CN109727145B - Method, device, storage medium and apparatus for judging warranty claim - Google Patents
Method, device, storage medium and apparatus for judging warranty claim Download PDFInfo
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Abstract
The invention discloses a policy claim settlement judging method, equipment, a storage medium and a device, wherein the method comprises the following steps: acquiring a to-be-processed policy set, traversing the to-be-processed policy set, and taking the traversed to-be-processed policy as a target policy; extracting a target insurance type and target claim settlement content from a target policy, and matching the target insurance type with each insurance type in a preset main configuration table; when the matching is successful, searching a target claim rule set corresponding to the target insurance type from a preset auxiliary configuration table; and judging whether the target claim settlement content meets the target claim settlement rule set, and if so, determining that the target policy meets the claim settlement condition. In the invention, whether the target claim settlement content meets the target claim settlement rule set searched from the preset auxiliary configuration table is judged, so that whether the target policy meets the claim settlement conditions is determined, and a set of logic is dynamically used for condition judgment, so that hard coding is reduced, the program maintenance difficulty is reduced, and the judgment efficiency is improved.
Description
Technical Field
The present invention relates to the technical field of insurance claims, and in particular, to a policy claim judgment method, device, storage medium and apparatus.
Background
The odds are proportional relations between odds and premium incomes in a certain accounting period (the accounting period is fixed, namely, the accounting period is one accounting year according to natural years, and the accounting period is 12 natural months, the insurance company can define according to own needs), when the odds are counted, whether the odds corresponding to each insurance meet the rules of claim or not needs to be judged, when the rules of claim are met, the calculation of the odds needs to be carried out, and then the calculation of the odds is further carried out, however, the rules of claim corresponding to various insurance types are different, and in the certain accounting period, the policy of claim is valid, the policy of claim needs to be calculated, the policy of claim is invalid, the odds do not meet the conditions of claim, the claim calculation is not required, in the prior art, a large number of hard codes appear when the conditions are judged, the program maintenance difficulty is large, when the judging conditions of a certain kind of insurance are updated, the program needs to be modified greatly, the difficulty is long, the efficiency is low, and therefore the technical problem of how to be solved is to judge the policy.
The foregoing is provided merely for the purpose of facilitating understanding of the technical solutions of the present invention and is not intended to represent an admission that the foregoing is prior art.
Disclosure of Invention
The invention mainly aims to provide a method, equipment, storage medium and device for judging insurance policy claims, and aims to solve the technical problem of low insurance policy claim judging efficiency in the prior art.
In order to achieve the above object, the present invention provides a policy claims judging method, which includes the following steps:
acquiring a to-be-processed policy set, traversing the to-be-processed policy set, and taking the traversed to-be-processed policy as a target policy;
extracting a target insurance type and target claim settlement content from the target insurance policy, and matching the target insurance type with each insurance type in a preset main configuration table;
searching a target claim rule set corresponding to the target insurance type from a preset auxiliary configuration table when the matching is successful;
and judging whether the target claim settlement content meets the target claim settlement rule set, and if so, judging that the target policy meets the claim settlement condition.
Preferably, the determining whether the target claim content meets the target claim rule set, and if yes, determining that the target policy meets the claim condition includes:
Traversing each item of target claim rule in the target claim rule set, and taking the traversed target claim rule as the current claim rule;
judging whether the target claim settlement content meets the current claim settlement rule;
and if the target claim settlement rules meet the traversed current claim settlement rules, the target policy is determined to meet the claim settlement conditions.
Preferably, after the determining whether the target claim content meets the current claim rule, the policy claim determining method further includes:
and if the target claim settlement content does not meet the current claim settlement rule, stopping traversing the target claim settlement rule set, and recognizing that the target policy does not meet the claim settlement condition.
