CN108257020A - A kind of computational methods and device of gold of settling a claim - Google Patents
A kind of computational methods and device of gold of settling a claim Download PDFInfo
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- CN108257020A CN108257020A CN201710223859.2A CN201710223859A CN108257020A CN 108257020 A CN108257020 A CN 108257020A CN 201710223859 A CN201710223859 A CN 201710223859A CN 108257020 A CN108257020 A CN 108257020A
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Abstract
The embodiment of the invention discloses a kind of computational methods for gold of settling a claim, for solving the problems, such as that the computational efficiency of existing Claims Resolution gold is low.Present invention method includes：Determine the target case of Claims Resolution gold to be calculated；Each bill of the target case is obtained by the background data base of insurance company；Each scene to be compensated of the target case is determined according to the bill information of the case information of the target case and each bill；According to the bill information of the policy information for accepting declaration form each under the target case and each bill according to preset adjustment rule calculate respectively it is each described in scene to be compensated the compensation amount of money；The sum of compensation amount of money of each scene to be compensated is calculated, obtains the Claims Resolution gold of the target case.The embodiment of the present invention also provides a kind of computing device for gold of settling a claim.
Description
Technical field
The present invention relates to financial services industry more particularly to a kind of computational methods and device of gold of settling a claim.
Background technology
In insurance industry, the links such as existing Claims Resolution case is needed by reporting a case to the security authorities, accepting, typing, audit operate, could be complete
Claims Resolution gold is compensated into complete flow of settling a claim, and to client is paid.In the process, it is related to the calculating of Claims Resolution gold.
The calculating of existing Claims Resolution gold is generally manually calculated by special staff, is not only easy to cause Claims Resolution gold
Computational efficiency is low, and in face of largely settle a claim case when, often result in a large amount of Claims Resolution cases and delay, substantially reduce Claims Resolution case
The efficiency of winding up the case of part.
Invention content
An embodiment of the present invention provides a kind of computational methods and device of gold of settling a claim, can improve the calculating effect of Claims Resolution gold
Rate, and cause being accurately calculated for Claims Resolution gold.
In a first aspect, a kind of computational methods for gold of settling a claim are provided, including：
Determine the target case of Claims Resolution gold to be calculated；
Each bill of the target case is obtained by the background data base of insurance company；
The target case is determined according to the bill information of the case information of the target case and each bill
Each scene to be compensated；
According to the bill information of the policy information for accepting declaration form each under the target case and each bill according to
Preset adjustment rule calculates the compensation amount of money of each scene to be compensated respectively；
The sum of compensation amount of money of each scene to be compensated is calculated, obtains the Claims Resolution gold of the target case.
Second aspect provides a kind of computing device for gold of settling a claim, including：
Case determining module, for determining the target case of Claims Resolution gold to be calculated；
Case bill acquisition module, for passing through each account that the background data base of insurance company obtains the target case
It is single；
Scene determining module is compensated, is believed for the bill of the case information according to the target case and each bill
Breath determines each scene to be compensated of the target case；
Amount of money computing module is compensated, for according to the policy information for accepting declaration form each under the target case and described each
The bill information of a bill calculates the compensation amount of money of each scene to be compensated according to preset adjustment rule respectively；
The golden computing module of case Claims Resolution for calculating the sum of compensation amount of money of each scene to be compensated, obtains described
The Claims Resolution gold of target case.
As can be seen from the above technical solutions, the embodiment of the present invention has the following advantages：
In the embodiment of the present invention, first, the target case of Claims Resolution gold to be calculated is determined；Then, after by insurance company
Platform database obtains each bill of the target case；Then, according to the case information of the target case and described each
The bill information of bill determines each scene to be compensated of the target case；In addition, according under the target case it is each by
It manages the policy information of declaration form and the bill information of each bill and calculates each described treat respectively according to preset adjustment rule
Compensate the compensation amount of money of scene；Finally, the sum of compensation amount of money of each scene to be compensated is calculated, obtains the target case
Claims Resolution gold.In embodiments of the present invention, each field to be compensated of target case is determined according to each bill of target case
Then scape using these scenes to be compensated as dimension is calculated the compensation amount of money of each scene to be compensated, finally calculates these respectively
It compensates the sum of amount of money and obtains the Claims Resolution gold of target case, the automation for not only realizing case Claims Resolution gold calculates, and substantially increases
The computational efficiency of Claims Resolution gold so as to improve the efficiency of winding up the case of Claims Resolution case, and is calculating of the dimension to Claims Resolution gold using scene
Process is become more meticulous so that gold of settling a claim is accurately calculated.
