Business insurance claim settlement method, device and electronic equipment

Abstract

The application provides a commercial insurance claim settlement method and device and electronic equipment, a target claim settlement project corresponding to a target business requirement is created according to a project creation instruction; an application adding instruction for a target application and a target data set is received, and the target application and the target data set are added to the target claim settlement project; the target application matches the target data set; a starting instruction for the target claim settlement project is received, the target claim settlement project is started, and the target application and the target data set are stored in a preset secure container; and a claim settlement output result corresponding to a policyholder is calculated based on the target data set and the target application through the secure container. In this way, the target data set can be obtained online, the target application and the target data set can be stored in the secure container for calculation after the target claim settlement project is started, the claim settlement output result is obtained, the consumption of human resources is reduced, the insurance and claim settlement cycle is shortened, the claim settlement efficiency is improved, and the experience of the policyholder is improved.

Description

TECHNICAL FIELD

[0001] The present application relates to the technical field of claim settlement, in particular to a commercial insurance claim settlement method and device and electronic equipment. BACKGROUND

[0002] Medical commercial insurance, as a supplement to China's medical insurance system and an important part of relieving medical security payment pressure, has developed rapidly in recent years, and more and more people have purchased medical commercial insurance.

[0003] However, the medical industry and the insurance industry cannot share data, making the commercial health insurance claim settlement process complex. When the policyholder initiates a claim settlement, the insurance company can only adopt an offline manual investigation method to visit various regional medical institutions to access medical data, and feed back the access evaluation results to the insurance company, resulting in the insurance company consuming a large amount of human resources, long policy and claim settlement cycle, low claim settlement efficiency, and poor policyholder experience. SUMMARY

[0004] The purpose of the present application is to provide a commercial insurance claim settlement method, device and electronic equipment to save human resources, shorten the policy and claim settlement cycle, improve the claim settlement efficiency, and improve the policyholder experience.

[0005] The commercial insurance claim settlement method provided by the present application comprises the following steps: 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 that information associated with the policyholder is allowed 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 claim settlement 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 claim settlement project, starting the target claim settlement project, and storing the target application and the target data set in a preset secure container; and calculating a claim settlement output result corresponding to the policyholder based on the target data set and the target application through the secure container.

[0006] Further, the step of 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 project comprises: receiving a first adding instruction for the target application, judging whether the target application matches the target business requirement, adding the target application to the target claim project if the target application matches the target business requirement, and outputting first information; wherein the first information is used to indicate that the user is allowed to apply for adding the data set; receiving a second adding instruction for the target data set, judging whether the target data set matches the target business requirement and the target application, and adding the target data set to the target claim project if the target data set matches the target business requirement and the target application.

[0007] Further, the step of receiving a start instruction for the target claim project, starting the target claim project, and storing the target application and the target data set in the preset secure container comprises: receiving a start instruction for the target claim project, starting the target claim project, scanning the target application in a preset scanning mode, and obtaining a first scanning result; wherein the first scanning result is used to indicate whether the target application has a security risk; and storing the target application and the target data set in the preset secure container if the first scanning result indicates that the target application does not have a security risk.

[0008] Further, the step of receiving a start instruction for the target claim project, starting the target claim project, and scanning the target application in a preset scanning mode to obtain a first scanning result comprises: receiving a start instruction for the target claim project, starting the target claim project, performing static scanning on the target application to obtain a static scanning result, performing simulation running on 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 the first scanning result based on the static scanning result, the dynamic scanning result, and the detection result.

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

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

[0011] Further, the method further comprises: if the third scanning result indicates that the claim settlement output result does not meet the expected result and / or there is sensitive data, determining a security risk level corresponding to the third scanning result; determining a management and control mode corresponding to the security risk level according to the security risk level, performing a corresponding operation according to the management and control mode, and generating an alarm indication.

[0012] The application provides a business insurance claim settlement device, which comprises: a creation module, configured to 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 a policyholder; the authorization file is used to indicate that information associated with the policyholder is allowed to be called; an adding module, configured 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 the target claim settlement project; wherein the target data set is data associated with the policyholder; 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; and a calculation module, configured to calculate a claim settlement output result corresponding to the policyholder based on the target data set and the target application through the secure container.