Preferably, the acquiring a to-be-processed policy set, traversing the to-be-processed policy set, and before taking the traversed to-be-processed policy as the target policy, the policy claim settlement judging method further includes:
obtaining an effective historical policy in a preset time from a database, and performing duplication removal processing on the effective historical policy to obtain a duplication removal policy;
analyzing the duplicate removal policy through a preset analysis model to obtain the insurance type and the corresponding claim settlement content of the duplicate removal policy;
Splitting the claim content into a plurality of claim rules, wherein the plurality of claim rules form a claim rule set;
and generating the preset main configuration table and the preset auxiliary configuration table according to the insurance type and the claim rule set.
Preferably, the extracting the target insurance type and the target claim content from the target policy, and matching the target insurance type with each insurance type in a preset main configuration table includes:
analyzing the target policy through the preset analysis model to obtain the target insurance type and the corresponding target claim settlement content of the target policy;
and matching the target insurance type with each insurance type in a preset main configuration table.
Preferably, after the target insurance type is matched with each insurance type in the preset main configuration table, the policy claim settlement method further includes:
and when the matching fails, sending out configuration table updating prompt information.
Preferably, when the matching fails, after sending out the update prompt information of the configuration table, the policy claim settlement judging method includes:
and acquiring an updated insurance type and a corresponding updated claim rule set, and updating the preset main configuration table and the preset auxiliary configuration table according to the updated insurance type and the corresponding updated claim rule set.
In addition, in order to achieve the above object, the present invention also proposes a policy claim judging device including a memory, a processor, and a policy claim judging program stored on the memory and executable on the processor, the policy claim judging program being configured to implement the steps of the policy claim judging method as described above.
In addition, in order to achieve the above object, the present invention also proposes a storage medium having stored thereon a policy claim judgment program which, when executed by a processor, implements the steps of the policy claim judgment method as described above.
In addition, in order to achieve the above object, the present invention also provides a policy and claim judgment device, which includes: the device comprises a traversing module, a matching module, a searching module and a judging module;
the traversing module is used for acquiring a to-be-processed policy set, traversing the to-be-processed policy set and taking the traversed to-be-processed policy as a target policy;
the matching module is used for extracting a target insurance type and target claim settlement content from the target policy and matching the target insurance type with each insurance type in a preset main configuration table;
The searching module is used for searching a target claim rule set corresponding to the target insurance type from a preset auxiliary configuration table when the matching is successful;
and the judging module is used for judging whether the target claim settlement content meets the target claim settlement rule set, and if so, the target policy is determined to meet the claim settlement condition.
According to the invention, by matching the target insurance types corresponding to the target insurance policy with the insurance types in the preset main configuration table, whether the target claim settlement content corresponding to the target insurance policy meets the target claim settlement rule set searched from the preset auxiliary configuration table is judged, so that whether the target insurance policy meets the claim settlement conditions is determined, whether the corresponding claim settlement algorithm is called to calculate the claim of the target insurance policy is further determined, the preset auxiliary configuration table stores the target claim settlement rule sets corresponding to the various insurance types, and a set of logic can be dynamically used for carrying out condition judgment, namely the target claim settlement content is judged through the corresponding target claim settlement rule sets in the preset configuration table, so that hard coding is reduced, and when the claim settlement rules of the insurance types change, only the preset auxiliary configuration table is required to be updated and maintained, so that the program maintenance difficulty is reduced, and the efficiency of judging the insurance policy claim settlement is improved.
Drawings
FIG. 1 is a schematic diagram of a policy and claim judging device in a hardware running environment according to an embodiment of the present invention;
FIG. 2 is a flowchart illustrating a method for determining a policy claim according to a first embodiment of the present invention;
FIG. 3 is a flowchart illustrating a policy claim determining method according to a second embodiment of the present invention;
FIG. 4 is a flowchart illustrating a third embodiment of a policy claim determining method according to the present invention;
fig. 5 is a block diagram of a first embodiment of a policy claim determining device according to the present invention.
The achievement of the objects, functional features and advantages of the present invention will be further described with reference to the accompanying drawings, in conjunction with the embodiments.
Detailed Description
It should be understood that the specific embodiments described herein are for purposes of illustration only and are not intended to limit the scope of the invention.