Description of the drawings
Fig. 1 is a kind of computational methods one embodiment flow chart for gold of settling a claim in the embodiment of the present invention；
Fig. 2 is flow of a kind of computational methods step 103 for gold of settling a claim under an application scenarios in the embodiment of the present invention
Schematic diagram；
Fig. 3 is flow of a kind of computational methods step 104 for gold of settling a claim under an application scenarios in the embodiment of the present invention
Schematic diagram；
Fig. 4 is flow of a kind of computational methods step 305 for gold of settling a claim under an application scenarios in Fig. 3 corresponding embodiments
Schematic diagram；
Fig. 5 is a kind of first example structure figure of computing device for gold of settling a claim in the embodiment of the present invention；
Fig. 6 is a kind of second example structure figure of computing device for gold of settling a claim in the embodiment of the present invention；
Fig. 7 is a kind of computing device third example structure figure for gold of settling a claim in the embodiment of the present invention.
Specific embodiment
An embodiment of the present invention provides a kind of computational methods and device of gold of settling a claim, for solving the calculating of existing Claims Resolution gold
The problem of inefficiency.
In order to make the invention's purpose, features and advantages of the invention more obvious and easy to understand, below in conjunction with the present invention
Attached drawing in embodiment is clearly and completely described the technical solution in the embodiment of the present invention, it is clear that disclosed below
Embodiment be only part of the embodiment of the present invention, and not all embodiment.Based on the embodiments of the present invention, this field
All other embodiment that those of ordinary skill is obtained without making creative work, belongs to protection of the present invention
Range.
Referring to Fig. 1, a kind of computational methods one embodiment for settling a claim gold includes in the embodiment of the present invention：
101st, the target case of Claims Resolution gold to be calculated is determined；
In the present embodiment, before the gold that settle a claim calculates, it is necessary first to determine the target case for needing to calculate Claims Resolution gold.
These target cases can be chosen from the case for having initiated Claims Resolution request.It is understood that it initiates to manage in claimant
When paying for request, generally require and carry out processing of reporting a case to the security authorities, i.e., by relevant case information, such as bill, claimant associated personal information,
The system that policy information etc. reports to insurance company generates corresponding Claims Resolution case after being accepted by insurance company's system.
102nd, each bill of the target case is obtained by the background data base of insurance company；
It is understood that after insurance company's system is accepted and generates related Claims Resolution case, the bill of these cases
It can be stored in the background data base of insurance company.For example, when claimant applies for medical treatment Claims Resolution, need medical bills, doctor
The upload materials such as expense invoices are treated to insurance company's system, these materials handle can be stored in back-end data by insurance company's system
In library.Therefore, each bill of the target case can be obtained by the background data base of insurance company.
103rd, the goal-trail is determined according to the bill information of the case information of the target case and each bill
Each scene to be compensated of part；
It should be noted that in the present embodiment, in order to accurately calculate the Claims Resolution of target case gold, due to the declaration form of case
In the Claims Resolution responsibility generally arranged be to be distinguished according to different scenes.For example, for same vehicle insurance declaration form, equally it is
By guarantor's vehicle damage, vehicle insurance declaration form undertakes under different scenes responsibility simultaneously differs.For example, if vehicle is in artificial field
It is damaged under scape, then this impaired event belongs to the Limitation on Liability of vehicle insurance declaration form；And if the vehicle is the scene under force majeure
It is damaged under (such as flood, typhoon), then this impaired event is not belonging to the Limitation on Liability of vehicle insurance declaration form.Therefore, Claims Resolution gold is being calculated
Before it needs to be determined that each scene to be compensated of the target case, is then segmenting according to different scenes and calculating respective
Compensate the amount of money.Wherein, scene to be compensated is and belongs to target case to correspond to scene in the Limitation on Liability of declaration form.
Further, as shown in Fig. 2, above-mentioned steps 103 can include：
201st, each bill is grouped according to default rule of classification, obtained each bill group respectively as
Each sub- case of the target case；
202nd, default first Attribute class of each sub- case is generated according to the case information and the bill information
The property value of type；
203rd, default second attribute type of each bill is generated according to the case information and the bill information
Property value；
204th, the attribute of the default core attribute of each all Claims Resolution responsibilities for accepting declaration form under the target case is extracted
Value；
205th, by the property value of default core attribute and the default core of the target case of all Claims Resolution responsibilities
The property value of attribute is matched, and obtains Claims Resolution responsibility of each Claims Resolution responsibility of successful match as the target case；
206th, by the bill under the property value of each Claims Resolution responsibility of the target case and each sub- case
Property value is matched, and obtains the corresponding Claims Resolution responsibility of each sub- case；
207th, predefined each scene under the corresponding responsibility of settling a claim of each sub- case is extracted respectively；
208th, by the property value of each scene of the sub- case according to preset Episode sequences successively with the sub- case
Property value matched, if successful match, the scene of successful match is determined as to the scene to be compensated of the sub- case；
209th, the scene to be compensated of each sub- case determined is determined as each of the target case to wait to pay for
Pay scene.