[0013] The application provides an electronic device, which comprises a processor and a memory, the memory stores machine executable instructions capable of being executed by the processor, and the processor executes the machine executable instructions to implement the business insurance claim settlement method of any one of the above.

[0014] The application provides a machine readable storage medium, which stores machine executable instructions, and the machine executable instructions enable the processor to implement the business insurance claim settlement method of any one of the above when the machine executable instructions are called and executed by the processor.

[0015] The business insurance claim settlement method, device and electronic equipment provided by the application 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 a policyholder; the authorization file is used to indicate that information associated with the policyholder is allowed to be called; an application adding instruction for a target application and a target data set is received, and the target application and the target data set are added to the target claim settlement project; wherein the target data set is data associated with the policyholder; the target application matches the target data set; a start instruction for the target claim settlement project is received, the target claim settlement project is started, and the target application and the target data set are stored in a preset secure container; and a claim settlement output result corresponding to the policyholder is calculated based on the target data set and the target application through the secure container. In this way, the target data set can be obtained online, the target application and the target data set can be stored in the secure container for calculation after the target claim settlement project is started, the claim settlement output result is obtained, the consumption of human resources is reduced, the insurance and claim settlement cycle is shortened, the claim settlement efficiency is improved, and the experience of the policyholder is improved. BRIEF DESCRIPTION OF DRAWINGS

[0016] In order to more clearly illustrate the technical solutions in the specific embodiments or the prior art, the drawings needed to be used in the specific embodiments or the prior art description will be briefly introduced. Obviously, the drawings in the following description are some embodiments of the application, and other drawings can be obtained by those skilled in the art without creative labor.

[0017] Figure 1 A flowchart of a business insurance claim settlement method provided by an embodiment of the application;

[0018] Figure 2 A schematic diagram of a business insurance claim settlement system provided by an embodiment of the application;

[0019] Figure 3 A structural schematic diagram of a business insurance claim settlement device provided by an embodiment of the application;

[0020] Figure 4 A structural schematic diagram of an electronic device provided by an embodiment of the application. DETAILED DESCRIPTION

[0021] The technical solutions of the application will be described in detail below with reference to the embodiments. Obviously, the described embodiments are only some of the embodiments of the application, not all the embodiments. Based on the embodiments in the application, all other embodiments obtained by those skilled in the art without creative labor are within the scope of protection of the application.

[0022] The existing commercial insurance claim process needs a large amount of manual offline investigation of the medical treatment information of the insured person, and cannot quickly obtain a continuous and stable high-quality medical insurance data source, which makes it difficult for the insurance company to continuously and quickly carry out claim investigation, and also needs to consume a large amount of human resources, and the insured period is long, the experience of the insured person is poor, and the further development of the commercial insurance industry is affected. Based on this, the embodiments of the present application provide a commercial insurance claim method, device and electronic equipment, which can be applied to the application scene of commercial claim.

[0023] In order to facilitate the understanding of the present embodiment, first, a commercial insurance claim method disclosed by the present embodiment is introduced, as shown in the figure, the method comprises the following steps: Figure 1

[0024] Step S102, 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 corresponding to the insured person and an authorization file; the authorization file is used to indicate that the information associated with the insured person is allowed to be called;

[0025] The target business requirement can be a pre-acquired business requirement of the insurance company, for example, the target business requirement can be a fast claim business requirement, etc. The above 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 requirement, the instruction is issued. The above user information can include user name, gender, ID number, etc. The above authorization file is usually a personal information authorization signed by the insurance company and the insured person, which can be signed offline or online. Only after signing the authorization file, the insurance company is allowed to call the information associated with the insured person, such as user information, medical diagnosis related information, etc. In actual implementation, the commercial insurance user can issue the above project creation instruction for the target business requirement after acquiring the target business requirement to create a target claim project, and the user information and authorization file of the insured person usually need to be carried in the project creation instruction. In the process of creating the target claim project, the commercial insurance user usually needs to fill in the project name, project type, project description, etc. When uploading the user information and authorization file of the insured person, the commercial insurance user can upload in batches according to the given template, or can manually input. If the insured person has multiple, the authorization file corresponding to each insured person needs to be uploaded, 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 the target claim project; wherein the target data set is data associated with the insured person; the target application matches the target data set;

[0027] ​The target application and the target data set are usually matched with the target business requirement, for example, if the target business requirement is a fast claim business requirement, the target application is a fast claim application corresponding to the fast claim business requirement, and the target data set is a data set corresponding to the fast claim business requirement, such as a settlement-related data set, a clinic-related data set, and the like. Correspondingly, the target application is also matched with the target data set. The application adding instruction can be an instruction issued by the commercial insurance user when the commercial insurance user needs to add the target application and the target data set to the target claim item.