Referring to fig. 1, fig. 1 is a schematic structural diagram of a policy and claim judgment device in a hardware running environment according to an embodiment of the present invention.
As shown in fig. 1, the policy claims judging device may include: a processor 1001, such as a central processing unit (Central Processing Unit, CPU), a communication bus 1002, a user interface 1003, a network interface 1004, a memory 1005. Wherein the communication bus 1002 is used to enable connected communication between these components. The user interface 1003 may include a Display (Display), and the optional user interface 1003 may also include a standard wired interface, a wireless interface, and the wired interface for the user interface 1003 may be a USB interface in the present invention. The network interface 1004 may optionally include a standard wired interface, a WIreless interface (e.g., a WIreless-FIdelity (WI-FI) interface). The Memory 1005 may be a high-speed random access Memory (Random Access Memory, RAM) Memory or a stable Memory (NVM), such as a disk Memory. The memory 1005 may also optionally be a storage device separate from the processor 1001 described above.
It will be appreciated by those skilled in the art that the structure shown in fig. 1 does not constitute a limitation of the policy claim judgement device, and may include more or less components than those illustrated, or may combine certain components, or may be arranged in different components.
As shown in fig. 1, an operating system, a network communication module, a user interface module, and a policy claims judging program may be included in a memory 1005 as one type of computer storage medium.
In the policy claim settlement device shown in fig. 1, the network interface 1004 is mainly used for connecting to a background server, and performing data communication with the background server; the user interface 1003 is mainly used for connecting the odds ratio computing system; the policy claims judging device invokes the policy claims judging program stored in the memory 1005 through the processor 1001, and executes the policy claims judging method provided by the embodiment of the present invention.
Based on the hardware structure, the embodiment of the policy claim judgment method is provided.
Referring to fig. 2, fig. 2 is a flowchart illustrating a first embodiment of a policy claim determining method according to the present invention.
In a first embodiment, the policy claims determining method includes the steps of:
Step S10: acquiring a to-be-processed policy set, traversing the to-be-processed policy set, and taking the traversed to-be-processed policy as a target policy.
It should be understood that the execution subject of the present embodiment is a policy claim judgment device, where the policy claim judgment device may be an electronic device such as a personal computer, a server, or the like. The odds are the proportional relation between the odds and the premium income of the insurance company in a certain accounting period, and in a certain accounting period, a large number of to-be-processed insurance policy sets of different insurance types are involved, so that the need of judging which insurance policies in the to-be-processed insurance policy sets are to be subjected to odds calculation is determined, and then corresponding odds calculation is performed, so that basic data is provided for subsequent odds calculation. When the odds are calculated, a to-be-processed policy set in a certain accounting period is generally obtained, whether the odds are required to be paid or not is judged for the to-be-processed policies in the to-be-processed policy set, and whether the subsequent odds are calculated for the target policy or not is determined by traversing the to-be-processed policy set, taking the traversed to-be-processed policies as target policies and judging whether the target policies are paid or not.
For example, during a certain accounting period, if the set of to-be-processed policies includes ten thousands of to-be-processed policies, traversing the ten thousands of to-be-processed policies, and when traversing to the to-be-processed policy a, taking the to-be-processed policy a as the target policy, and further judging whether the target policy meets the claims.
Step S20: and extracting a target insurance type and target claim settlement content from the target insurance policy, and matching the target insurance type with each insurance type in a preset main configuration table.