For step 201, in general, a target case has multiple bills mostly, these bills may have not
Therefore same statement date, type, consumption area etc., can set rule of classification to these bills according to these bill attributes
Sorted out, be grouped, so as to which multiple bills are divided into more than one bill group.For example, for medical treatment Claims Resolution case, it is corresponding
Bill for medical bills, will can on the same day go to a doctor, same visit type, same disease type and same hospital's conduct
Same bill group.Each bill group is a sub- case of target case.In subsequent steps with sub- case
As calculating dimension.
For step 202, first attribute type can be set, such as can include according to different sub- cases
Nature of occurence, refinement administer type, go out strategical vantage point etc., and the property value of these the first attribute types can pass through the case of target case
Information and bill information obtain or generation obtains.
For step 203, second attribute type can be set according to different bill types, such as can be wrapped
It includes expense item, consume the date, organization of entering an item of expenditure in the accounts etc., the property value of these the second attribute types can pass through target case
Case information and bill information obtain or generation obtains.
For step 204, the core attribute is the underlying attribute for the Claims Resolution responsibility for accepting declaration form, these core attributes can
According to different insurance companies set.The declaration form that accepts refers to that the target case corresponds to effective guarantor in declaration form
It is single.It is understood that the corresponding warrantee of target case, which may correspond to purchase, has multiple declaration forms, but have in view of different declaration forms
There are the different term of validity and other agreements, therefore, may some declaration form be only in these declaration forms of warrantee's purchase
Valid Policy.
After each under determining target case accepts declaration form, it may be determined that these accept the Claims Resolution arranged in declaration form
Then responsibility extracts the property value of the core attribute of all these Claims Resolution responsibilities.For example, in medical declaration form, these core categories
Property can include nature of occurence, refinement treatment type, expense item etc..After extraction, nature of occurence can be obtained to be unexpected, refinement
Type is treated as outpatient service and is hospitalized, expense item is including payment for medical care, diagnosis and treatment expense, bed takes, drug takes.
It should be noted that not limiting priority between above-mentioned steps 202,203 and 204 performs sequence.
For step 205, the default core category of each all Claims Resolution responsibilities for accepting declaration form in the case where obtaining target case
The property value of property and after obtaining the property value of default core attribute of the target case, can be by the attribute of the two
Value is matched, and the Claims Resolution responsibility of successful match is the Claims Resolution responsibility of target case.Wherein, the default core category of target case
Property property value can be obtained according to the case acquisition of information of target case or generation.
It is understood that when the property value for responsibility of settling a claim and the property value successful match of target case, show the reason
It is to meet requirement or the situation of target case from the aspect of core attribute, therefore can be by the Claims Resolution of successful match to pay for responsibility
Responsibility is determined as the Claims Resolution responsibility of target case.If for example, unexpected malpractice insurance, nature of occurence is unexpected, refinement treatment class
Type is outpatient service and is hospitalized, and expense item includes payment for medical care, diagnosis and treatment expense, and bed takes, and drug takes.When the accident of a certain target case
Property, the treatment type of case bill, the property value all same of expense item and unexpected malpractice insurance, it may be considered that the target
Case has matched unexpected malpractice insurance.
It, can be according to each Claims Resolution responsibility after each Claims Resolution responsibility of target case is determined for step 206
The property value of bill is matched under property value and above-mentioned each sub- case, and each Claims Resolution responsibility of the target case is subdivided into
The corresponding Claims Resolution responsibility of each sub- case.
For step 207, after the corresponding responsibility of settling a claim of each sub- case is obtained, each son can be extracted respectively
Predefined each scene under the corresponding Claims Resolution responsibility of case.It is understood that in the present embodiment, under each Claims Resolution responsibility
The scene that should be settled a claim is made an appointment, is defined and records.For example, for medical treatment Claims Resolution responsibility, which can make an appointment
A little scenes belong to the Claims Resolution range of medical treatment Claims Resolution responsibility, which scene is then not belonging to the Claims Resolution range of medical treatment Claims Resolution responsibility.
For step 208, it is to be understood that predefined each in the case where obtaining the corresponding responsibility of settling a claim of a sub- case
After scene, do not represent these predefined each scenes and be just suitable for the sub- case.Therefore, a sub- case is come
Say, need to match the property value of the sub- case with the property value of these scenes, if successful match, can will matching into
The scene of work(is determined as the scene to be compensated of the sub- case namely applicable scene.
For step 208, further, in order to improve scene matching success rate, by each field of the sub- case
When the property value of scape is matched according to preset Episode sequences with the property value of the sub- case successively, if the sub- case
The non-successful match of each scene, then can by the Episode sequences the last one scene be determined as the sub- case
Scene to be compensated.So as to improve the matching efficiency of scene, the determining efficiency of the scene to be compensated of target case is also improved indirectly.