[0028] In actual implementation, the commercial insurance user can apply for the target application and the target data set corresponding to the target business requirement by adding the target application and the target data set. Specifically, the preset application market can provide application management services such as viewing, previewing, and querying of investigation applications. The application market can provide catalog management of applications published by insurance companies to display basic information of the applications in a view mode, so as to facilitate the commercial insurance user to view and understand the applications. The application market can also provide a preview viewing function of selected applications, including provider, function description, and required points. The commercial insurance user can select the target application from the application market and apply for adding the target application.

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

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

[0031] In step S106, a start instruction for the target claim item is received, the target claim item is started, and the target application and the target data set are stored in a preset secure container.

[0032] The start instruction can be an instruction issued by the commercial insurance user when the commercial insurance user needs to start the target claim item. The secure container refers to a framework providing an additional security layer, which is usually used when an application is constructed 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 item. After receiving the start instruction, the target claim item can be started, and the target application and the target data set in the target claim item can be placed in the preset secure container.

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

[0034] After the target data set and the target application are put into the security container, the security container can perform associated calculation on the target data set and the target application, for example, the calculation can be performed by a pre-configured model, and specific calculation manners can refer to related technologies, which will not be described here. The claim output result corresponding to the policyholder is obtained by calculation, which can include medical insurance reimbursement information, etc.

[0035] The above business insurance claim method receives a project creation instruction for a target business requirement, creates a target claim project corresponding to the target business requirement according to the project creation instruction, wherein the project creation instruction carries user information corresponding to the policyholder and an authorization file; the authorization file is used to indicate that information associated with the policyholder is allowed to be called; an application addition instruction for the target application and the target data set is received, and the target application and the target data set are added to the target claim project; the target data set is data associated with the policyholder; the target application matches the target data set; a start instruction for the target claim project is received, the target claim project is started, and the target application and the target data set are stored in a preset security container; and the security container calculates a claim output result corresponding to the policyholder based on the target data set and the target application. This way, the target data set can be obtained online, and after the target claim 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 claim period, improves the claim efficiency, and improves the experience of the policyholder.

[0036] The embodiment of the application also provides another business insurance claim method, which is implemented based on the above-mentioned 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, such as 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 comprises the following steps:

[0037] Step 1, receiving a project creation instruction for a target business requirement, 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 corresponding to the policyholder and an authorization file; the authorization file is used to indicate that information associated with the policyholder is allowed to be called;

[0038] The commercial insurance user can browse the data market and the application market through the user terminal, and check whether the fields of the medical insurance data set in the data market meet the target business demand; specifically, the medical insurance data set in the data market usually displays field names such as data set name, alias, type, business scenario, label, owner, and release time. By checking the various field names included in the medical insurance data set, it can be determined whether the medical insurance data set meets the target business demand; that is, the commercial insurance user can only see the field names, and cannot see the specific field values corresponding to each field name; among them, the above data set name usually represents a large category, such as medical insurance settlement data, expense details, etc.; the above alias usually pre-classifies the corresponding medical insurance data set, such as adding "fast claim" before the data set name of the original medical insurance data set, indicating that the medical insurance data set corresponds to the fast claim business demand; the above type can be understood as the data type in the medical insurance data set, such as string, numeric, float, etc.; the above business scenario can be understood as the application scenario in which the medical insurance data set can be used; the above label is usually a system automatically configured label; the above owner indicates a party that owns the medical insurance data set, such as a hospital, etc.; and the above 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, the creator, the business application scenario description, and the creation time of each application; among them, the application scenario name can be fast claim, investigation, etc.; the creator indicates a party that creates the application, such as an insurance company, etc.; and 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 demand, the commercial insurance user can issue a project creation instruction of the target business demand to create a target claim project according to the project creation instruction.