It should be noted that, the target policy generally includes information such as a policy identifier, basic information of the applicant, a target insurance type, and target claim settlement content, where the target claim settlement content includes contents such as specific application content, and an application validity period of the policy. The insurance types comprise regular death life insurance, life death life insurance, double insurance, annuity insurance, universal life insurance and the like, each insurance type has corresponding claim settlement rules, and the insurance types are different, so that the corresponding claim settlement rules are different. The preset main configuration table comprises various insurance types, the various insurance types and claim rules corresponding to the insurance types are counted through analysis of historical data, the insurance types are configured into the preset main configuration table, and the claim rules corresponding to the insurance types are configured into a preset auxiliary configuration table. When whether the target policy needs to pay or not is judged, the target policy can be judged according to the claim rule corresponding to the target policy by matching the target insurance type of the target policy with each insurance type in the preset main configuration table, if the matching is successful, the claim rule corresponding to the target insurance type is included in the preset auxiliary configuration table, and whether the claim calculation is needed for the target policy is determined according to the judging result. Because the main configuration table only stores various insurance types, the capacity of the main configuration table is smaller, each insurance type in the main configuration table can be traversed rapidly, whether the insurance type matched with the target insurance type exists or not is judged, and if the matching fails, the auxiliary configuration table is not required to be acquired for judging the reimbursement condition, so that the efficiency of reimbursement judgment is improved.
It may be appreciated that the preset main configuration table may further include related information corresponding to each insurance type, where the related information includes: effective insurance, incidence, liability, and claims primary content. Because the number of insurance types is huge, a plurality of insurance types are similar, errors can occur when the target insurance types are matched, and at the moment, the insurance types matched in the preset main configuration table can be detected through the related information, so that whether the insurance types are matched correctly is further confirmed.
Step S30: and when the matching is successful, searching a target claim rule set corresponding to the target insurance type from a preset auxiliary configuration table.
In a specific implementation, when the secondary configuration table is created, a mapping relationship between the primary configuration table and the secondary configuration table is already established, and a target claim rule set corresponding to the target insurance type can be found from the secondary configuration table through the mapping relationship according to the target insurance type. There are typically a plurality of rules for claims corresponding to each insurance type, and the target set of rules for claims is a set of rules for claims corresponding to the target insurance type. For example, if the target insurance type is an a risk, and the target claim rule corresponding to the a risk is 15, the 15 claim rules are stored in the preset secondary configuration table in a set form, that is, the 15 claim rules form the target claim rule set.
Step S40: and judging whether the target claim settlement content meets the target claim settlement rule set, and if so, judging that the target policy meets the claim settlement condition.
It can be understood that the target claim rule set includes a plurality of claim rules, the target claim content and each target claim rule can be judged piece by piece, for example, the target claim rule set includes 15 target claim rules, whether the target claim content meets a first target claim rule in the target claim rule set can be judged first, if yes, whether the target claim content meets a second target claim rule in the target claim rules is continuously judged, and if so, until all 15 target claim rules are met, the target claim content is determined to meet the target claim rule set. If the rule of the target claim does not accord with the rule of the target claim, the target claim is judged to be unsatisfied with the set of the target claim rule, and the judgment of the subsequent target claim rule is not continued.
In this embodiment, after the step S40, the method further includes: and calling a payment algorithm corresponding to the target insurance type to calculate the claim of the target insurance policy.
In a specific implementation, if the target claim content satisfies the target claim rule set, it is indicated that the target policy needs to make a certain claim, and if claim calculation is needed, a corresponding claim algorithm can be obtained according to the target insurance type, and the claim of the target policy is calculated through the claim algorithm and used as basic data for calculating the subsequent claim rate. And if the target claim settlement content does not meet the target claim settlement rule, the target policy does not need to pay the claim, and the calculation of the claim is not involved.
Such as: the target policy content includes: class B life insurance, main insurance amount 41 ten thousand, serious diseases 40 ten thousand, long-term accidents 50 ten thousand; judging whether the serious arteritis meets the target claim rule or not according to the target claim content acquired from the target policy, and continuously judging whether the serious arteritis meets other target claim rules such as the guarantee period or not if one of the serious arteritis in the target claim rules of class B life insurance comprises the serious arteritis, and calling an claim payment algorithm corresponding to the class B life insurance serious disease item if all the target claim rules are met, namely the target claim content meets the target claim rule set. Calculating the total cost of the treatment of the user, if the total cost is less than 40 ten thousand, and reporting the actual cost; if the payment is greater than or equal to 40 ten thousand, 40 ten thousand is paid.
