the functions of each module / unit are as follows:

[0150] The submission module 110 is used to obtain the case data of the pending claim case from a preset database according to the preset case information after receiving the case review request submitted by the user containing the preset case information of the pending claim case;

[0151] The verification module 120 is used to verify whether the acquired case data lacks preset type claim information. If the preset type claim information is missing, a corresponding supplementary request text is generated for the missing preset type claim information according to a preset supplementary information speech script. The case data of the pending claim case includes a first communication account of a claim specialist responsible for the pending claim case and a second communication account of the user. The first communication account and the second communication account complete communication registration on a preset first server and realize mutual communication. The first communication account completes call permission registration on a preset second server.

[0152] The sending module 130 is used to determine whether the current time is within the working time period. If so, the first communication account is called to simulate the claims specialist to send the supplementary payment request text to the second communication account, and receive the target text data returned by the second communication account based on the supplementary payment request text;

[0153] The judgment module 140 is used to judge whether the target text data contains missing preset type claim data. If so, the missing preset type claim data is stored in the case data corresponding to the pending claim case to complete the review request for the pending claim case.

[0154] like Figure 3 , which is a schematic diagram of the structure of an electronic device for implementing a method for automatically collecting claim settlement information provided by an embodiment of the present invention.

[0155] In this embodiment, the electronic device 1 includes, but is not limited to, a memory 11, a processor 12, and a network interface 13, which can be interconnected and communicated via a system bus. The memory 11 stores an automatic claim information collection program 10, and the automatic claim information collection program 10 can be executed by the processor 12. Figure 3 Only the electronic device 1 having components 11-13 and the automatic claim data collection program 10 is shown. It can be understood by those skilled in the art that Figure 3 The structure shown does not constitute a limitation on the electronic device 1 , and may include fewer or more components than shown in the figure, or combine certain components, or arrange the components differently.

[0156] The memory 11 includes a memory and at least one type of readable storage medium. The memory provides a cache for the operation of the electronic device 1; the readable storage medium may be a non-volatile storage medium such as a flash memory, a hard disk, a multimedia card, a card-type memory (e.g., SD or DX memory, etc.), a random access memory (RAM), a static random access memory (SRAM), a read-only memory (ROM), an electrically erasable programmable read-only memory (EEPROM), a programmable read-only memory (PROM), a magnetic memory, a disk, an optical disk, etc. In some embodiments, the readable storage medium may be an internal storage unit of the electronic device 1; in other embodiments, the non-volatile storage medium may also be an external storage device of the electronic device 1, such as a plug-in hard disk, a smart memory card (SmartMediaCard, SMC), a secure digital (SecureDigital, SD) card, a flash card (FlashCard), etc. equipped on the electronic device 1. In this embodiment, the readable storage medium of the memory 11 is generally used to store an operating system and various application software installed on the electronic device 1, such as storing the code of the automatic supplementary collection program 10 of the claim information in one embodiment of the present invention. In addition, the memory 11 can also be used to temporarily store various types of data that have been output or are to be output.

[0157] In some embodiments, the processor 12 may be a central processing unit (CPU), a controller, a microcontroller, a microprocessor, or other data processing chips. The processor 12 is generally used to control the overall operation of the electronic device 1, such as performing control and processing related to data interaction or communication with other devices. In this embodiment, the processor 12 is used to run the program code stored in the memory 11 or process data, such as running the automatic supplementary collection program 10 for claim information.

[0158] The network interface 13 may include a wireless network interface or a wired network interface, and the network interface 13 is used to establish a communication connection between the electronic device 1 and a terminal (not shown in the figure).

[0159] Optionally, the electronic device 1 may further include a user interface, which may include a display (Display), an input unit such as a keyboard (Keyboard), and the optional user interface may also include a standard wired interface and a wireless interface. Optionally, in some embodiments, the display may be an LED display, a liquid crystal display, a touch-sensitive liquid crystal display, and an OLED (Organic Light-Emitting Diode) touch device, etc. Among them, the display may also be appropriately referred to as a display screen or a display unit, which is used to display information processed in the electronic device 1 and to display a visual user interface.

[0160] It should be understood that the embodiment is for illustration only and the scope of the patent application is not limited to this structure.

[0161] The automatic supplementary claim information collection program 10 stored in the memory 11 of the electronic device 1 is a combination of multiple instructions. When running in the processor 12, it can achieve:

[0162] After receiving a case review request submitted by a user containing preset case information of a pending claim case, obtaining case data of the pending claim case from a preset database according to the preset case information;

[0163] Check whether the acquired case data lacks preset type claim information. If the preset type claim information is missing, generate a corresponding supplementary request text for the missing preset type claim information according to the preset supplementary information speech script. The case data of the pending claim case includes the first communication account of the claim specialist responsible for the pending claim case and the second communication account of the user. The first communication account and the second communication account complete communication registration on the preset first server and realize mutual communication. The first communication account completes the call permission registration on the preset second server.