[0041] Step two, receiving a first addition instruction for the target application, and judging whether the target application matches the target business demand;

[0042] In actual implementation, after creating the target claim project, the target application usually needs to be applied for first. The commercial insurance user can select the target application and apply for adding, at which time the first addition instruction can be generated. After receiving the first addition instruction sent by the commercial insurance user, it is usually necessary to approve whether the target application selected by the user matches the target business demand, such as if the target business demand is fast claim, and the application selected by the commercial insurance user is investigation application, then the two are not matched, and the approval is not passed. If the commercial insurance user selects a fast claim application, then the two are matched, and the approval is passed.

[0043] Step three, if the target application matches the target business requirement, adding the target application to the target claim project, and outputting first information; wherein the first information is used to indicate that the user is allowed to apply to add a data set;

[0044] When it is determined that the target application matches the target business requirement, the target application can be added to the target claim project, and first information is outputted to indicate that the user is allowed to continue to apply to add a data set, that is, after the target application is approved, the data set can be allowed to be applied.

[0045] Step four, receiving a second adding instruction for the target data set, and judging whether the target data set matches the target business requirement and the target application;

[0046] In actual implementation, the commercial insurance user can select a target data set and apply to add, at this time, a second adding instruction can be generated, and 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 requirement, and at the same time, whether the target data set matches the target application, for example, if the target business requirement is a fast claim business requirement, the target application is a fast claim application, and the target data set is a settlement type data set, the three are matched, and the approval is passed, if the target data set is a medical device type data set, the target data set does not match the target business requirement, and does not match the target application, and the approval is not passed. Different applications and different data sets are usually pre-configured to correspond to each other, and the data sets corresponding to different applications can be different, if the target application selected by the user is not the same as the application matched by the target data set, the approval will not be passed.

[0047] Step five, if the target data set matches the target business requirement and the target application, adding the target data set to the target claim project; wherein the target data set is a data set associated with the policyholder;

[0048] When it is determined that the target data set matches the target business requirement and the target application, that is, the target data set is approved, the project resource can be configured for the target claim project, by default, the project resource is automatically recommended by the system, of course, it can also be manually adjusted according to actual requirements, and the upper limit of the project resource is all available resources owned by the commercial insurance user.

[0049] Step six, receiving a start instruction for the target claim project, starting the target claim project, and scanning the target application in a preset scanning mode to obtain 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 through the following steps 60 to 63:

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

[0052] Step 61, performing a simulation run on the target application to obtain a dynamic scan result;

[0053] Step 62, receiving a detection instruction for the target application to detect the target application according to the detection instruction to obtain a detection result;

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

[0055] In order to ensure the safety of the target application, before the target application is put into the secure container, three stages of security scanning are usually performed to ensure that the target application entering the secure container has no security risks. Firstly, the first stage is to scan the code vulnerabilities and risks of the target application in a static scanning manner, to determine whether there is a potential risk based on a preset rule, to obtain a corresponding static scan result; the second stage is to simulate the running of the target application in a dynamic scanning manner, to determine whether there are unreported ports, protocols, output data, etc., to obtain a corresponding dynamic scan result; the third stage is to manually detect possible security risks according to business logic, specifically, a detection personnel can manually issue a detection instruction according to business logic to detect whether there is a security risk, for example, manually detecting whether the result after running the target application conforms to the specification, to obtain a corresponding detection result; according to the obtained static scan result, dynamic scan result, and detection result, a first scan result is determined; specifically, if the static scan result, dynamic scan result, and detection result all indicate that the target application has no security risks, the first scan result can indicate that the target application has no security risks; if at least one result indicates that the target application has security risks, the first scan result can indicate that the target application has security risks.

[0056] Step seven, if the first scan result indicates that the target application has no security risks, storing the target application and the target data set into a preset secure container;

[0057] After determining that the target application has no security risks, the target application and the target data set can be stored into a preset secure container.