In this embodiment, by matching the target insurance types corresponding to the target policy with each insurance type in the preset main configuration table, if matching, it is determined whether the target claim content corresponding to the target policy meets the target claim rule set found from the preset auxiliary configuration table, so as to determine whether the target policy meets the claim condition, further determine whether to invoke a corresponding claim algorithm to calculate the claim of the target policy, and if the preset auxiliary configuration table stores the target claim rule sets corresponding to the various insurance types, it is possible to dynamically use a set of logic to perform condition determination, that is, determine the target claim content through the corresponding target claim rule sets in the preset configuration table, thereby reducing hard coding, and when the claim rule of each insurance type changes, only updating and maintaining the preset auxiliary configuration table is required, so as to reduce the program maintenance difficulty and improve the efficiency of policy claim determination.
Referring to fig. 3, fig. 3 is a flowchart illustrating a second embodiment of the policy claim determining method according to the present invention, and the second embodiment of the policy claim determining method according to the present invention is proposed based on the first embodiment shown in fig. 2.
In a second embodiment, the step S40 includes:
Step S401: traversing the item mark claim rules in the target claim rule set, and taking the traversed target claim rules as current claim rules.
It can be understood that each item of the target claim rule set is traversed, so that the target claim content and each target claim rule are judged one by one, the traversed target claim rule is used as a current claim rule, and the target claim content and the current claim rule can be compared to judge whether the target claim content accords with the current claim rule.
For example, the target claim rule set includes 15 target claim rules, respectively: and traversing the 15 item claim-marking rules, wherein when the rule A is traversed, the rule A is used as the current claim-marking rule, and whether the target claim-marking content meets the rule A in the target claim-marking rule set is judged.
Step S402: and judging whether the target claim settlement content meets the current claim settlement rule.
It should be appreciated that the target claim rule set includes a plurality of claim rules, the target claim rule set is traversed, and the target claim content is compared with the traversed current claim rules to determine whether the target claim content meets the current claim rules. If yes, continuing traversing, taking the traversed next target claim rule as a new current claim rule, and judging whether the target claim content meets the new current claim rule; if not, skipping out the traversal, and considering that the target claim rule does not meet the target claim rule set.
Step S403: and if the target claim settlement rules meet the traversed current claim settlement rules, the target policy is determined to meet the claim settlement conditions.
If the target claim content meets the current claim rule, continuing traversing each item of target claim rule in the target claim rule set, and taking the traversed target claim rule as a new current claim rule. And continuing traversing each target claim rule in the target claim rule set, taking the traversed next target claim rule as a new current claim rule, judging whether the target claim content meets the new current claim rule, if so, continuing traversing and continuing judging until each target claim rule in the target claim rule set is traversed, and the target claim rule meets each traversed current claim rule, namely, the target claim content meets all target claim rules in the target claim rule set, and then the target policy corresponding to the target claim content meets the claim condition and needs to carry out corresponding claim calculation. If any one current claim rule is not satisfied in the judging process, skipping out of traversal, and considering that the target claim content does not satisfy the target claim rule set, then the subsequent claim calculation is not needed for the target policy.
In this embodiment, after the step S402, the method further includes:
step S404: and if the target claim settlement content does not meet the current claim settlement rule, stopping traversing the target claim settlement rule set, and recognizing that the target policy does not meet the claim settlement condition.
In a specific implementation, in order to improve the efficiency of the claim settlement of the policy, if the target claim settlement content does not meet the current claim settlement rule, it is indicated that the target policy does not meet the claim settlement condition, and no claim calculation is required, and no other claim settlement rules in the target claim settlement rule set are required to be further judged, so that other policies can be directly obtained as new target policies, and the process of the claim settlement of the policy is performed on the new target policies.