For step 209, the scene to be compensated of each sub- case, a sub- case can be determined respectively by step 208
Part can determine more than one scene to be compensated, all these after the scene to be compensated for determining each sub- case
The scene to be compensated of sub- case can be determined as each scene to be compensated of the target case.
104th, according to the bill information of the policy information for accepting declaration form each under the target case and each bill
Calculate the compensation amount of money of each scene to be compensated respectively according to preset adjustment rule；
It, can be according to the target case after each scene to be compensated of target case is determined in the present embodiment
Under the bill information of each policy information for accepting declaration form and each bill calculated respectively respectively according to preset adjustment rule
The compensation amount of money of a scene to be compensated.It is understood that the mistake of the compensation amount of money in each scene to be compensated of the calculating
Cheng Zhong is calculated using scene as smallest dimension, that is, calculates the compensation amount of money of each scene to be compensated.
Further, as shown in figure 3, above-mentioned steps 104 can include：
301st, it is insured amount to obtain each residue for accepting declaration form under the scene to be compensated；
302nd, expense should be compensated under the scene to be compensated by calculating each bill；
303rd, the compensation expense quota whether expense is more than the scene to be compensated should be compensated described in judging, if so, holding
Row step 304, if it is not, then performing step 305；
304th, the value that should compensate expense is updated to the value for compensating expense quota；
305th, expense, each remaining deductible excess for accepting declaration form under the scene to be compensated should be compensated according to
And each amount for which loss settled for accepting declaration form under the scene to be compensated is calculated in corresponding compensation ratio；
306th, take the amount for which loss settled with it is described it is remaining insured amount in smaller value compensation of scene to be compensated described in asing it is golden
Volume.
For step 301, the maximum under residue protection amount namely the scene to be compensated of the declaration form under scene to be compensated is accepted
The amount of money can be compensated.The residue protection amount can include three parts：The residue of declaration form is insured amount, responsibility residue is insured amount, scene residue
Protection amount is minimized the protection amount of more than three parts, obtains these and accepts residue protection amount of the declaration form under the scene to be compensated.
For step 302, according to the bill information of each bill, these bills can be calculated under the scene to be compensated
Expense should be compensated.Specifically, this should compensate the amount of money of expense=billing amount-unreasonable medical expense-at one's own expense-medical insurance payment gold
Volume.
For step 303, the compensation expense quota of the scene to be compensated refers to that the maximum under the scene to be compensated can be paid for
The amount of money paid.It is understood that when this should compensate expense and be more than this wait the compensation expense quota for compensating scene, it should perform
Step 304, which is adjusted to the compensation expense quota of the scene to be compensated.
For step 305, which refers to these amounts for accepting abatement of the declaration form under the scene to be compensated,
The amount of specific abatement is arranged in advance by the insurer and insurant, and loss is within quota, and insurant is certainly
Row bears a loss, the amount of the not responsible reparation of the insurer.If there is no the amount of abatement under the scene to be compensated, it may be considered that should
Remaining deductible excess is 0.
Specifically, as shown in figure 4, above-mentioned steps 305 can specifically include：
401st, each remaining deductible excess for accepting declaration form under the scene to be compensated is obtained；
402nd, the difference of expense and the remaining deductible excess should be compensated described in calculating, obtains reasonable compensation expense；
403rd, the expense section fallen into according to the reasonable compensation expense determines that each declaration form that accepts is waited to pay for described
It pays and compensates ratio under scene, there are correspondences for the expense section and the compensation ratio；
404th, each declaration form that accepts is calculated described according to the compensation ratio and the reasonable compensation expense
Amount for which loss settled under scene to be compensated.
For above-mentioned steps 401 and 402, it is contemplated that the remaining deductible excess under the scene to be compensated is calculating amount for which loss settled
It before, should be from this some residual deductible excess should be subtracted in compensation expense, so as to obtain reasonable compensation expense.
For step 403, in the present embodiment, different compensation ratios is provided with to different expense sections in advance.For example,
In scenario A, there are two expense section possibility：When 0<Rationally compensate expense<When 999, ratio of compensating is 0.9；It is compensated when reasonable
Expense>=1000, ratio of compensating is then 0.8.
For step 404, after reasonable compensation expense is calculated and determines corresponding compensation ratio, Ke Yigen
The amount for which loss settled under the scene to be compensated is calculated according to the reasonable compensation expense and corresponding compensation ratio.Specifically, this is treated
It compensates the amount for which loss settled under scene=reasonable expense * that compensates and compensates ratio.It waits to compensate at this so as to calculate each declaration form that accepts
Amount for which loss settled under scene.