[0164] Determine whether the current time is within the working hours, and if so, call the first communication account to simulate the claims specialist to send the supplementary payment request text to the second communication account, and receive the target text data returned by the second communication account based on the supplementary payment request text;

[0165] Determine whether the target text data contains missing claims data of a preset type. If so, store the missing claims data of the preset type in the case data corresponding to the pending claims case to complete the review request for the pending claims case.

[0166] Specifically, the specific implementation method of the processor 12 for the above-mentioned claim information automatic supplementary collection program 10 can refer to Figure 1 The description of the relevant steps in the corresponding embodiments will not be repeated here.

[0167] Furthermore, if the module / unit integrated in the electronic device 1 is implemented in the form of a software functional unit and sold or used as an independent product, it can be stored in a computer-readable storage medium. The computer-readable medium can be non-volatile or non-volatile. The computer-readable medium can include: any entity or device capable of carrying the computer program code, a recording medium, a USB flash drive, a mobile hard disk, a magnetic disk, an optical disk, a computer memory, and a read-only memory (ROM).

[0168] The computer-readable storage medium stores an automatic claim information collection program 10, which can be executed by one or more processors. The specific implementation method of the computer-readable storage medium of the present invention is basically the same as the above-mentioned embodiments of the automatic claim information collection method, and will not be repeated here.

[0169] In the several embodiments provided by the present invention, it should be understood that the disclosed devices, apparatuses and methods can be implemented in other ways. For example, the device embodiments described above are only schematic, for example, the division of the modules is only a logical function division, and there may be other division methods in actual implementation.

[0170] The modules described as separate components may or may not be physically separated, and the components shown as modules may or may not be physical units, that is, they may be located in one place or distributed on multiple network units. Some or all of the modules may be selected according to actual needs to achieve the purpose of the solution of this embodiment.

[0171] In addition, each functional module in each embodiment of the present invention may be integrated into one processing unit, each unit may exist physically separately, or two or more units may be integrated into one unit. The above-mentioned integrated unit may be implemented in the form of hardware or in the form of hardware plus software functional modules.

[0172] It is obvious to those skilled in the art that the present invention is not limited to the details of the above exemplary embodiments, and that the present invention can be implemented in other specific forms without departing from the spirit or essential characteristics of the present invention.

[0173] Therefore, no matter from which point of view, the embodiments should be regarded as illustrative and non-restrictive, and the scope of the present invention is limited by the appended claims rather than the above description, so it is intended that all changes falling within the meaning and scope of the equivalent elements of the claims are included in the present invention. Any attached figure mark in the claims should not be regarded as limiting the claims involved.

[0174] In addition, it is clear that the word "comprising" does not exclude other units or steps, and the singular does not exclude the plural. Multiple units or devices stated in the system claim can also be implemented by one unit or device through software or hardware. The second and other words are used to indicate names, but not to indicate any particular order.

[0175] Finally, it should be noted that the serial numbers of the above-mentioned embodiments of the present invention are only for description and do not represent the advantages and disadvantages of the embodiments. Through the description of the above implementation methods, those skilled in the art can clearly understand that the above-mentioned embodiment methods can be implemented by means of software plus a necessary general hardware platform, and of course, by hardware, but in many cases the former is a better implementation method. Based on such an understanding, the technical solution of the present invention, in essence, or the part that contributes to the prior art, can be embodied in the form of a software product, which is stored in a storage medium (such as ROM / RAM, disk, optical disk) as described above, including a number of instructions for enabling a terminal device (which can be a mobile phone, a computer, a server, or a network device, etc.) to execute the methods described in each embodiment of the present invention.

[0176] The above are only preferred embodiments of the present invention, and are not intended to limit the patent scope of the present invention. Any equivalent structure or equivalent process transformation made using the contents of the present invention specification and drawings, or directly or indirectly applied in other related technical fields, are also included in the patent protection scope of the present invention.

Claims

1. A method for automatically collecting claims data, characterized in that: The method comprises: After receiving a case review request submitted by a user containing preset case information of a pending claim case, obtaining case data of the pending claim case from a preset database according to the preset case information; Check whether the acquired case data lacks preset type claim information. If the preset type claim information is missing, generate a corresponding supplementary request text for the missing preset type claim information according to the preset supplementary information speech script. The case data of the pending claim case includes the first communication account of the claim specialist responsible for the pending claim case and the second communication account of the user. The first communication account and the second communication account complete communication registration on the preset first server and realize mutual communication. The first communication account completes the call permission registration on the preset second server. Determine whether the current time is within the working hours, and if so, call the first communication account to simulate the claims specialist to send the supplementary payment request text to the second communication account, and receive the target text data returned by the second communication account based on the supplementary payment request text; Determine whether the target text data contains missing claims data of a preset type. If so, store the missing claims data of the preset type in the case data corresponding to the pending claims case to complete the review request for the pending claims case.