[0058] Step eight, performing decryption processing on the target data set through the secure container to obtain a decrypted data set;

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

[0060] Step nine, 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 is tampered with;

[0061] When the target application enters the secure container, the secure container starts a daemon process to perform image security scanning on the image file corresponding to the target application, confirms the image source through image signature, to confirm whether the target application is tampered with in the transmission process; for example, a pair of public key and private key can be obtained in advance, the image file corresponding to the target application is subjected to hash processing to obtain a first result, the private key is used to encrypt the first result to obtain an image signature, when the target application is put into the secure container, the image file of the target application and the image signature thereof are usually put into the secure container, the public key is used by the secure container to decrypt the image signature to obtain the first result; then the image file is subjected to the same hash processing to obtain a second result; if the second result is the same as the first result, it can be considered that the target application is not tampered with, and specific reference can be made to related technologies, which will not be described here.

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

[0063] After it is determined that the target application is not tampered with, the decrypted data set and the target application can be associated and calculated to obtain a claim output result corresponding to the policyholder; during the calculation in the secure container, the communication protocol and interface of the target application can be monitored to prevent the target application from performing illegal communication.

[0064] Step eleven, 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 conforms to a preset expected result, whether there is preset sensitive data;

[0065] The above expected result generally includes fields that need to be included in the preset claim output result; the above sensitive data generally refers to data that may cause serious harm to society or individuals after being leaked, such as the name, ID number, address, and telephone number of an individual; in actual implementation, a corresponding rule is generally preset for the field value of each field included in the expected result, such as the length, type, and format of the field value; after obtaining the above claim output result, the claim output result can be scanned to determine whether the fields included in the claim output result match the preset expected result, and if they match, it can be determined that the claim output result meets the preset expected result; it is further determined whether the field value of each field of the claim output result meets the rule corresponding to the field value of the field, and if it does, it is considered that there is a risk of bringing out sensitive data through comparison, reverse deduction, or the like.

[0066] Step twelve, 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 the preset user terminal;

[0067] When the third scanning 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; generally, if there are multiple policyholders, the commercial insurance user can obtain the claim output result corresponding to each policyholder, including the total medical expense, medical insurance reimbursement amount, and personal expenditure 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 thirteen, destroying the secure container and all data in the secure container.

[0069] After the secure container is calculated and the claim output result is output, the secure container can be destroyed, and all data in the secure container, such as the target data set, is destroyed, thereby ensuring the security of the target data set.

[0070] Step fourteen, 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;

[0071] Different security risk levels can be preset according to actual needs, and the standards corresponding to different security risk levels are preset, such as a low risk level if one field does not match the expected result, a medium risk level if two fields do not match the expected result, and the like; if the third scanning result indicates that the claim output result does not meet the expected result and / or there is sensitive data, the security risk level corresponding to the third scanning result can be determined according to the situation of the third scanning result.

[0072] Step fifteen, determining the management and control mode corresponding to the security risk level according to the security risk level, performing the corresponding operation according to the management and control mode, and generating an alarm indication.

[0073] Different security risk levels usually correspond to different degrees of management and control mode, for example, the management and control mode can include: limiting output, suspending service, fusing service, etc.; in actual implementation, after determining the security risk level corresponding to the third scanning result, the management and control mode corresponding to the security risk level can be used for security management and control, for example, the output can be limited, the service can be suspended, the service can be fused, etc., and the alarm can be started at the same time, so as to remind the commercial insurance user to take corresponding measures in time.

[0074] For easy understanding, refer to Figure 2 The system includes a security 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 security data service 11 is connected with the data market 12, the trusted computing service 14 is connected with the data market 12, the application market 13, the approval process management 15, and the privacy computing environment 16, respectively, and the privacy computing environment 16 is connected with the data market 12 and the application market 13, respectively. The functions of each part are described below.

[0075] (1) Security data service 11: Provide secure encryption storage, retrieval, release, field information browsing, and other data access management services for medical insurance data sets. The secure encryption storage of the data set is realized by software encryption, and each data set is encrypted separately; the data demander obtains the right to use the compliant encrypted data set through approval authorization, but cannot really obtain the data; provide multi-dimensional data retrieval and viewing capabilities to provide flexible and convenient data usage for institutional users, and facilitate data administrators to manage data.