For above-mentioned steps 306, since the residue that step 301 is got under the scene to be compensated is insured amount, and amount for which loss settled
It is insured amount that the residue cannot be more than, therefore, can take and be treated described in the amount for which loss settled and the smaller value conduct in the remaining protection amount
Compensate the compensation amount of money of scene.
105th, the sum of compensation amount of money of each scene to be compensated is calculated, obtains the Claims Resolution gold of the target case.
By above-mentioned steps 104, the compensation amount of money of each scene to be compensated can be calculated, and since the target case can
Can be there are one or more scene to be compensated, therefore, the Claims Resolution gold of the target case is corresponding equal to its to be needed to be compensated scene
The sum of the compensation amount of money.For example, it is assumed that there are three scene to be compensated, respectively scenario A, scenario B and scene C, fields for target case
The compensation amount of money of scape A is A1, and the compensation amount of money of scenario B is B1, and the compensation amount of money of scene C is the Claims Resolution of C1, then the target case
Gold=A1+B1+C1.
In the present embodiment, first, the target case of Claims Resolution gold to be calculated is determined；Then, pass through the rear number of units of insurance company
Each bill of the target case is obtained according to library；Then, according to the case information of the target case and each bill
Bill information determine each scene to be compensated of the target case；In addition, guarantor is accepted according to each under the target case
Single policy information and the bill information of each bill according to preset adjustment rule calculate and each described wait to compensate respectively
The compensation amount of money of scene；Finally, the sum of compensation amount of money of each scene to be compensated is calculated, obtains the reason of the target case
Pay for gold.In the present embodiment, each scene to be compensated of target case is determined according to each bill of target case, then with
These scenes to be compensated calculate the compensation amount of money of each scene to be compensated as dimension respectively, finally calculate these compensate amount of money it
With obtain target case Claims Resolution gold, not only realize case Claims Resolution gold automation calculate, substantially increase Claims Resolution gold meter
Efficiency is calculated, so as to improve the efficiency of winding up the case of Claims Resolution case, and the calculating process of Claims Resolution gold is carried out using scene as dimension
It becomes more meticulous so that gold of settling a claim is accurately calculated.
A kind of computational methods for gold of settling a claim are essentially described above, a kind of computing device for gold of settling a claim will be carried out below detailed
Thin description.
Fig. 5 shows a kind of first example structure figure of computing device for gold of settling a claim in the embodiment of the present invention.
As shown in figure 5, in the present embodiment, a kind of computing device for settling a claim gold includes：
Case determining module 501, for determining the target case of Claims Resolution gold to be calculated；
Case bill acquisition module 502 obtains each of the target case for passing through the background data base of insurance company
A bill；
Scene determining module 503 is compensated, for the case information according to the target case and the account of each bill
Single information determines each scene to be compensated of the target case；
Amount of money computing module 504 is compensated, for according to the policy information for accepting declaration form each under the target case and institute
The bill information for stating each bill calculates the compensation amount of money of each scene to be compensated according to preset adjustment rule respectively；
The golden computing module 505 of case Claims Resolution for calculating the sum of compensation amount of money of each scene to be compensated, obtains institute
State the Claims Resolution gold of target case.
Fig. 6 shows a kind of second example structure figure of computing device for gold of settling a claim in the embodiment of the present invention.
As shown in fig. 6, further, the compensation scene determining module 503 can include：
Bill grouped element 5031, for being grouped according to default rule of classification to each bill, what is obtained is each
A bill group is respectively as each sub- case of the target case；
First property value generation unit 5032, for according to the case information and bill information generation are each
The property value of default first attribute type of sub- case；
Second attribute value generation unit 5033, for according to the case information and bill information generation are each
The property value of default second attribute type of bill；
Core attribute values extraction unit 5034, for extracting each all Claims Resolutions duty for accepting declaration form under the target case
The property value for the default core attribute appointed；
Case responsibility matching unit 5035, for by it is described it is all Claims Resolution responsibilities default core attribute property value and institute
The property value for stating the default core attribute of target case is matched, and obtains each Claims Resolution responsibility of successful match as the mesh
Mark the Claims Resolution responsibility of case；
Sub- case responsibility matching unit 5036, for by the property value of each Claims Resolution responsibility of the target case with it is each
The property value of the bill is matched under the sub- case, obtains the corresponding Claims Resolution responsibility of each sub- case；
Scene extraction unit 5037, it is predefined each under the corresponding responsibility of settling a claim of each sub- case for extracting respectively
A scene；
Sub- case scene matching unit 5038, for by the property value of each scene of the sub- case according to preset field
Property value of the scape sequence successively with the sub- case is matched, if successful match, the scene of successful match is determined as institute
State the scene to be compensated of sub- case；
Scene determination unit 5039 to be compensated, for the scene to be compensated of each sub- case determined to be determined as
Each scene to be compensated of the target case.
