Common insurance settlement system and method, and medium

Abstract

The invention discloses a common insurance automatic settlement system and method based on an intelligent matching algorithm. The system receives co-insurance data through the data access module, automatically matches settlement rules according to a co-insurance protocol by using an intelligent matching engine, supports automatic execution of multiple settlement modes through the settlement processing module, realizes automatic processing of tax data by means of the tax integration module, and provides whole-process monitoring through the risk management module. The method can effectively solve the problems of information isolation, complex operation, flow breakpoint, large compliance risk and the like in traditional common insurance settlement, realizes intelligent, automatic and standardized processing of common insurance settlement, and greatly improves settlement efficiency and risk control capability.

Description

Technical Field

[0001] This invention relates to the field of insurance information processing technology, and in particular to an automated settlement system and method for co-insurance based on an intelligent matching algorithm. Background Technology

[0002] Co-insurance (or simply "co-insurance") refers to an insurance transaction in which two or more insurers jointly underwrite the same insurance policy. In co-insurance, each insurer assumes insurance liability and shares the premium according to an agreed-upon proportion. However, the traditional co-insurance settlement model has serious flaws: 1. Severe information isolation: Business data among the various participants is isolated from each other, and there is a lack of a unified data exchange platform, resulting in extremely high communication costs.

[0003] 2. Complex and cumbersome operation: The settlement process involves multiple steps such as premium verification, commission calculation, and invoice issuance, which require a lot of manual intervention and repetitive operations.

[0004] 3. Multiple process breakpoints: There are multiple data breakpoints between the core business system and the financial and tax systems, making it impossible to achieve end-to-end automated processing.

[0005] 4. High compliance risks: Manual operation is prone to errors and lacks an effective monitoring mechanism, resulting in significant operational and compliance risks.

[0006] Traditional solutions attempt to improve these problems through local optimization, but they cannot fundamentally resolve the core contradictions of data silos and process disruptions between systems. Summary of the Invention

[0007] The purpose of this invention is to overcome the shortcomings of existing technologies and provide an automated settlement system and method for co-insurance based on intelligent matching algorithms, achieving full automation and intelligence of the co-insurance settlement process through technological innovation. This invention adopts the following technical solution.

[0008] On one hand, the present invention provides a joint insurance settlement system, comprising: The data access module receives co-protection data from the core business system and generates a unique identifier to associate the data of this business in subsequent processes; The intelligent matching engine automatically matches settlement rules based on the terms of the co-insurance agreement; The settlement processing module supports the automated execution of multiple settlement modes; The tax integration module completes tax-related operations; The risk management module provides end-to-end risk monitoring.

[0009] Furthermore, the intelligent matching engine includes: The rule parsing unit is used to parse the business rules of the co-guarantee agreement; Pattern recognition unit, used to identify features of business scenarios; The matching algorithm unit performs rule matching based on a preset algorithm.

[0010] Furthermore, the matching algorithm unit adopts a multi-factor weighted algorithm, considering factors including: insurance type, coverage ratio, commission rate, and settlement cycle.

[0011] Furthermore, the settlement processing module supports at least the following settlement modes: Choose to issue invoices and settle accounts separately, without needing to use channels, only perform policy netting settlement; Each party issues its own invoice and settles with the main contractor. When confirming the order, the invoice must be uploaded for verification before the subsequent process can be completed. The principal accepts and issues invoices for the full amount, and the principal's handling fee and insurance premium are all processed automatically by the system and the reimbursement is completed automatically. The principal underwriter does not issue invoices for settlement, and there is no need to issue invoices subsequently. Only the invoicing and reconciliation of premiums are completed.

[0012] Furthermore, the settlement model also includes: settlement fee. For this type of policy, after the premium has been cleared, you can still choose to settle only the handling fee.

[0013] Furthermore, the settlement processing module is further configured to: be coupled with the financial system, and be used to automatically and proportionally calculate and release the settlement amount of each follow-up insurer after the main insurer completes the premium write-off, and make the settlement data visible to the main insurer and the follow-up insurer; the release of the settlement amount is performed in near real-time, and the released data constitutes the basis for initiating settlement instructions; Furthermore, the tax integration module is further configured to interface with the VAT invoice system and the invoice ledger system, and to automatically initiate invoice issuance requests, receive written-back invoice information, automatically perform invoice verification and anti-duplicate checks after settlement approval, and automatically trigger the financial reconciliation process after verification; and to automate the following functions: invoice issuance; invoice verification; anti-duplicate checks; and input tax authentication.

[0014] Furthermore, the risk management module provides: real-time process monitoring; automatic anomaly alerts; compliance checks; and audit log recording.

