Commercial insurance claim settlement method and device and electronic equipment

Abstract

The invention provides a commercial insurance claim settlement method and apparatus, and an electronic device. The method comprises the steps of creating a target claim settlement item corresponding to a target business demand according to an item creation instruction; receiving an application adding instruction for the target application and the target data set, and adding the target application and the target data set to the target claim settlement item; the target application is matched with the target data set; a starting instruction for the target claim settlement item is received, the target claim settlement item is started, and the target application and the target data set are stored in a preset safety container; and calculating a claim settlement output result corresponding to the insurance applicant through the security container based on the target data set and the target application. According to the method, the target data set can be obtained online, and after the target claim settlement item is started, the target application and the target data set can be stored in the security container for calculation to obtain the claim settlement output result, so that the consumption of human resources is reduced, the insurance and claim settlement periods are shortened, the claim settlement efficiency is improved, and meanwhile, the experience of an insurance applicant is improved.

Description

Technical Field

[0001] The present invention relates to the field of claims settlement technology, and in particular to a commercial insurance claims settlement method, device and electronic equipment. Background Art

[0002] As a supplement to my country's medical insurance system and an important component in alleviating the pressure of medical insurance payment, commercial medical insurance has developed rapidly in recent years, and more and more people have purchased commercial medical insurance.

[0003] However, data from the medical and insurance industries cannot be shared, making the commercial health insurance claims process more complicated. When a policyholder initiates a claim, the insurance company can only conduct offline manual investigations, visit medical institutions in various regions to review medical data, and feed back the review and evaluation results to the insurance company. This causes the insurance company to consume a large amount of human resources, and the insurance and claims cycles are long, the claims efficiency is low, and the policyholder experience is poor. Summary of the invention

[0004] The purpose of the present invention is to provide a commercial insurance claims settlement method, device and electronic equipment to save human resources, shorten the insurance and claims settlement cycle, improve claims settlement efficiency, and enhance the insured's experience.

[0005] The present invention provides a commercial insurance claims method, which includes: receiving a project creation instruction for a target business demand, and creating a target claims project corresponding to the target business demand according to the project creation instruction; wherein the project creation instruction carries user information and an authorization file corresponding to the policyholder; the authorization file is used to indicate: allowing the information associated with the policyholder to be called; receiving an application addition instruction for a target application and a target data set, and adding the target application and the target data set to a target claims project; wherein the target data set is data associated with the policyholder; the target application matches the target data set; receiving a start instruction for the target claims project, starting the target claims project, and storing the target application and the target data set in a preset security container; and calculating the claims output result corresponding to the policyholder based on the target data set and the target application through the security container.

[0006] Furthermore, receiving an application addition instruction for a target application and a target data set, and the step of adding the target application and the target data set to a target claim item includes: receiving a first addition instruction for the target application, and determining whether the target application matches the target business requirement; if the target application matches the target business requirement, adding the target application to the target claim item, and outputting first information; wherein the first information is used to indicate that the user is allowed to apply to add a data set; receiving a second addition instruction for the target data set, and determining whether the target data set matches both the target business requirement and the target application; if the target data set matches both the target business requirement and the target application, adding the target data set to the target claim item.

[0007] Furthermore, the steps of receiving a startup instruction for a target claim project, starting the target claim project, and storing a target application and a target data set in a preset security container include: receiving a startup instruction for a target claim project, starting the target claim project, scanning the target application according to a preset scanning method, and obtaining a first scanning result; wherein the first scanning result is used to indicate whether there is a security risk in the target application; if the first scanning result indicates that there is no security risk in the target application, storing the target application and the target data set in a preset security container.

[0008] Furthermore, the steps of receiving a startup instruction for a target claim project, starting the target claim project, scanning the target application according to a preset scanning method, and obtaining a first scanning result include: receiving a startup instruction for the target claim project, starting the target claim project, statically scanning the target application, and obtaining a static scanning result; simulating the operation of the target application to obtain a dynamic scanning result; receiving a detection instruction for the target application to detect the target application according to the detection instruction to obtain a detection result; and obtaining a first scanning result based on the static scanning result, the dynamic scanning result, and the detection result.

[0009] Furthermore, the target data set is encrypted using a preset encryption method; the step of calculating the claim output result corresponding to the policyholder based on the target data set and the target application through a secure container includes: decrypting the target data set through the secure container to obtain a decrypted data set; scanning the target application through the secure container to obtain a second scanning result; wherein the second scanning result is used to indicate whether the target application has been tampered with; if the second scanning result indicates that the target application has not been tampered with, the claim output result corresponding to the policyholder is calculated based on the decrypted data set and the target application.

[0010] Furthermore, the method also includes: scanning the claim output result to obtain a third scanning result; wherein the third scanning result is used to indicate: whether the claim output result meets the preset expected result and whether there is preset sensitive data; if the third scanning result indicates that the claim output result meets the expected result and there is no sensitive data, the claim output result is sent to a preset user terminal; and the security container and all data in the security container are destroyed.

[0011] Furthermore, the method also includes: if the third scanning result indicates that the claim output result does not meet the expected result, and / or there is sensitive data, determining the security risk level corresponding to the third scanning result; determining the control method corresponding to the security risk level according to the security risk level, performing corresponding operations according to the control method, and generating an alarm indication.