Further, the computing device of the Claims Resolution gold can also include：
Scene matching module 506, in the sub- case scene matching unit 5038 by each field of the sub- case
When the property value of scape is matched according to preset Episode sequences with the property value of the sub- case successively, if the sub- case
Each scene non-successful match, then by the Episode sequences the last one scene be determined as the sub- case and wait to pay for
Pay scene.
Fig. 7 shows a kind of computing device third example structure figure for gold of settling a claim in the embodiment of the present invention.
As shown in fig. 7, further, the compensation amount of money computing module 504 can include：
Remaining protection amount acquiring unit 5041, for obtaining each residue for accepting declaration form under the scene to be compensated
It is insured amount；
Expense unit 5042 should be compensated, expense should be compensated under the scene to be compensated for calculating each bill
With；
Cost value updating unit 5043, if for the compensation expense limit that should be compensated expense and be more than the scene to be compensated
The value that expense should be compensated then is updated to the value for compensating expense quota by volume；
Amount for which loss settled computing unit 5044, for that should compensate expense according to, each declaration form that accepts is treated described
The remaining deductible excess and corresponding compensation ratio compensated under scene are calculated each declaration form that accepts and wait to compensate described
Amount for which loss settled under scene；
Amount of money value unit 5045 is compensated, for taking the amount for which loss settled with the smaller value in the remaining protection amount as institute
State the compensation amount of money of scene to be compensated.
Further, the amount for which loss settled computing unit 5044 can include：
Deductible excess obtains subelement 441, for obtaining each residue for accepting declaration form under the scene to be compensated
Deductible excess；
Reasonable expense computation subunit 442 for calculating the difference that should compensate expense and the remaining deductible excess, obtains
Rationally compensate expense；
Compensation ratio determination subelement 443, described in the expense section for being fallen into according to the reasonable compensation expense determines
Each declaration form that accepts compensates ratio under the scene to be compensated, and the expense section and the compensation ratio have corresponding close
System；
Amount of money computation subunit 444, described in being calculated according to the compensation ratio and the reasonable compensation expense
Each amount for which loss settled for accepting declaration form under the scene to be compensated.
It is apparent to those skilled in the art that for convenience and simplicity of description, the system of foregoing description,
The specific work process of device and unit can refer to the corresponding process in preceding method embodiment, and details are not described herein.
In several embodiments provided herein, it should be understood that disclosed system, device and method can be with
It realizes by another way.For example, the apparatus embodiments described above are merely exemplary, for example, the unit
It divides, only a kind of division of logic function can have other dividing mode, such as multiple units or component in actual implementation
It may be combined or can be integrated into another system or some features can be ignored or does not perform.Another point, it is shown or
The mutual coupling, direct-coupling or communication connection discussed can be the indirect coupling by some interfaces, device or unit
It closes or communicates to connect, can be electrical, machinery or other forms.
The unit illustrated as separating component may or may not be physically separate, be shown as unit
The component shown may or may not be physical unit, you can be located at a place or can also be distributed to multiple
In network element.Some or all of unit therein can be selected according to the actual needs to realize the mesh of this embodiment scheme
's.
In addition, each functional unit in each embodiment of the present invention can be integrated in a processing unit, it can also
That each unit is individually physically present, can also two or more units integrate in a unit.Above-mentioned integrated list
The form that hardware had both may be used in member is realized, can also be realized in the form of SFU software functional unit.
If the integrated unit is realized in the form of SFU software functional unit and is independent product sale or uses
When, it can be stored in a computer read/write memory medium.Based on such understanding, technical scheme of the present invention is substantially
The part to contribute in other words to the prior art or all or part of the technical solution can be in the form of software products
It embodies, which is stored in a storage medium, is used including some instructions so that a computer
Equipment (can be personal computer, server or the network equipment etc.) performs the complete of each embodiment the method for the present invention
Portion or part steps.And aforementioned storage medium includes：USB flash disk, mobile hard disk, read-only memory (ROM, Read-Only
Memory), random access memory (RAM, Random Access Memory), magnetic disc or CD etc. are various can store journey
The medium of sequence code.
The above, the above embodiments are merely illustrative of the technical solutions of the present invention, rather than its limitations；Although with reference to before
Embodiment is stated the present invention is described in detail, it will be understood by those of ordinary skill in the art that：It still can be to preceding
The technical solution recorded in each embodiment is stated to modify or carry out equivalent replacement to which part technical characteristic；And these
Modification is replaced, the spirit and scope for various embodiments of the present invention technical solution that it does not separate the essence of the corresponding technical solution.