[0076] (2) Data market 12: Provide data set management services such as viewing, previewing, and querying medical insurance data sets. Provide asset catalog management of medical insurance data and insurance company data, including querying and summary information viewing operations, to provide data asset catalogs for various users on the platform; provide previewing and viewing functions of selected data sets, only provide field information preview, and do not include specific data content.

[0077] (3) Application market 13: Provide application management services such as viewing, previewing, and querying survey applications. Provide catalog management of platform and institutional published applications to display basic information of the applications in a view mode, facilitating institutional users to view and understand the applications; provide previewing and viewing functions of selected applications, including provider, function description, required points, and other summary information.

[0078] (4) Trusted Computing Service 14: Provide project and application management capabilities such as user project creation, data application association, etc. On the basis of obtaining data sets and applications, create instances, and after completing the configuration of resources such as CPU, memory, etc., realize the creation of work instances, and provide a secure container environment support for business computing; Provide asset management of applications to which the user belongs, support application detailed information viewing, searching and other operations, and facilitate user management of application assets; Provide a list display of created projects, support project creation, search and other operations, and facilitate user understanding of all project summary information.

[0079] (5) Approval process management 15: Provide management of work approval processes, including data set release and use approval and application shelving and use approval, and record the decision-making process and results of each approval node, facilitating monitoring and management of the approval process by relevant personnel.

[0080] (6) Privacy computing environment 16: Provide privacy computing environment management capabilities such as container creation, running monitoring, and container / image scanning monitoring for secure computing. Based on a secure container, a secure computing environment is provided to ensure the privacy and security of data and applications required for computing in the environment, which cannot be accessed, tampered with, etc., and the data and applications inside the secure container are destroyed after computing is completed.

[0081] The above commercial insurance claim settlement method can make the insurance company more quickly investigate the medical treatment information, cost information and reimbursement information of the insured, improve the business efficiency of claim settlement investigation and reduce the business cost, at the same time, develop more targeted insurance products to meet the specific needs of different groups of people and provide personalized insurance services, thereby improving the coverage and satisfaction of services and enabling more people to enjoy commercial insurance services.

[0082] The medical insurance data operator can realize the value realization of medical insurance data by providing reliable medical insurance data services that are safe and compliant for insurance companies, and promote the digital transformation and market operation of medical insurance. The present scheme realizes medical insurance data claim settlement business analysis through project management and secure containers.

[0083] In the scheme, the secure container monitors the application image communication through the daemon container process to ensure that the computing process of the target application meets the expectations. The security and reliability of the target application are ensured through static scanning, dynamic scanning and manual scanning. Under the premise of obtaining the medical insurance data authorized operation end, the present scheme realizes online claim settlement investigation based on medical insurance data by constructing a claim settlement investigation data privacy and security computing space based on project management, which greatly improves the claim settlement efficiency of insurance companies, reduces the operation cost, and helps process and product innovation, and also provides an implementation path for the marketization of medical insurance data elements.

[0084] The embodiment of the present application provides a commercial insurance claim settlement device,Figure 3 As shown, the device comprises: a creation module 30, configured to receive a project creation instruction for a target business requirement, and create 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 that information associated with the policyholder is allowed to be called;

[0085] An adding module 31 is configured 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 the target claim project; wherein the target data set is data associated with the policyholder; the target application matches the target data set.

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

[0087] A calculation module 33 is configured to calculate a claim output result corresponding to the policyholder based on the target data set and the target application through the secure container.

[0088] The commercial insurance claim device can obtain the target data set online, store the target application and the target data set in the secure container for calculation to obtain the claim output result after the target claim project is started, reduces the consumption of human resources, shortens the policy and claim period, improves the claim efficiency, and improves the experience of the policyholder.

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

[0090] Further, the receiving module is further configured to: receive a starting instruction for the target claim project, start the target claim project, scan the target application according to a preset scanning mode, and obtain 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, store the target application and the target data set in a preset secure container.

[0091] Further, the receiving module is further configured to: receive a starting instruction for the target claim item, start the target claim item, perform a static scan on the target application to obtain a static scan result; perform a simulation run 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] Further, the computing module is further configured to: perform decryption processing on the target data set through the secure container to obtain a decrypted data set; and perform scanning on the target application through the secure container to obtain a second scan result; wherein the second scan result is used to indicate whether the target application is tampered with; and if the second scan result indicates that the target application is not tampered with, the claim output result corresponding to the policyholder is calculated based on the decrypted data set and the target application.