[0015] Secondly, the present invention also provides a method for settlement based on mutual insurance, implemented based on the aforementioned mutual insurance settlement system, comprising the following steps: Data access steps: Receive co-protection data and generate a unique identifier to associate the data of this business in all subsequent processes; Intelligent matching steps: Automatically match settlement rules; Settlement processing steps: Execute automated settlement; Tax processing steps: Complete tax-related operations; Risk monitoring steps: Monitor the entire settlement process.

[0016] Thirdly, the present invention also provides an electronic device, including a processor and a memory, wherein the memory stores a computer program, characterized in that, when the computer program is executed by the processor, it implements the aforementioned co-insurance settlement method.

[0017] Through the above technical solutions, the present invention can achieve the following beneficial technical effects: 1. Full-process automation: It realizes the full-process automation from premium reimbursement to final reimbursement, reducing the manual operation that originally required several days to be completed in hours.

[0018] 2. Intelligent routing and decision-making: The system can automatically select the settlement mode according to business rules and intelligently call relevant system interfaces to obtain necessary data, reducing manual intervention.

[0019] 3. Tax compliance assurance: Through deep integration between systems, ensure the compliance and accuracy of tax processing procedures such as invoicing, verification, and authentication.

[0020] 4. Real-time risk monitoring: Throughout the entire process, the system monitors the status of each stage in real time, provides timely warnings of abnormal situations, and ensures the reliability of business processing. Attached Figure Description

[0021] Figure 1 This is a framework diagram of the co-insurance settlement system of this invention; Figure 2 This is a schematic diagram of the co-insurance settlement process of the method of the present invention; Figure 3 This is a schematic diagram of the hardware structure of the computer in the system of the present invention. Detailed Implementation

[0022] To make the objectives, technical solutions, and advantages of the embodiments of this application clearer, the technical solutions of the embodiments of this application will be clearly and completely described below with reference to the accompanying drawings. It should be understood that the accompanying drawings in the embodiments of this application are for illustrative and descriptive purposes only and are not intended to limit the protection scope of the embodiments of this application. Furthermore, it should be understood that the schematic drawings are not drawn to scale. The flowcharts used in the embodiments of this application illustrate operations implemented according to some embodiments of this application. It should be understood that the operations in the flowcharts may not be implemented in sequence, and steps without logical contextual relationships may be reversed or implemented simultaneously. In addition, those skilled in the art, guided by the content of the embodiments of this application, may add one or more other operations to the flowcharts, or remove one or more operations from the flowcharts.

[0023] Furthermore, the described embodiments are merely a part of the embodiments of this application, and not all of them. The components of the embodiments of this application described and illustrated herein can generally be arranged and designed in various different configurations. Therefore, the following detailed description of the embodiments of this application provided in the accompanying drawings is not intended to limit the scope of the claimed embodiments of this application, but merely to illustrate selected embodiments of this application.

[0024] The specific embodiments of the present invention will now be described in detail with reference to the accompanying drawings.

[0025] like Figure 1 The diagram shows the framework of the co-insurance settlement system of the present invention, which includes the following core components: Data access module: It connects with the core business system through the API gateway, receives co-insurance policy data, and generates a globally unique co-insurance batch number for each business.

[0026] This module is deployed on the core policy issuance system side. When a co-insurance policy is generated, this module will assign it a globally unique co-insurance batch number (such as GB202311140001) and push the policy data with this batch number to the financial system and channel system.

[0027] Intelligent matching engine: With a built-in rule base and algorithm model, it can automatically match applicable settlement rules and parameters according to the specific terms of the co-insurance agreement.

[0028] The specific implementation of the intelligent matching algorithm may include the following process: Rule Analysis: Analyzing the key clauses in the co-guarantee agreement; Pattern recognition: Identifying characteristic parameters of a business scenario; Optimal matching: Select the most suitable settlement plan based on a preset algorithm; Data validation: Perform compliance checks on the matching results.

[0029] Specifically, the system employs an intelligent matching mechanism based on a rule engine, with a rule base containing matching rules for various business scenarios. Each rule clearly defines its applicable conditions, priority, and execution action. The system automatically triggers rule sets that meet the conditions based on the input business characteristic parameters. Matching rules are categorized and managed according to business dimensions, including but not limited to underwriting ratio rules, risk level rules, and settlement cycle rules. The rule engine supports dynamic loading and hot updates, enabling adjustments and optimizations of business rules without restarting the service.

[0030] The matching algorithm employs a multi-factor weighted calculation model, comprehensively considering parameters from multiple dimensions such as business type, risk characteristics, and settlement requirements. The algorithm first extracts and standardizes the features of the input business data, then evaluates the degree of matching with each rule using a similarity calculation model. The algorithm execution process includes four stages: feature engineering, rule filtering, weight calculation, and result verification. The system generates a confidence score for each matching result and sets a threshold for result filtering to ensure the accuracy and reliability of the matching results.