2. The method for automatically collecting claim information according to claim 1, characterized in that: The inspection is to determine whether the acquired case data lacks the preset type of claim information, including: According to the type of the pending claim case, a list of inspection data corresponding to the pending claim case is obtained, wherein the list of inspection data includes various target data types corresponding to the pending claim case; Check whether there is any claim data of the target data type that is not included in the case data; If there is claim data of the target data type that is not included in the case data, it is determined that there is missing claim data of the preset type, and the claim data of the target data type that is not included in the case data is the missing claim data of the preset type.

3. The method for automatically collecting claim information according to claim 1, characterized in that: The inspection is to determine whether the acquired case data lacks the preset type of claim information, including: Using a preset optical character recognition technology to identify data type keywords corresponding to various claim data in the case data, and obtaining a data type keyword set; According to the type of the pending claim case, a preset keyword inspection list corresponding to the pending claim case is obtained, and whether there are keywords in the preset keyword inspection list that are not included in the data type keyword set; If any keyword in the preset keyword check list is not included in the data type keyword set, it is determined that preset type claim data is missing, and the data type corresponding to the keyword not included in the data type keyword set is the data type of the missing claim data.

4. The method for automatically collecting claim information according to claim 1, characterized in that: The method of generating a corresponding supplementary payment request text for the missing preset type of claim settlement information according to the preset supplementary collection information script includes: According to the type of the missing claim information of the preset type, the script for collecting supplementary information corresponding to the missing claim information of the preset type is obtained from the preset database; Extracting user personal information from the case data and obtaining basic information of missing preset types of claims data; The user personal information and the basic information are filled into the corresponding blank items in the basic template of the supplementary information collection script to generate the supplementary submission request text.

5. The method for automatically collecting claim information according to claim 1, characterized in that: The method further comprises: When it is determined that the current time is not within the working time period, a delayed sending task alarm is set according to the supplementary submission request text; The delayed sending task alarm is used to automatically call the first communication account within the next working time period to simulate the claims specialist sending the supplementary payment request text to the second communication account.

6. The method for automatically collecting claim information according to claim 1, characterized in that: The communication account includes an email account, and the calling of the first communication account simulates the claims specialist sending the supplementary payment request text to the second communication account, including: According to the first communication account, the calling authority registration is completed on the preset second server, and the email account of the claims specialist is called on the second server to log in to the mail client or web mailbox service of the first server; In the email client or the webmail service, call the email account of the claims specialist to create a new email, and set the recipient to the email account of the user; The supplementary submission request text is input into the body of the new email and sent.

7. The method for automatically collecting claim information according to claim 1, characterized in that: The communication account includes an instant messaging software account, and the calling of the first communication account simulates the claims specialist sending the supplementary payment request text to the second communication account, including: The calling permission registration is completed on the preset second server according to the first communication account, and the instant messaging software account of the claims specialist is called on the second server to log in to the instant messaging software of the first server; Open the chat window corresponding to the instant messaging software account of the user in the instant messaging software, input the supplementary payment request text in the chat window and send it.

8. A device for automatically collecting claims information, characterized in that: The device comprises: A submission module, configured to, after receiving a case review request submitted by a user containing preset case information of a pending claim case, obtain case data of the pending claim case from a preset database according to the preset case information; A verification module is used to verify whether the acquired case data lacks preset type claim information. If the preset type claim information is missing, a corresponding supplementary request text is generated for the missing preset type claim information according to a preset supplementary information speech script. The case data of the pending claim case includes a first communication account of a claim specialist responsible for the pending claim case and a second communication account of the user. The first communication account and the second communication account complete communication registration on a preset first server and realize mutual communication. The first communication account completes call permission registration on a preset second server. The sending module is used to determine whether the current time is within the working time period. If so, the first communication account is called to simulate the claims specialist to send the supplementary payment request text to the second communication account, and receive the target text data returned by the second communication account based on the supplementary payment request text; The judgment module is used to judge whether the target text data contains missing preset type claim data. If so, the missing preset type claim data is stored in the case data corresponding to the pending claim case to complete the review request for the pending claim case.

9. An electronic device, characterized in that: The electronic device comprises: at least one processor; and, a memory communicatively connected to the at least one processor; wherein, The memory stores an automatic claim data collection program that can be executed by the at least one processor, and the automatic claim data collection program is executed by the at least one processor so that the at least one processor can execute the automatic claim data collection method as described in any one of claims 1 to 7.

10. A computer-readable storage medium, characterized in that: The computer-readable storage medium stores a program for automatically collecting claims information, and the program for automatically collecting claims information can be executed by one or more processors to implement the method for automatically collecting claims information as described in any one of claims 1 to 7.

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