It should be noted that, in general, counting the pay condition of each policy in a certain accounting period (such as a year), a large number of to-be-processed policies may be involved, the large number of to-be-processed policies form the to-be-processed policy set, after judging whether one policy makes a pay or not, another policy may be obtained from the to-be-counted policy set to be counted as a new target policy, where the other policy refers to a policy in the to-be-processed policy set that has already made a pay judgment is removed, and then the above-mentioned pay judgment is performed on the new target policy. In this embodiment, after the step S404, the method further includes: and acquiring other insurance policies from the to-be-processed insurance policy set as new target insurance policies.
For the above example, traversing the 15-item claim rules, when traversing to the rule a, taking the rule a as the current claim rule, judging whether the target claim content meets the rule a in the target claim rule set, if yes, continuing traversing the target rule set, taking the traversed rule B as the new current claim rule, judging whether the target claim content meets the rule B, and if so, traversing until the 15-item claim rules are all met, and if yes, recognizing that the target claim content meets the target claim rule set. If a certain current claim rule is not satisfied in the judging process, the target claim rule set is determined not to be satisfied by the target claim content, and then the judgment of the subsequent target claim rule is not continued, for example, when the rule C is traversed, whether the traversed rule C is satisfied by the target claim content as a new current claim rule is judged, if the judgment result is not satisfied, the target claim rule set is not traversed, and other target claim rules which are not traversed do not need to be judged, so that the efficiency of claim judgment is improved, and the target claim rule set is determined not to be satisfied by the target claim content.
In this embodiment, by traversing each item of the target claim rule set, using the traversed target claim rule as a current claim rule, determining whether the target claim content meets the current claim rule, if the target claim rule meets the traversed current claim rule, determining that the target claim content meets the target claim rule set, and then invoking a corresponding claim algorithm to calculate the claim of the target policy, and for other policies in the policy set to be processed, determining in the above manner, thereby implementing a dynamic condition determination using a set of logic, reducing hard coding and reducing program maintenance difficulty; and if the target claim settlement content does not meet the current claim settlement rule, stopping traversing the target claim settlement rule set, recognizing that the target claim settlement content does not meet the target claim settlement rule set, directly acquiring other insurance policies in the insurance policy set to be processed as new target insurance policies, judging the insurance policies, and judging other target claim settlement rules which are not traversed without judging, thereby improving the efficiency of claim settlement judgment.
Referring to fig. 4, fig. 4 is a flowchart illustrating a third embodiment of the policy claim determining method according to the present invention, and based on the second embodiment shown in fig. 3, a third embodiment of the policy claim determining method according to the present invention is provided.
In a third embodiment, before the step S10, the method further includes:
step S01: and obtaining an effective historical policy in a preset time from a database, and performing de-duplication processing on the effective historical policy to obtain a de-duplication policy.
It can be appreciated that the historical insurance policy before the current accounting period is stored in the database, and each insurance type and corresponding claim rules can be combed by analyzing each historical insurance policy in the database. The database generally includes a large number of historical policies, all of which need not be analyzed, and the historical policies of the last year or two years may be obtained for analysis, and the preset time includes one year or two years, which is not limited in this embodiment. In a plurality of historical insurance policies, the historical insurance policies which do not meet the claim settlement conditions do not have reference significance, the historical insurance policies can be removed, only the effective historical insurance policies which meet the claim settlement conditions in the preset time are required to be obtained from the database, normally, when the historical insurance policies are judged in the past accounting period and subjected to claim settlement and pay, the historical insurance policies are classified and stored according to judgment results, then the effective historical insurance policies meeting the class of the claim settlement conditions can be searched from the database, the obtained effective historical insurance policies generally have the insurance policies with the same part of insurance types, and for the insurance policies with the same insurance types, the corresponding claim settlement conditions are also the same, the effective historical insurance policies can be subjected to duplication removal processing, so that duplicate removal insurance policies are obtained, and the insurance types of the duplicate removal insurance policies are different.
Step S02: and analyzing the duplicate removal policy through a preset analysis model to obtain the insurance type and the corresponding claim settlement content of the duplicate removal policy.