[0093] Further, the device is further configured to: perform scanning on the claim output result to obtain a third scan result; wherein the third scan result is used to indicate whether the claim output result meets a preset expected result and whether there is preset sensitive data; if the third scan 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 secure container and all data in the secure container are destroyed.

[0094] Further, the device is further configured to: if the third scan result indicates that the claim output result does not meet the expected result and / or there is sensitive data, determine a security risk level corresponding to the third scan result; determine a control mode corresponding to the security risk level according to the security risk level, perform a corresponding operation according to the control mode, and generate an alarm instruction.

[0095] The commercial insurance claim device provided by the embodiment of the present application has the same implementation principle and technical effects as the foregoing commercial insurance claim method embodiment. For brevity of description, the part of the commercial insurance claim device embodiment not mentioned can refer to the corresponding content in the foregoing commercial insurance claim method embodiment.

[0096] The embodiment of the present application further provides an electronic device, as shown in Figure 4 The electronic device includes a processor 130 and a memory 131, and 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 claim method.

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

[0098] The memory 131 can include a high-speed random access memory (RAM) and can also include a non-volatile memory such as at least one disk memory. 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 can be wired or wireless), and the Internet, a wide area network, a local network, a metropolitan area network, etc. can be used. The bus 132 can be an ISA bus, a PCI bus, an EISA bus, etc. The bus can 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 figure to represent the bus, but it does not mean that there is only one bus or only one type of bus.

[0099] The processor 130 can be an integrated circuit chip with signal processing capability. In the implementation process, each step of the above method can be completed by the integrated logic circuit of hardware in the processor 130 or the instructions in the form of software. The processor 130 described above 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. Each method, step and logic block disclosed in the embodiment of the present application can be implemented or executed. The general-purpose processor can be a microprocessor or the processor can also be any conventional processor. The steps of the method disclosed in combination with the embodiment of the present application can be directly embodied as a hardware code processor for execution, or a combination of hardware and software modules in the code processor for execution. The software module can be located in a random access memory, a flash memory, a read-only memory, a programmable read-only memory, an electrically erasable programmable memory, a register, etc. The storage medium in the art. The storage medium is located in the memory 131, and the processor 130 reads the information in the memory 131, and combines the hardware to complete the steps of the method of the above embodiment.

[0100] The embodiment of the present application further provides a machine readable storage medium which stores machine executable instructions, when the machine executable instructions are invoked and executed by a processor, the machine executable instructions cause the processor to implement the commercial insurance claim settlement method, and the specific implementation can be referred to the method embodiment, and will not be repeated here.

[0101] The computer program product of the commercial insurance claim settlement method, device and electronic equipment provided by the embodiment of the present application comprises a computer readable storage medium which stores program codes, and the instructions included in the program codes can be used to execute the method described in the foregoing method embodiment, and the specific implementation can be referred to the method embodiment, and will not be repeated here.

[0102] The function can be stored in a computer readable storage medium if the function is realized in the form of a software function unit and sold or used as an independent product. Based on such understanding, the technical solutions of the present application or parts of the technical solutions that make essential contributions to the prior art can be embodied in the form of a software product. The computer software product is stored in a storage medium, and includes a plurality of instructions for causing a computer device (which can be a personal computer, a server, or a network device, etc.) to execute all or part of the steps of the methods described in the various embodiments of the present application. The foregoing storage medium includes a U disk, a mobile hard disk, a read-only memory (ROM), a random access memory (RAM), a magnetic disk or an optical disk, and various media that 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 application, and not to limit them; although the present application has been described in detail with reference to the foregoing embodiments, those skilled in the art should understand that: it can still modify the technical solutions recorded in the foregoing embodiments, or make equivalent replacement for part or all of the technical features; and these modifications or replacements do not make the essence of the corresponding technical solutions deviate from the scope of the technical solutions of the embodiments of the present application.