[0012] The present invention provides a commercial insurance claims device, which includes: a creation module, used to receive a project creation instruction for a target business demand, and create a target claims project corresponding to the target business demand according to the project creation instruction; wherein the project creation instruction carries user information and an authorization file corresponding to the policyholder; the authorization file is used to indicate: it is allowed to call information associated with the policyholder; an adding module, used to receive an application addition instruction for a target application and a target data set, and add the target application and the target data set to the target claims project; wherein the target data set is data associated with the policyholder; the target application matches the target data set; a receiving module, used to receive a start instruction for the target claims project, start the target claims project, and store the target application and the target data set in a preset security container; a calculation module, used to calculate the claims output result corresponding to the policyholder based on the target data set and the target application through the security container.

[0013] An electronic device provided by the present invention includes a processor and a memory, wherein the memory stores machine executable instructions that can be executed by the processor, and the processor executes the machine executable instructions to implement any of the above commercial insurance claims settlement methods.

[0014] The present invention provides a machine-readable storage medium, which stores machine-executable instructions. When the machine-executable instructions are called and executed by a processor, the machine-executable instructions prompt the processor to implement any of the above-mentioned commercial insurance claims settlement methods.

[0015] The commercial insurance claims method, device and electronic device provided by the present invention receive a project creation instruction for a target business demand, and create a target claims project corresponding to the target business demand according to the project creation instruction; wherein the project creation instruction carries user information and authorization files corresponding to the policyholder; the authorization file is used to indicate: allowing the information associated with the policyholder to be called; receiving an application addition instruction for a target application and a target data set, adding the target application and the target data set to the target claims project; wherein the target data set is data associated with the policyholder; the target application matches the target data set; receiving a start instruction for the target claims project, starting the target claims project, storing the target application and the target data set in a preset security container; and calculating the claims output result corresponding to the policyholder based on the target data set and the target application through the security container. This method can obtain the target data set online, and after the target claims project is started, the target application and the target data set can be stored in the security container for calculation to obtain the claims output result, thereby reducing the consumption of human resources, shortening the insurance and claims cycle, improving the claims efficiency, and improving the policyholder's experience. BRIEF DESCRIPTION OF THE DRAWINGS

[0016] In order to more clearly illustrate the specific implementation methods of the present invention or the technical solutions in the prior art, the drawings required for use in the specific implementation methods or the description of the prior art will be briefly introduced below. Obviously, the drawings described below are some implementation methods of the present invention. For ordinary technicians in this field, other drawings can be obtained based on these drawings without paying creative work.

[0017] Figure 1 A flowchart of a commercial insurance claims settlement method provided by an embodiment of the present invention;

[0018] Figure 2 A schematic diagram of a commercial insurance claims system provided by an embodiment of the present invention;

[0019] Figure 3 A schematic diagram of the structure of a commercial insurance claims settlement device provided by an embodiment of the present invention;

[0020] Figure 4 A schematic diagram of the structure of an electronic device provided by an embodiment of the present invention. DETAILED DESCRIPTION

[0021] The technical solution of the present invention will be clearly and completely described below in conjunction with the embodiments. Obviously, the described embodiments are part of the embodiments of the present invention, rather than all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0022] The existing commercial insurance claims process requires a lot of manual offline investigation of the insured's medical treatment information, and it is impossible to quickly obtain a continuous and stable high-quality medical insurance data source, which makes it difficult for insurance companies to conduct claims investigations continuously and quickly. It also requires a lot of human resources, and the insurance and claims cycle is long, and the insured experience is poor, which affects the further development of the commercial insurance industry. Based on this, the embodiments of the present invention provide a commercial insurance claims method, device and electronic device, which can be applied to the application scenario of commercial claims.

[0023] To facilitate understanding of this embodiment, a commercial insurance claims settlement method disclosed in an embodiment of the present invention is first introduced. Figure 1 As shown, the method comprises the following steps:

[0024] Step S102, receiving a project creation instruction for a target business requirement, and creating a target claim settlement project corresponding to the target business requirement according to the project creation instruction; wherein the project creation instruction carries user information and an authorization file corresponding to the policyholder; the authorization file is used to indicate: allowing to call information associated with the policyholder;

[0025] The target business demand can be the business demand of the insurance company obtained in advance, for example, the target business demand can be a quick compensation business demand, etc.; the above-mentioned project creation instruction can be understood as: when the commercial insurance user (i.e. the staff of the insurance company) needs to create a target claim project corresponding to the target business demand, the instruction issued; the above-mentioned user information can include basic information such as user name, gender, ID number, etc.; the above-mentioned authorization document is usually a personal information authorization signed between the insurance company and the insured, which can be signed offline or online; only after the authorization document is signed, the insurance company is allowed to call information related to the insured, such as user information, medical diagnosis-related information, etc.; in actual implementation, after obtaining the above-mentioned target business requirements, the commercial insurance user can issue the above-mentioned project creation instructions for the target business requirements to create a target claim project. The project creation instruction usually needs to carry the policyholder's user information and authorization documents; in the process of creating a target claim project, the commercial insurance user is usually required to fill in the project name, project type, project description and other information; when uploading the policyholder's user information and authorization documents, the commercial insurance user can upload them in batches according to the given template, or enter them manually. If there are multiple policyholders, it is necessary to upload the corresponding authorization files for each policyholder, otherwise the target claim project cannot be created.