Claims (10)
1. a kind of computational methods for gold of settling a claim, which is characterized in that including：
Determine the target case of Claims Resolution gold to be calculated；
Each bill of the target case is obtained by the background data base of insurance company；
The each of the target case is determined according to the bill information of the case information of the target case and each bill
Scene to be compensated；
According to the bill information of the policy information for accepting declaration form each under the target case and each bill according to default
Adjustment rule calculate the compensation amount of money of each scene to be compensated respectively；
The sum of compensation amount of money of each scene to be compensated is calculated, obtains the Claims Resolution gold of the target case.
2. the computational methods of Claims Resolution gold according to claim 1, which is characterized in that the case according to the target case
The bill information of part information and each bill determines that each scene to be compensated of the target case includes：
Each bill is grouped according to default rule of classification, obtained each bill group is respectively as the target
Each sub- case of case；
The attribute of default first attribute type of each sub- case is generated according to the case information and the bill information
Value；
The property value of default second attribute type of each bill is generated according to the case information and the bill information；
Extract the property value of the default core attribute of each all Claims Resolution responsibilities for accepting declaration form under the target case；
By the property value of default core attribute and the category of the default core attribute of the target case of all Claims Resolution responsibilities
Property value is matched, and obtains Claims Resolution responsibility of each Claims Resolution responsibility of successful match as the target case；
By the property value of the bill under the property value of each Claims Resolution responsibility of the target case and each sub- case into
Row matching obtains the corresponding Claims Resolution responsibility of each sub- case；
Predefined each scene under the corresponding responsibility of settling a claim of each sub- case is extracted respectively；
By the property value of each scene of the sub- case according to the preset Episode sequences successively property value with the sub- case
It is matched, if successful match, the scene of successful match is determined as to the scene to be compensated of the sub- case；
The scene to be compensated of each sub- case determined is determined as to each scene to be compensated of the target case.
3. the computational methods of Claims Resolution gold according to claim 2, which is characterized in that by each scene of the sub- case
Property value when being matched successively with the property value of the sub- case according to preset Episode sequences, if the sub- case is each
A scene non-successful match, then by the Episode sequences the last one scene be determined as the sub- case and wait to compensate
Scene.
4. the computational methods of Claims Resolution gold according to any one of claim 1 to 3, which is characterized in that described in the basis
The bill information of each policy information for accepting declaration form and each bill is according to preset adjustment rule point under target case
The compensation amount of money for not calculating each scene to be compensated includes：
It is insured amount to obtain each residue for accepting declaration form under the scene to be compensated；
Expense should be compensated under the scene to be compensated by calculating each bill；
If the compensation expense quota that expense should be compensated and be more than the scene to be compensated, by the value that should compensate expense more
It is newly the value for compensating expense quota；
Expense, each remaining deductible excess and correspondence for accepting declaration form under the scene to be compensated should be compensated according to described
Compensation ratio each amount for which loss settled for accepting declaration form under the scene to be compensated is calculated；
Take the amount for which loss settled with it is described it is remaining insured amount in smaller value scene to be compensated as described in the compensation amount of money.
5. it is according to claim 4 Claims Resolution gold computational methods, which is characterized in that should be compensated described in the basis expense,
Each remaining deductible excess for accepting declaration form under the scene to be compensated and corresponding compensation ratio are calculated described
Each amount for which loss settled for accepting declaration form under the scene to be compensated includes：
Obtain each remaining deductible excess for accepting declaration form under the scene to be compensated；
The difference of expense and the remaining deductible excess should be compensated described in calculating, obtains reasonable compensation expense；
The expense section fallen into according to the reasonable compensation expense determines each declaration form that accepts under the scene to be compensated
There are correspondences for compensation ratio, the expense section and the compensation ratio；
Each declaration form that accepts is calculated in the field to be compensated according to the compensation ratio and the reasonable compensation expense
Amount for which loss settled under scape.
6. a kind of computing device for gold of settling a claim, which is characterized in that including：
Case determining module, for determining the target case of Claims Resolution gold to be calculated；
Case bill acquisition module, for passing through each bill that the background data base of insurance company obtains the target case；
Scene determining module is compensated, the bill information for the case information according to the target case and each bill is true
Each scene to be compensated of the fixed target case；
Amount of money computing module is compensated, for according to the policy information for accepting declaration form each under the target case and each account
Single bill information calculates the compensation amount of money of each scene to be compensated according to preset adjustment rule respectively；
The golden computing module of case Claims Resolution for calculating the sum of compensation amount of money of each scene to be compensated, obtains the target
The Claims Resolution gold of case.