Claims

1. A commercial insurance claims settlement method, characterized in that, The method includes: The system receives a project creation instruction for a target business need and creates a target claims project corresponding to that business need based on the instruction. The project creation instruction carries user information and an authorization file for the policyholder. The authorization file indicates that access to information associated with the policyholder is permitted. The system receives an application to add a target application and a target dataset, and adds the target application and the target dataset to the target claim item; wherein the target dataset is data associated with the policyholder; and the target application matches the target dataset. Receive a start command for the target claim project, start the target claim project, and store the target application and the target dataset in a preset secure container; The security container calculates the claim output result corresponding to the policyholder based on the target dataset and the target application.

2. The method according to claim 1, characterized in that, The steps of receiving an application to add a target application and a target dataset, and adding the target application and the target dataset to the target claims project, include: Receive a first add instruction for the target application and determine 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 claims project, and first information is output; wherein, the first information is used to indicate that the user is allowed to apply to add a dataset; Receive a second add instruction for the target dataset, and determine whether the target dataset matches both the target business requirement and the target application; If the target dataset matches both the target business requirement and the target application, the target dataset is added to the target claims project.

3. The method according to claim 1, characterized in that, The steps of receiving a startup command for the target claim project, starting the target claim project, and storing the target application and the target dataset in a preset secure container include: Upon receiving a start command for the target claim item, the system initiates the target claim item and scans the target application using a preset scanning method to obtain a first scan result; wherein, the first scan result is used to indicate whether the target application has any security risks; If the first scan result indicates that the target application does not pose a security risk, the target application and the target dataset are stored in a preset secure container.

4. The method according to claim 3, characterized in that, The steps of receiving a start command for the target claim item, starting the target claim item, scanning the target application according to a preset scanning method, and obtaining a first scan result include: Receive a start command for the target claim project, start the target claim project, perform a static scan on the target application, and obtain the static scan results; The target application was simulated and run to obtain dynamic scan results; Receive a detection instruction for the target application, detect the target application according to the detection instruction, and obtain a detection result; Based on the static scan results, the dynamic scan results, and the detection results, a first scan result is obtained.

5. The method according to claim 1, characterized in that, The target dataset is encrypted using a preset encryption method; the step of calculating the claim output result corresponding to the policyholder through the secure container based on the target dataset and the target application includes: The target dataset is decrypted using the secure container to obtain the decrypted dataset. The target application is scanned using the secure container to obtain a second scan result; wherein the second scan result is used to indicate whether the target application has been tampered with. If the second scan 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 dataset and the target application.

6. The method according to claim 1, characterized in that, The method further includes: The claims output results are scanned to obtain a third scan result; wherein, the third scan result is used to indicate whether the claims output results meet the preset expected results and whether there is preset sensitive data; If the third scan result indicates that the claim output result matches the expected result, and there is no sensitive data, the claim output result is sent to the preset user terminal; Destroy the secure container and all data within it.

7. The method according to claim 6, characterized in that, The method further includes: If the third scan result indicates that the claims output result does not meet the expected result, and / or, the sensitive data exists, determine the security risk level corresponding to the third scan result; Based on the security risk level, determine the control method corresponding to the security risk level, perform the corresponding operation according to the control method, and generate an alarm instruction.

8. A commercial insurance claims processing device, characterized in that, The device includes: A creation module is used to receive a project creation instruction for a target business need, and create a target claims project corresponding to the target business need according to the project creation instruction; wherein, the project creation instruction carries user information and authorization documents corresponding to the policyholder; the authorization documents are used to indicate: it is allowed to access information associated with the policyholder; An add module is used to receive an application to add a target application and a target dataset, and add the target application and the target dataset to the target claim item; wherein, the target dataset is data associated with the policyholder; and the target application matches the target dataset. The receiving module is used to receive a start command for the target claim project, start the target claim project, and store the target application and the target dataset into a preset secure container; The calculation module is used to calculate the claim output result corresponding to the policyholder based on the target dataset and the target application through the security container.

9. An electronic device, characterized in that, It includes a processor and a memory, the memory storing machine-executable instructions that can be executed by the processor, the processor executing the machine-executable instructions to implement the commercial insurance claims method according to any one of claims 1-7.

10. A machine-readable storage medium, characterized in that, The machine-readable storage medium stores machine-executable instructions that, when invoked and executed by a processor, cause the processor to implement the commercial insurance claims method as described in any one of claims 1-7.

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