[0026] Step S104, receiving an application adding instruction for a target application and a target data set, and adding the target application and the target data set to a target claim item; wherein the target data set is data associated with the policyholder; and the target application matches the target data set;

[0027] The above-mentioned target application and target data set usually match the target business demand. For example, if the target business demand is a quick compensation business demand, the target application is a quick compensation application corresponding to the quick compensation business demand, and the target data set is a data set corresponding to the quick compensation business demand, such as a settlement-related data set, a medical treatment-related data set, etc. Correspondingly, the target application also matches the target data set; the above-mentioned application addition instruction can be an instruction issued when a commercial insurance user needs to add the target application and target data set to the target claim project.

[0028] In actual implementation, commercial insurance users can apply for target applications and target data sets corresponding to target business needs by adding target applications and target data sets. Specifically, the preset application market can provide application management services such as viewing, previewing, and querying of survey applications; it can provide catalog management of applications released by insurance companies, and display the basic information of applications in a visual way, making it convenient for commercial insurance users to view and understand the applications; it can also provide a preview viewing function for selected applications, including summary information such as the provider, function description, and required points; commercial insurance users can select target applications from the application market and apply to add them.

[0029] The preset data market can provide data set management services such as viewing, previewing, and querying of medical insurance data sets. It can also provide asset catalog management of medical insurance data and insurance company data, including operations such as query and summary information viewing, and provide a data asset catalog for various users on the platform. It can also provide a preview viewing function for selected data sets, which only provides a preview of field information, not including specific data content. Commercial insurance users can select the target data set from the data market and apply to add it.

[0030] After receiving the application addition instruction for the target application and the target data set from the commercial insurance user, the target application and the target data set can be added to the created target claim item.

[0031] Step S106, receiving a start instruction for a target claim settlement project, starting the target claim settlement project, and storing the target application and the target data set in a preset secure container;

[0032] The above-mentioned start instruction can be an instruction issued by a commercial insurance user when he needs to start the target claim project; the above-mentioned secure container refers to a framework that provides an additional security layer, which is usually used when building applications to ensure the integrity and security of the container. In this embodiment, the secure container is a privacy computing environment. In actual implementation, the commercial insurance user can issue a start instruction for the target claim project. After receiving the start instruction, the target claim project can be started. After the target claim project is started, the target application and target data set in the target claim project can be placed in a preset secure container.

[0033] Step S108, calculating the claim output result corresponding to the policyholder based on the target data set and the target application through the secure container.

[0034] After placing the target data set and target application into the secure container, the secure container can perform associated calculations on the target data set and the target application. For example, calculations can be performed through a pre-configured model. The specific calculation method can refer to related technologies and will not be repeated here. The claim output result corresponding to the insured is obtained through calculation. The claim output result may include medical insurance reimbursement information, etc.

[0035] The commercial insurance claims method receives a project creation instruction for a target business requirement, and creates a target claims project corresponding to the target business requirement according to the project creation instruction; wherein the project creation instruction carries the user information and authorization file corresponding to the policyholder; the authorization file is used to indicate: allowing the information associated with the policyholder to be called; receiving an application addition instruction for a target application and a target data set, and adding the target application and the target data set to the target claims project; wherein the target data set is data associated with the policyholder; the target application matches the target data set; receiving a start instruction for the target claims project, starting the target claims project, and storing the target application and the target data set in a preset security container; and calculating the claim output result corresponding to the policyholder based on the target data set and the target application through the security container. This method can obtain the target data set online, and after the target claims project is started, the target application and the target data set can be stored in the security container for calculation to obtain the claim output result, which reduces the consumption of human resources, shortens the insurance and claims cycle, improves the claims efficiency, and improves the policyholder's experience.

[0036] The embodiment of the present invention further provides another commercial insurance claims settlement method, which is implemented on the basis of the above embodiment method. In the method, the target data set is encrypted by using a preset encryption method; the preset encryption method can be selected according to actual needs, for example, it can be symmetric encryption, asymmetric encryption, hash encryption, etc.; in actual implementation, in order to ensure the security of the data set, the data set in the data market is usually encrypted; the method includes the following steps:

[0037] Step 1: receiving a project creation instruction for a target business requirement, and creating a target claim project corresponding to the target business requirement according to the project creation instruction; wherein the project creation instruction carries user information and an authorization file corresponding to the policyholder; the authorization file is used to indicate: allowing information associated with the policyholder to be called;

[0038] Commercial insurance users can browse the data market and application market through user terminals to check whether the fields of the medical insurance data set in the data market meet the target business needs. Specifically, the medical insurance data set in the data market usually displays: data set name, alias, type, business scenario, label, owner, release time and other field names. By checking the names of each field contained in the medical insurance data set, it can be judged whether the medical insurance data set meets the target business needs. In other words, commercial insurance users can only see the field name, but cannot see the specific field value corresponding to each field name. Among them, the above-mentioned data set name usually represents a large category, for example, it can be medical insurance settlement data, cost details, etc.; the above-mentioned alias usually pre-classifies the corresponding medical insurance data set, for example, "Quick Compensation" can be added to the front of the data set name of the original medical insurance data set, indicating that the medical insurance data set corresponds to the quick compensation business needs; the above-mentioned type can be understood as the data type in the medical insurance data set, for example, it can be a string, a number, a floating point type, etc.; the above-mentioned business scenario can be understood as the application scenario in which the medical insurance data set can be used; the above-mentioned label is usually a label automatically configured by the system; the above-mentioned owner indicates the party that owns the medical insurance data set, for example, it can be a hospital, etc.; the above-mentioned release time indicates the time when the medical insurance data set is released.