7. the computing device of Claims Resolution gold according to claim 6, which is characterized in that the compensation scene determining module packet
It includes：
Bill grouped element, for being grouped according to default rule of classification to each bill, obtained each bill is small
Group is respectively as each sub- case of the target case；
First property value generation unit, for generating each sub- case according to the case information and the bill information
The property value of default first attribute type；
Second attribute value generation unit, for generating the pre- of each bill according to the case information and the bill information
If the property value of the second attribute type；
Core attribute values extraction unit, for extracting the default of each all Claims Resolution responsibilities for accepting declaration form under the target case
The property value of core attribute；
Case responsibility matching unit, for by property value and the goal-trail of the default core attribute of all Claims Resolution responsibilities
The property value of the default core attribute of part is matched, and obtains each Claims Resolution responsibility of successful match as the target case
Claims Resolution responsibility；
Sub- case responsibility matching unit, for by the property value of each Claims Resolution responsibility of the target case and each sub- case
The property value of the bill is matched under part, obtains the corresponding Claims Resolution responsibility of each sub- case；
Scene extraction unit, for extracting predefined each scene under the corresponding responsibility of settling a claim of each sub- case respectively；
Sub- case scene matching unit, for by the property value of each scene of the sub- case according to preset Episode sequences according to
The secondary property value with the sub- case is matched, if successful match, the scene of successful match is determined as the sub- case
Scene to be compensated；
Scene determination unit to be compensated, for the scene to be compensated of each sub- case determined to be determined as the target
Each scene to be compensated of case.
8. the computing device of Claims Resolution gold according to claim 7, which is characterized in that the computing device of the Claims Resolution gold also wraps
It includes：
Scene matching module, for pressing the property value of each scene of the sub- case in the sub- case scene matching unit
When being matched successively with the property value of the sub- case according to preset Episode sequences, if each scene of the sub- case is not
Successful match, then by the Episode sequences the last one scene be determined as the scene to be compensated of the sub- case.
9. the computing device of the Claims Resolution gold according to any one of claim 6 to 8, which is characterized in that the compensation amount of money
Computing module includes：
Remaining protection amount acquiring unit, it is insured amount for obtaining each residue for accepting declaration form under the scene to be compensated；
Expense unit should be compensated, expense should be compensated under the scene to be compensated for calculating each bill；
Cost value updating unit, if for the compensation expense quota that should be compensated expense and be more than the scene to be compensated, it will
The value that expense should be compensated is updated to the value for compensating expense quota；
Amount for which loss settled computing unit, for expense, each declaration form that accepts should to be compensated in the scene to be compensated according to
Under remaining deductible excess and corresponding compensation ratio each declaration form that accepts is calculated under the scene to be compensated
Amount for which loss settled；
Amount of money value unit is compensated, waits to compensate described in the smaller value conduct in the amount for which loss settled and the remaining protection amount for taking
The compensation amount of money of scene.
10. the computing device of Claims Resolution gold according to claim 9, which is characterized in that the amount for which loss settled computing unit packet
It includes：
Deductible excess obtains subelement, for obtaining each remaining deductible excess for accepting declaration form under the scene to be compensated；
Reasonable expense computation subunit for calculating the difference that should compensate expense and the remaining deductible excess, is rationally paid for
Payment is used；
Compensation ratio determination subelement, the expense section for being fallen into according to the reasonable compensation expense determine described each accept
Declaration form compensates ratio under the scene to be compensated, and there are correspondences for the expense section and the compensation ratio；
Amount of money computation subunit, for described each accept to be calculated according to the compensation ratio and the reasonable compensation expense
Amount for which loss settled of the declaration form under the scene to be compensated.
Priority Applications (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201710223859.2A CN108257020A (en) | 2017-04-07 | 2017-04-07 | A kind of computational methods and device of gold of settling a claim |
| PCT/CN2018/081824 WO2018184550A1 (en) | 2017-04-07 | 2018-04-04 | Compensation calculation method, device, terminal device and medium |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201710223859.2A CN108257020A (en) | 2017-04-07 | 2017-04-07 | A kind of computational methods and device of gold of settling a claim |
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| CN108257020A true CN108257020A (en) | 2018-07-06 |
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| CN201710223859.2A Pending CN108257020A (en) | 2017-04-07 | 2017-04-07 | A kind of computational methods and device of gold of settling a claim |
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| Country | Link |
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| CN (1) | CN108257020A (en) |
| WO (1) | WO2018184550A1 (en) |
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| CN109523409A (en) * | 2018-11-09 | 2019-03-26 | 泰康保险集团股份有限公司 | Data processing method, device, medium and electronic equipment |
| CN110489705A (en) * | 2019-07-23 | 2019-11-22 | 深圳木成林科技有限公司 | Manage cost calculating method, device, terminal device and storage medium |
| CN111652581A (en) * | 2020-05-29 | 2020-09-11 | 泰康保险集团股份有限公司 | Method and device for processing arithmetic data, storage medium and electronic equipment |
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| WO2018184550A1 (en) | 2018-10-11 |
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Application publication date: 20180706 |