[0031] Settlement processing module: Supports automated processing of five settlement modes, including complex scenarios such as premium netting and commission settlement.

[0032] As part of the financial system, this module is triggered when the lead insurer confirms receipt of the premium and executes the write-off operation in the financial system. It immediately calculates the settlementable amount for each co-insurer based on the share ratio in the co-insurance agreement and updates the "settlementable status" of these records in the database to "released." This status change is then communicated to the relevant parties via a message queue.

[0033] The underwriter's sales personnel can filter by dimensions such as "co-insurance batch number" and "policy number" on the settlement interface, select the released settlement records, and choose the "premium commission netting" mode. The engine then automatically calls the channel system's API to obtain the commission details of the corresponding policy, completes the netting calculation, and generates a settlement statement pending approval.

[0034] Tax integration services: Exchange data with VAT invoice systems, e-invoice platforms, etc. through standard interfaces.

[0035] After the settlement statement passes the approval process, this module is invoked. It first calls the VAT invoice system via API to transmit invoicing information and complete the issuance of the electronic invoice. After the invoice code and number are written back to the system, the module then calls the verification interface of the "Invoice Ledger System" to ensure the authenticity and uniqueness of the invoice. Upon successful verification, the module automatically generates a reconciliation voucher in the financial system and can automatically trigger the authentication process according to preset rules (such as invoice amounts exceeding a certain threshold).

[0036] The risk management module provides end-to-end risk monitoring.

[0037] The risk management module provides: real-time process monitoring; automatic alerts for anomalies; compliance checks; and audit log recording.

[0038] Figure 2 The following is a flowchart of the co-insurance settlement method of the present invention, in conjunction with... Figure 2 The specific implementation methods will be further explained in the context of specific application scenarios.

[0039] Suppose insurance company A acts as the lead insurer, jointly underwriting a large engineering project with co-insurers B and C. The total premium is 10 million yuan, with coverage ratios of 50%, 30%, and 20% respectively. The commission rate is 15% of the premium. Specific implementation steps

[0040] Step S1: Data Access and Synchronization 1. The core business system generates standardized co-insurance policy data, including key information such as policy number, policyholder information, insured object, premium amount, and the underwriting ratio of each insurer.

[0041] 2. The system automatically generates a unique co-insurance batch number for this transaction (e.g., CI202311200001), which will serve as a unique identifier throughout the entire process.

[0042] 3. The payment system accesses the co-insurance data through the data interface and synchronizes it to Caihui and Channel to complete the initial distribution of the data.

[0043] Step S2: Premium verification and settlement ready 1. After the lead insurer A confirms receipt of the RMB10 million premium paid by the policyholder through the financial system, it will execute the premium write-off operation.

[0044] 2. Settlement readiness mechanism triggered by write-off action: The system automatically calculates and releases the settlementable amount for each party based on the preset coverage ratios (A: 50%, B: 30%, C: 20%). The amount that the lead insurer A can settle is: 10 million yuan × 50% = 5 million yuan. Settlement amount for party B: 10 million yuan × 30% = 3 million yuan Settlement amount for party C: 10 million yuan × 20% = 2 million yuan 3. At this point, all business personnel can view the released settlement data in the system, and the status will change to "pending settlement".

[0045] Step S3: Settlement Mode Confirmation and Fee Processing 1. The business personnel of the lead insurer A select all settlementable records under this batch number on the settlement interface of Caihui.

[0046] 2. Select the "premium and commission netting settlement" mode according to the co-insurance agreement.

[0047] 3. The system automatically calls the channel interface to obtain the commission data of RMB 1.5 million (RMB 10 million × 15%) corresponding to the policy, and automatically splits it according to the underwriting ratio: The insurer, A, shall bear the handling fee: 1.5 million × 50% = 750,000 yuan. Party B, the party handling the transaction, shall bear the following handling fee: 1.5 million × 30% = 450,000 yuan. The transaction fee to be borne by party C is: 1.5 million × 20% = 300,000 yuan. 4. The system generates a complete settlement statement, clearly listing the premium settlement amount, the commission settlement amount, and the net amount after netting.

[0048] Step S4: Approval Process and Tax Treatment 1. Settlement forms enter the electronic approval process, and approval personnel at all levels complete the approval process online.

[0049] 2. After approval, confirm the settlement information online with parties B and C.

[0050] 3. The system automatically sends invoice data to the VAT invoice system, including necessary information such as invoice amount and taxpayer identification number.

[0051] 4. The VAT invoice system completes the issuance of electronic invoices and writes back key information such as invoice code, number, and invoice issuance time to the business system.

[0052] Step S5: Invoice verification and financial reconciliation 1. After receiving the written-back invoice information, Caihui automatically calls the verification interface of the invoice ledger system.

[0053] 2. The bottom ledger system verifies the authenticity and checks for duplicates of invoice information and returns the verification results.