[0039] The application market can display information such as the business application scenario name, creator, business application scenario description, creation time, etc. corresponding to each application; among them, the application scenario name can be quick compensation, investigation, etc.; the creator indicates the party that created the application, for example, it can be an insurance company, etc.; the above business application scenario description is used to indicate the scenario to which the application is applicable.

[0040] When the commercial insurance user determines that the target data set meets the target business requirements, he or she can issue a project creation instruction for the target business requirements to create a target claims project based on the project creation instruction.

[0041] Step 2: receiving a first adding instruction for a target application, and determining whether the target application matches the target business requirement;

[0042] In actual implementation, after creating a target claims project, it is usually necessary to apply for a target application first. The commercial insurance user can select the target application and apply to add it. At this time, a first addition instruction can be generated. After receiving the first addition instruction sent by the commercial insurance user, it is usually necessary to review and determine whether the target application selected by the user matches the target business requirement. For example, if the target business requirement is a quick compensation type, and the application selected by the commercial insurance user is an investigation application, the two do not match and the approval is not passed. If the commercial insurance user selects a quick compensation application, the two match and the approval is passed.

[0043] Step 3: If the target application matches the target business requirement, add the target application to the target claim item and output first information; wherein the first information is used to indicate that the user is allowed to apply to add a data set;

[0044] Once it is determined that the target application matches the target business requirements, the target application can be added to the target claims project, and the first information is output to indicate that the user is allowed to continue to apply to add data sets, that is, the application for data sets can only be allowed after the target application is approved.

[0045] Step 4: receiving a second adding instruction for the target data set, and determining whether the target data set matches both the target business requirement and the target application;

[0046] In actual implementation, the commercial insurance user can select the target data set and apply to add it. At this time, a second adding instruction can be generated. After receiving the second adding instruction sent by the commercial insurance user, it is usually necessary to approve whether the target data set matches the target business demand, and at the same time determine whether the target data set matches the target application. For example, if the target business demand is a quick compensation business demand, the target application is a quick compensation application, and the target data set is a settlement data set, then the three are matched and approved. If the target data set is a medical device data set, then the target data set does not match the target business demand, and does not match the target application, and the approval is not passed. Usually, the correspondence between different applications and different data sets is pre-configured, and the data sets corresponding to different applications may be different. If the selected target application is different from the application matched by the target data set, it will not be approved.

[0047] Step 5: If the target data set matches both the target business requirement and the target application, the target data set is added to the target claim item; wherein the target data set is data associated with the policyholder;

[0048] Once it is determined that the target data set matches the target business requirements and target applications, that is, after the target data set is approved, project resources can be configured for the target claims project. By default, project resources are automatically recommended by the system, and of course they can be manually adjusted according to actual needs. The upper limit of project resources is all available resources owned by commercial insurance users.

[0049] Step 6: receiving a start instruction for a target claim settlement project, starting the target claim settlement project, scanning the target application according to a preset scanning method, and obtaining a first scanning result; wherein the first scanning result is used to indicate whether the target application has a security risk;

[0050] The step six can be implemented by following the steps 60 to 63:

[0051] Step 60, receiving a start instruction for a target claim settlement project, starting the target claim settlement project, performing a static scan on the target application, and obtaining a static scan result;

[0052] Step 61, simulate running the target application to obtain dynamic scanning results;

[0053] Step 62, receiving a detection instruction for a target application, detecting the target application according to the detection instruction, and obtaining a detection result;

[0054] Step 63, obtaining a first scanning result based on the static scanning result, the dynamic scanning result and the detection result.

[0055] In order to ensure the security of the target application, before placing the target application into the secure container, a three-stage security scan is usually performed to ensure that the target application entering the secure container has no security risks. First, in the first stage, the target application is scanned for code vulnerabilities and risks in a static scanning manner, and whether there are potential risks based on preset rules, etc., to obtain the corresponding static scanning results; in the second stage, the target application is simulated to run in a dynamic scanning manner to determine whether there are unreported ports, protocols, output data, etc., to obtain the corresponding dynamic scanning results; in the third stage, the possible security risks are manually detected according to the business logic in a manual inspection manner. Specifically, according to the business logic, the inspection personnel can manually issue inspection instructions to detect whether there are security risks, such as manually inspecting whether the results after the target application runs meet the specifications, etc., to obtain the corresponding inspection results; the first scanning result is determined based on the obtained static scanning results, dynamic scanning results and inspection results; specifically, if the static scanning results, dynamic scanning results and inspection results all indicate that the target application has no security risks, then the first scanning result can indicate that the target application has no security risks; if there is at least one result indicating that the target application has security risks, then the first scanning result can indicate that the target application has security risks.

[0056] Step 7: If the first scanning result indicates that the target application does not have a security risk, the target application and the target data set are stored in a preset security container;

[0057] After determining that the target application does not pose a security risk, the target application and target data set can be stored in a preset secure container.