It should be understood that, in general, an insurance policy has the same text structure type, and a preset analysis model corresponding to the text structure type can be established, where the preset analysis model can be an Xpath path expression corresponding to the document structure type, the duplicate insurance policy is analyzed by the Xpath path expression, the insurance type and the corresponding claim settlement content are located, and Xpath is an XML path language, which is a language used to determine a position of a part in an XML (subset of standard universal markup language) document.
The insurance types include: regular life insurance, annuity insurance, universal life insurance, etc., each insurance type has corresponding claim rules, and if the insurance types are different, the corresponding claim rules are different, for example: the regular death life insurance provides death guarantee in a specific period, the insurance period can be 1 year, 5 years, 10 years or 20 years, and the like, and the conditions that the insured life insurance is intentionally killed, intentionally injured, self-disabled or self-injured by the insured person and the like are not charged with paying personal insurance money are set, and the rules are the rules of claim settlement corresponding to the regular death life insurance, and the calculation of the claim of the regular death life insurance is carried out when the rules of claim settlement corresponding to the set regular death life insurance are met, so that the calculation of the odds ratio is carried out.
Step S03: splitting the claim content into a plurality of claim rules, the plurality of claim rules comprising a claim rule set.
In a specific implementation, the claim content is usually more, so that the following rules can be matched one by one, the claim content can be split into a plurality of claim rules, and the plurality of claim rules form the claim rule set.
Step S04: and generating the preset main configuration table and the preset auxiliary configuration table according to the insurance type and the claim rule set.
It can be appreciated that, in order to improve the efficiency of the odds ratio calculation, in combination with the service scenario, a preset primary configuration table and a preset secondary configuration table may be created, where the preset primary configuration table is used to store each insurance type and related information, where the related information includes: effective insurance, incidence, liability, and claims primary content. The preset auxiliary configuration table is used for storing specific judgment conditions corresponding to each insurance type, namely, claim rules, and usually, one insurance type corresponds to a plurality of claim rules, so that the claim rules corresponding to each insurance type are stored in a group form in the preset auxiliary configuration table, and one group of claim rules is a claim rule set. And when the preset main configuration table and the preset auxiliary configuration table are created, a mapping relation between the preset main configuration table and the preset auxiliary configuration table is established, and a claim rule set corresponding to the insurance type can be searched from the auxiliary configuration table according to the insurance type through the mapping relation. When the claim rule of a dangerous seed of a certain type is updated, only the auxiliary configuration table is required to be updated correspondingly, so that the flexibility is high, and the judgment condition is increased more conveniently and rapidly.
In this embodiment, the step S20 includes:
analyzing the target policy through the preset analysis model to obtain the target insurance type and the corresponding target claim settlement content of the target policy;
and matching the target insurance type with each insurance type in a preset main configuration table.
It should be noted that, in general, the insurance policy has the same text structure type, the preset analysis model may be an Xpath path expression corresponding to the document structure type, and the target insurance policy is analyzed by the Xpath path expression, so as to locate the target insurance type and the corresponding target claim content.
It should be understood that, when it is required to determine whether the target policy needs to pay, the target policy may be determined according to each claim rule corresponding to the target policy by matching the target policy's type of insurance with each type of insurance in the preset primary configuration table, and determining whether it is required to pay the target policy according to the determination result.
In this embodiment, after the step S20, the method further includes:
step S201: and when the matching fails, sending out configuration table updating prompt information.
In a specific implementation, the preset main configuration table and the preset auxiliary configuration table are both preconfigured, when policy settlement and claim judgment are performed, the preset main configuration table and the preset auxiliary configuration are directly called, when the preset main configuration table and the preset auxiliary configuration are used for a period of time, new dangerous types may not be updated into the preset main configuration table and the preset auxiliary configuration, so that when the target insurance types are matched with the insurance types in the preset main configuration table, the situation of failure in matching occurs, and at this time, configuration table update prompt information can be sent, for example, when a display interface displays: if the insurance type fails to match, the primary and secondary configuration tables are updated, or the update prompting information is directly sent to the user equipment, which is not limited in this embodiment.