[0054] 3. After verification, the system will automatically trigger the reconciliation process: Send instructions to the payment and collection department to complete the automatic transfer of premium funds; Send instructions to the channel to complete the reconciliation of transaction fee data.

[0055] Step S6: Tax Authentication and Reimbursement Processing 1. For input invoices that require authentication, the system automatically triggers the authentication process according to preset rules (such as the invoice amount exceeding a specific threshold).

[0056] 2. Automatically authenticate invoices upon receipt and payment, and generate corresponding financial vouchers.

[0057] 3. The system automatically completes the expense reimbursement process and updates the balance information of the relevant accounts.

[0058] 4. The entire co-insurance settlement process is now complete. The system will update the business status to "settled" and generate a complete audit trail.

[0059] Please refer to Figure 3 , Figure 3 A schematic diagram of the hardware structure of a computer for implementing the above-described methods and embodiments of this disclosure is shown. Figure 3 As shown, the computer device may include a processor, a computer-readable storage medium, a bus, and a communication unit.

[0060] In its implementation, the processor executes computer-executable instructions stored in the computer-readable storage medium, enabling it to execute the multi-screen collaborative control system and method described in the above method embodiments. The processor, computer-readable storage medium, and communication unit can be connected via a bus. The specific implementation process of the processor can be found in the various method embodiments executed by the aforementioned computer device, as their implementation principles and technical effects are similar, and will not be repeated here.

[0061] Computer-readable storage media can be, but is not limited to, random access memory (RAM), read-only memory (ROM), programmable read-only memory (PROM), erasable programmable read-only memory (EPROM), and electrically erasable programmable read-only memory (EEPROM). The memory is used to store programs or data.

[0062] The above description is merely a preferred embodiment of this application and is not intended to limit this application. Various modifications and variations can be made to this application by those skilled in the art. Any modifications, equivalent substitutions, improvements, etc., made within the spirit and principles of this application should be included within the protection scope of this application.

Claims

1. A co-insurance settlement system characterized by, Comprise: a data access module that receives co-insurance data from a core business system and generates a unique identifier to associate the data of the business in subsequent processes; an intelligent matching engine that automatically matches settlement rules according to co-insurance agreement terms; a settlement processing module that supports the automatic execution of multiple settlement modes; a tax integration module that completes tax-related operations; a risk management module that provides whole-process risk monitoring.

2. The system of claim 1, wherein, The intelligent matching engine comprises: a rule analysis unit for analyzing business rules of the co-insurance agreement; a pattern recognition unit for identifying business scenario characteristics; a matching algorithm unit that performs rule matching based on a preset algorithm.

3. The system of claim 2, wherein, The matching algorithm unit uses a multi-factor weighted algorithm, taking into account factors including insurance type, underwriting ratio, commission rate, and settlement period.

4. The system of claim 1, wherein, The settlement processing module supports at least the following settlement modes: Selecting separate billing and separate settlement, without calling the channel, only performing policy difference settlement; Each billing and main underwriting settlement, with invoice upload for verification after single confirmation to complete subsequent processes; Main underwriting full invoice conversion to billing, with main underwriting commission and single premium following the system automatic mode and automatically completing cancellation; Main underwriting settlement without billing, with only premium billing and cancellation-related processes completed.

5. The system of claim 1, wherein, The settlement mode also includes settlement commission, which can be selected for the policy after premium cancellation is completed.

6. The system of claim 1, wherein, The settlement processing module is further configured to be coupled with the financial system to automatically and proportionally calculate and release the settleable amount of each single insurance party after the main underwriting party completes premium cancellation, and to make the settleable data visible to the main underwriting party and the single party; the release of the settleable amount is quasi-real-time, and the data after release constitutes the basis for initiating settlement instructions.

7. The system of claim 1, wherein, The tax integration module is further configured to interface with the value-added tax invoice system and the invoice base account library system to automatically initiate billing requests, receive written invoice information, automatically perform invoice verification and duplicate checking, and automatically trigger financial cancellation processes after verification is passed; And realize the automation of the following functions: invoice issuance; invoice verification; duplicate checking; input authentication.

8. The system of claim 1, wherein, The risk management module provides real-time process monitoring, automatic abnormality warning, compliance checking, and audit log recording.

9. A method of co-insurance settlement based on the system of any one of claims 1-6, characterized by, Comprise steps: Data access step: receiving co-insurance data and generating a unique identifier to associate the data of the business in all subsequent processes; Intelligent matching step: automatically matching settlement rules; Settlement processing step: performing automated settlement; Tax processing step: completing tax-related operations; Risk monitoring step: whole-process monitoring of the settlement process.

10. An electronic device comprising a processor and a memory, said memory having stored thereon a computer program, characterized in that, The computer program, when executed by the processor, implements the co-insurance settlement method of claim 9.

Images