[0058] Step 8: decrypt the target data set through the secure container to obtain a decrypted data set;

[0059] Since the target data set is data encrypted using a preset encryption method, after the target data set enters the secure container, the corresponding decryption algorithm can be called to decrypt the target data set. After decryption, format conversion is usually required to convert it into the format required by the database to facilitate query and calculation, so as to obtain the decrypted data set.

[0060] Step nine, scanning the target application through the security container to obtain a second scanning result; wherein the second scanning result is used to indicate whether the target application has been tampered with;

[0061] When the target application enters the secure container, the secure container starts a daemon process, performs an image security scan on the image file corresponding to the target application, and confirms the image source through the image signature to confirm whether the target application has been tampered with during transmission; for example, a pair of public keys and private keys can be obtained in advance, and the image file corresponding to the target application can be hashed to obtain a first result, and the first result can be encrypted with the private key to obtain the image signature. When the target application is placed in the secure container, the image file of the target application and its image signature are usually placed in the secure container, and the image signature is decrypted using the public key through the secure container to obtain the first result; then the image file is hashed in the same way to obtain a second result; if the second result is the same as the first result, it can be considered that the target application has not been tampered with. For details, please refer to the relevant technology, which will not be repeated here.

[0062] Step ten: if the second scanning result indicates that the target application has not been tampered with, the claim output result corresponding to the policyholder is calculated based on the decrypted data set and the target application.

[0063] After confirming that the target application has not been tampered with, the decrypted data set and the target application can be associated with each other to obtain the corresponding claim output result for the policyholder. During the secure container calculation process, the communication protocol and interface of the target application can be monitored to prevent the target application from conducting illegal communication.

[0064] Step 11: Scan the claim output result to obtain a third scanning result; wherein the third scanning result is used to indicate whether the claim output result meets the preset expected result and whether there is preset sensitive data;

[0065] The above-mentioned expected results usually include the fields that need to be included in the preset claims output results; the above-mentioned sensitive data usually refers to data that may cause serious harm to society or individuals after leakage, such as personal name, ID number, address, telephone number, etc.; in actual implementation, corresponding rules are usually pre-set for the field value of each field contained in the expected results, such as the length, type, format, etc. of the field value; after obtaining the above-mentioned claims output results, the claim output results can be scanned to determine whether the fields contained in the claims output results match the preset expected results. If they match, it can be confirmed that the claims output results meet the preset expected results; further determine whether the field value of each field of the claims output results meets the rules corresponding to the field value of the field. If they do, it is considered that there is a risk of bringing out sensitive data through comparison, reverse deduction, etc.

[0066] Step 12: If the third scanning result indicates that the claim output result meets the expected result and no sensitive data exists, the claim output result is sent to a preset user terminal;

[0067] When the third scan result indicates that the claim output result meets the expected result and there is no sensitive data, the claim output result can be sent to the user terminal of the commercial insurance user to facilitate the commercial insurance user to carry out subsequent business; usually if there are multiple policyholders, the commercial insurance user can obtain the claim output result corresponding to each policyholder, including: total medical expenses, medical insurance reimbursement amount, personal expenses and other fields. The commercial insurance user can compare the claim information actually submitted by the policyholder with the calculated claim output result to confirm whether they match, which can further ensure the accuracy of the claim.

[0068] Step 13: destroy the secure container and all data in the secure container.

[0069] After the security container calculation is completed and the claim output result is output, the security container can be destroyed, and all data including the target data set in the security container can be destroyed at the same time, thus ensuring the security of the target data set.

[0070] Step 14: if the third scanning result indicates that the claim output result does not meet the expected result and / or sensitive data exists, determine the security risk level corresponding to the third scanning result;

[0071] Standards corresponding to different security risk levels can be pre-set according to actual needs. For example, if one field does not match the expected result, it is a low risk level; if two fields do not match the expected result, it is a medium risk level; and so on. If the third scan result indicates that the claims output result does not meet the expected result, and / or that sensitive data exists, the corresponding security risk level can be determined based on the third scan result.

[0072] Step 15: determine the control method corresponding to the security risk level according to the security risk level, perform corresponding operations according to the control method, and generate an alarm indication.

[0073] Different security risk levels usually correspond to different degrees of control methods. For example, the control methods may include: limiting output, suspending services, and fusing services, etc.; in actual implementation, after determining the security risk level corresponding to the third scanning result, the control method corresponding to the security risk level can be used for security control. For example, output can be restricted, services can be suspended, and services can be fused, etc. At the same time, an alarm can be activated to promptly remind commercial insurance users to take corresponding measures.

[0074] For easier understanding, see Figure 2 A schematic diagram of a commercial insurance claims system is shown, which includes a secure data service 11, a data market 12, an application market 13, a trusted computing service 14, an approval process management 15, and a privacy computing environment 16. The secure data service 11 is connected to the data market 12, the trusted computing service 14 is connected to the data market 12, the application market 13, the approval process management 15, and the privacy computing environment 16, and the privacy computing environment 16 is connected to the data market 12 and the application market 13. The functions of each part are described below.

[0075] (1) Secure Data Service 11: Provides data access management services such as secure encrypted storage, retrieval, and publishing of medical insurance data sets, and field information browsing. The secure encrypted storage of data sets is achieved through software encryption, and each data set is encrypted separately; data demanders obtain the right to use compliant encrypted data sets through approval authorization, but cannot actually obtain the data; provides multi-dimensional data retrieval and viewing capabilities, providing institutional users with flexible and convenient data usage methods, and facilitating data administrators to manage data.

[0076] (2) Data Market 12: Provides data set management services such as viewing, previewing, and querying of medical insurance data sets. Provides asset catalog management of medical insurance data and insurance company data, including operations such as querying and viewing summary information, and provides data asset catalogs for various users on the platform; provides preview viewing function for selected data sets, only providing field information preview, not including specific data content.

[0077] (3) Application Market 13: Provides application management services such as viewing, previewing, and querying of survey applications. Provides directory management for applications published by platforms and institutions, displays basic information of applications in a visual manner, and facilitates institutional users to view and understand applications; provides preview viewing function for selected applications, including summary information such as provider, function description, and required points.

[0078] (4) Trusted Computing Service 14: Provides project and application management capabilities such as user project creation and data application association. Creates instances based on data sets and applications. After completing the configuration of resources such as CPU and memory, creates working instances to provide a secure container environment support for business computing. Provides asset management of user-owned applications, supports viewing and searching application details, and facilitates user management of application assets. Provides a list of created projects, supports project creation and search, and facilitates users to understand all project overview information.

[0079] (5) Approval process management15: Provides management of the work approval process, including the release and use approval of data sets and the listing and use approval of applications, and records the decision-making process and results of each approval node to facilitate the monitoring and management of the approval process by relevant personnel.

[0080] (6) Privacy computing environment 16: Provides privacy computing environment management capabilities such as container creation, operation monitoring, container / image scanning monitoring, etc. for data security computing. Provides a secure computing environment based on secure containers to ensure the privacy and security of data and applications required for computing in the environment. The data and applications in the secure container cannot be obtained or tampered with. After the computing is completed, the data and applications in the secure container are destroyed.

[0081] The above-mentioned commercial insurance claims method, by providing high-quality, sustainable medical insurance data sets and a privacy-secure computing environment, can enable insurance companies to investigate policyholders' medical treatment information, expense information, and reimbursement information more quickly, improve the efficiency of claims investigation business, and reduce business costs. At the same time, it can develop more targeted insurance products to meet the specific needs of different groups of people and provide personalized insurance services, thereby improving service coverage and satisfaction and enabling more people to enjoy commercial insurance services.

[0082] By providing insurance companies with safe, compliant and reliable medical insurance data services, medical insurance data operators can realize the value of medical insurance data and promote the digital transformation and market-oriented operation of medical insurance. This solution implements claims business analysis of medical insurance data through project-based and secure containers.

[0083] In this solution, the secure container monitors the application image communication by guarding the container process to ensure that the computing process of the target application meets expectations. Static scanning, dynamic scanning, and manual scanning are used to ensure the security and reliability of the target application. Under the premise of obtaining the authorized operation end of medical insurance data, this solution realizes online claims investigation based on medical insurance data by building a project-managed claims investigation data privacy security computing space, which greatly improves the insurance company's claims efficiency, reduces operating costs, and helps process and product innovation. It also provides a path for the market-oriented configuration of medical insurance data elements.

[0084] The embodiment of the present invention provides a commercial insurance claims settlement device, such as Figure 3 As shown, the device includes: a creation module 30, which is used to receive a project creation instruction for a target business demand, and create a target claim project corresponding to the target business demand according to the project creation instruction; wherein the project creation instruction carries user information and an authorization file corresponding to the insured; the authorization file is used to indicate: it is allowed to call the information associated with the insured;

[0085] The adding module 31 is used to receive an application adding instruction for a target application and a target data set, and add the target application and the target data set to a target claim item; wherein the target data set is data associated with the policyholder; and the target application matches the target data set;

[0086] A receiving module 32, configured to receive a start instruction for a target claim settlement project, start the target claim settlement project, and store the target application and the target data set in a preset secure container;

[0087] The calculation module 33 is used to calculate the claim output result corresponding to the insured based on the target data set and the target application through the security container.

[0088] The above-mentioned commercial insurance claims device can obtain the target data set online. After the target claims project is started, the target application and the target data set can be stored in a secure container for calculation to obtain the claims output result, which reduces the consumption of human resources, shortens the insurance and claims cycle, improves the claims efficiency, and at the same time enhances the insured's experience.

[0089] Furthermore, the adding module is also used to: receive a first adding instruction for the target application, determine whether the target application matches the target business requirement; if the target application matches the target business requirement, add the target application to the target claim item, and output first information; wherein the first information is used to indicate that the user is allowed to apply to add a data set; receive a second adding instruction for the target data set, determine whether the target data set matches both the target business requirement and the target application; if the target data set matches both the target business requirement and the target application, add the target data set to the target claim item.

[0090] Furthermore, the receiving module is also used to: receive a startup instruction for a target claims project, start the target claims project, scan the target application according to a preset scanning method, and obtain a first scanning result; wherein the first scanning result is used to indicate whether there is a security risk in the target application; if the first scanning result indicates that there is no security risk in the target application, the target application and the target data set are stored in a preset security container.

[0091] Furthermore, the receiving module is also used to: receive a startup instruction for a target claims project, start the target claims project, perform a static scan on the target application, and obtain a static scan result; perform a simulated operation on the target application to obtain a dynamic scan result; receive a detection instruction for the target application to detect the target application according to the detection instruction to obtain a detection result; and obtain a first scan result based on the static scan result, the dynamic scan result, and the detection result.

[0092] Furthermore, the computing module is also used to: decrypt the target data set through the security container to obtain a decrypted data set; scan the target application through the security container to obtain a second scanning result; wherein the second scanning result is used to indicate whether the target application has been tampered with; if the second scanning result indicates that the target application has not been tampered with, based on the decrypted data set and the target application, calculate the corresponding claim output result of the policyholder.

[0093] Furthermore, the device is also used to: scan the claim output result to obtain a third scanning result; wherein the third scanning result is used to indicate: whether the claim output result meets the preset expected result and whether there is preset sensitive data; if the third scanning result indicates that the claim output result meets the expected result and there is no sensitive data, the claim output result is sent to a preset user terminal; and the security container and all data in the security container are destroyed.

[0094] Furthermore, the device is also used to: if the third scanning result indicates that the claim output result does not meet the expected result, and / or there is sensitive data, determine the security risk level corresponding to the third scanning result; determine the control method corresponding to the security risk level according to the security risk level, perform corresponding operations according to the control method, and generate an alarm indication.

[0095] The commercial insurance claims settlement device provided in the embodiment of the present invention has the same implementation principle and technical effects as those in the aforementioned commercial insurance claims settlement method embodiment. For the sake of brief description, for matters not mentioned in the commercial insurance claims settlement device embodiment, reference may be made to the corresponding contents in the aforementioned commercial insurance claims settlement method embodiment.

[0096] The embodiment of the present invention further provides an electronic device, see Figure 4 As shown, the electronic device includes a processor 130 and a memory 131, wherein the memory 131 stores machine executable instructions that can be executed by the processor 130, and the processor 130 executes the machine executable instructions to implement the above-mentioned commercial insurance claims settlement method.

[0097] Further, Figure 4 The electronic device shown further includes a bus 132 and a communication interface 133 , and the processor 130 , the communication interface 133 and the memory 131 are connected via the bus 132 .

[0098] The memory 131 may include a high-speed random access memory (RAM), and may also include a non-volatile memory, such as at least one disk storage. The communication connection between the system network element and at least one other network element is realized through at least one communication interface 133 (which may be wired or wireless), and the Internet, wide area network, local area network, metropolitan area network, etc. may be used. The bus 132 may be an ISA bus, a PCI bus, or an EISA bus, etc. The bus may be divided into an address bus, a data bus, a control bus, etc. For ease of representation, Figure 4 Only one bidirectional arrow is used in the diagram, but this does not mean that there is only one bus or only one type of bus.

[0099] The processor 130 may be an integrated circuit chip with signal processing capabilities. In the implementation process, each step of the above method can be completed by the hardware integrated logic circuit or software instructions in the processor 130. The above processor 130 can be a general-purpose processor, including a central processing unit (CPU), a network processor (NP), etc.; it can also be a digital signal processor (DSP), an application-specific integrated circuit (ASIC), a field-programmable gate array (FPGA) or other programmable logic devices, discrete gates or transistor logic devices, discrete hardware components. The methods, steps and logic block diagrams disclosed in the embodiments of the present invention can be implemented or executed. The general-purpose processor can be a microprocessor or the processor can also be any conventional processor, etc. The steps of the method disclosed in conjunction with the embodiments of the present invention can be directly embodied as a hardware decoding processor for execution, or a combination of hardware and software modules in the decoding processor for execution. The software module may be located in a storage medium mature in the art, such as a random access memory, a flash memory, a read-only memory, a programmable read-only memory, or an electrically erasable programmable memory, a register, etc. The storage medium is located in the memory 131, and the processor 130 reads the information in the memory 131 and completes the steps of the method of the above embodiment in combination with its hardware.

[0100] An embodiment of the present invention also provides a machine-readable storage medium, which stores machine-executable instructions. When the machine-executable instructions are called and executed by a processor, the machine-executable instructions prompt the processor to implement the above-mentioned commercial insurance claims settlement method. The specific implementation can be found in the method embodiment, which will not be repeated here.

[0101] The computer program products of the commercial insurance claims settlement method, device and electronic device provided in the embodiments of the present invention include a computer-readable storage medium storing program code. The instructions included in the program code can be used to execute the methods described in the previous method embodiments. The specific implementation can be found in the method embodiments and will not be repeated here.

[0102] If the functions are implemented in the form of software functional units and sold or used as independent products, they can be stored in a computer-readable storage medium. Based on this understanding, the technical solution of the present invention, or the part that contributes to the prior art or the part of the technical solution, can be embodied in the form of a software product. The computer software product is stored in a storage medium, including several instructions for a computer device (which can be a personal computer, a server, or a network device, etc.) to perform all or part of the steps of the methods described in each embodiment of the present invention. The aforementioned storage medium includes: U disk, mobile hard disk, read-only memory (ROM, Read-Only Memory), random access memory (RAM, Random Access Memory), disk or optical disk, etc., which can store program codes.

[0103] Finally, it should be noted that the above embodiments are only used to illustrate the technical solutions of the present invention, rather than to limit it. Although the present invention has been described in detail with reference to the aforementioned embodiments, those skilled in the art should understand that they can still modify the technical solutions described in the aforementioned embodiments, or replace some or all of the technical features therein with equivalents. However, these modifications or replacements do not cause the essence of the corresponding technical solutions to deviate from the scope of the technical solutions of the embodiments of the present invention.

Claims

1. A commercial insurance claims settlement method, characterized in that: The method comprises: Receive a project creation instruction for a target business requirement, and create a target claim settlement project corresponding to the target business requirement according to the project creation instruction; wherein the project creation instruction carries user information and an authorization file corresponding to the policyholder; the authorization file is used to indicate that it is allowed to call information associated with the policyholder; receiving an application adding instruction for a target application and a target data set, and adding the target application and the target data set to the target claim item; wherein the target data set is data associated with the policyholder; and the target application matches the target data set; Receiving a start instruction for the target claim settlement project, starting the target claim settlement project, and storing the target application and the target data set in a preset secure container; The security container calculates the claim output result corresponding to the policyholder based on the target data set and the target application.

2. The method according to claim 1, characterized in that: The step of receiving an application addition instruction for a target application and a target data set, and adding the target application and the target data set to the target claim settlement item comprises: receiving a first adding instruction for a target application, and determining whether the target application matches the target business requirement; If the target application matches the target business requirement, the target application is added to the target claim settlement item, and first information is output; wherein the first information is used to indicate that the user is allowed to apply to add a data set; receiving a second adding instruction for a target data set, and determining whether the target data set matches both the target business requirement and the target application; If the target data set matches both the target business requirement and the target application, the target data set is added to the target claim settlement item.

3. The method according to claim 1, characterized in that: The steps of receiving a start instruction for the target claim settlement project, starting the target claim settlement project, and storing the target application and the target data set in a preset secure container include: Receiving a start instruction for the target claim settlement project, starting the target claim settlement project, scanning the target application according to a preset scanning method, and obtaining a first scanning result; wherein the first scanning result is used to indicate whether the target application has a security risk; If the first scanning result indicates that the target application does not have a security risk, the target application and the target data set are stored in a preset security container.

4. The method according to claim 3, characterized in that The steps of receiving a start instruction for the target claim settlement project, starting the target claim settlement project, scanning the target application according to a preset scanning method, and obtaining a first scanning result include: Receiving a start instruction for the target claim settlement project, starting the target claim settlement project, performing a static scan on the target application, and obtaining a static scan result; Performing simulation operation on the target application to obtain dynamic scanning results; receiving a detection instruction for the target application, detecting the target application according to the detection instruction, and obtaining a detection result; A first scanning result is obtained based on the static scanning result, the dynamic scanning result and the detection result.

5. The method according to claim 1, characterized in that The target data set is encrypted using a preset encryption method; the step of calculating the claim output result corresponding to the policyholder based on the target data set and the target application through the secure container includes: Decrypting the target data set through the secure container to obtain a decrypted data set; Scanning the target application through the secure container to obtain a second scanning result; wherein the second scanning result is used to indicate whether the target application has been tampered with; If the second scanning result indicates that the target application has not been tampered with, the claim output result corresponding to the policyholder is calculated based on the decrypted data set and the target application.

6. The method according to claim 1, characterized in that The method further comprises: Scanning the claim output result to obtain a third scanning result; wherein the third scanning result is used to indicate whether the claim output result meets the preset expected result and whether there is preset sensitive data; If the third scanning result indicates that the claim output result meets the expected result and the sensitive data does not exist, sending the claim output result to a preset user terminal; Destroy the secure container and all data in the secure container.

7. The method according to claim 6, characterized in that The method further comprises: If the third scanning result indicates that the claim output result does not meet the expected result, and / or the sensitive data exists, determining a security risk level corresponding to the third scanning result; Determine a control method corresponding to the security risk level according to the security risk level, perform corresponding operations according to the control method, and generate an alarm indication.

8. A commercial insurance claims device, characterized in that: The device comprises: A creation module, used to receive a project creation instruction for a target business demand, and create a target claim settlement project corresponding to the target business demand according to the project creation instruction; wherein the project creation instruction carries user information and an authorization file corresponding to the policyholder; the authorization file is used to indicate: it is allowed to call the information associated with the policyholder; An adding module, used for receiving an application adding instruction for a target application and a target data set, and adding the target application and the target data set to the target claim item; wherein the target data set is data associated with the policyholder; and the target application matches the target data set; A receiving module, configured to receive a start instruction for the target claim settlement project, start the target claim settlement project, and store the target application and the target data set in a preset secure container; A calculation module is used to calculate the claim output result corresponding to the insured person based on the target data set and the target application through the security container.

9. An electronic device, characterized in that: It includes a processor and a memory, wherein the memory stores machine executable instructions that can be executed by the processor, and the processor executes the machine executable instructions to implement the commercial insurance claims settlement method described in any one of claims 1 to 7.

10. A machine-readable storage medium, characterized in that: The machine-readable storage medium stores machine-executable instructions. When the machine-executable instructions are called and executed by the processor, the machine-executable instructions prompt the processor to implement the commercial insurance claims settlement method described in any one of claims 1-7.

Images