In this embodiment, after the step S201, the method further includes:
step S202: and acquiring an updated insurance type and a corresponding updated claim rule set, and updating the preset main configuration table and the preset auxiliary configuration table according to the updated insurance type and the corresponding updated claim rule set.
It should be understood that the configuration time may be recorded when the preset primary configuration table and the preset secondary configuration table are configured, the current time may be obtained, the current time and the insurance type of the configuration time may be combed, and the new insurance type and the corresponding claim rule appearing in the period of time may be counted, to form the updated insurance type and the corresponding updated claim rule set. The updated insurance type and the corresponding updated claim rule set may be added to the preset primary configuration table and the preset secondary configuration table, respectively, to implement updating of the preset primary configuration table and the preset secondary configuration table.
In this embodiment, a preset main configuration table and a preset auxiliary configuration table are generated according to each insurance type and a corresponding claim rule set, so that only the target claim settlement content corresponding to the target policy and the target claim settlement rule set corresponding to the target insurance type in the preset auxiliary configuration table are required to be judged, whether the target policy meets the claim settlement condition can be judged, a large number of policies in the policy set to be processed can be judged by the set of logic, hard coding is reduced, program maintenance difficulty is reduced, when matching between one type of risk and the insurance type in the preset main configuration table fails, configuration table updating prompt information is sent, so that the preset main configuration table and the preset auxiliary configuration table are correspondingly updated according to the updated insurance types between the current time and the configuration time of the preset main configuration table and the preset auxiliary configuration table, and accordingly re-matching and judgment can be performed, and the judgment condition is increased.
In addition, the embodiment of the invention also provides a storage medium, wherein the storage medium stores a policy and claim judging program, and the policy and claim judging program realizes the steps of the policy and claim judging method when being executed by a processor.
In addition, referring to fig. 5, an embodiment of the present invention further provides a policy claim settlement device, where the policy claim settlement device includes: the device comprises a traversing module 10, a matching module 20, a searching module 30 and a judging module 40;
the traversing module 10 is configured to obtain a to-be-processed policy set, traverse the to-be-processed policy set, and take the traversed to-be-processed policy as a target policy;
the matching module 20 is configured to extract a target insurance type and target claim content from the target policy, and match the target insurance type with each insurance type in a preset main configuration table;
the searching module 30 is configured to search a target claim rule set corresponding to the target insurance type from a preset secondary configuration table when the matching is successful;
the judging module 40 is configured to judge whether the target claim content meets the target claim rule set, and if yes, determine that the target policy meets the claim condition.
In an embodiment, the policy claims determining device further includes: a determination module;
the traversing module 10 is further configured to traverse each item of the target claim rule set, and take the traversed target claim rule as a current claim rule;
the judging module 40 is further configured to judge whether the target claim content meets the current claim rule;
and the identification module is used for identifying that the target policy meets the claim settlement conditions if the target claim settlement rules meet the traversed current claim settlement rules.
In an embodiment, the identifying module is further configured to terminate traversing the target claim rule set if the target claim content does not meet the current claim rule, and identify that the target policy does not meet the claim condition.
In an embodiment, the policy claims determining device further includes: the device comprises a de-duplication module, an analysis module, a splitting module and a generation module;
the duplicate removal module is used for obtaining an effective historical policy in a preset time from a database, and performing duplicate removal processing on the effective historical policy to obtain a duplicate removal policy;
the analysis module is used for analyzing the duplicate protection policy through a preset analysis model to obtain the insurance type and the corresponding claim settlement content of the duplicate protection policy;
The splitting module is used for splitting the claim content into a plurality of claim rules, and the plurality of claim rules form a claim rule set;
the generation module is used for generating the preset main configuration table and the preset auxiliary configuration table according to the insurance type and the claim rule set.
In an embodiment, the analyzing module is further configured to analyze the target policy through the preset analyzing model to obtain a target insurance type and corresponding target claim content of the target policy;
the matching module 20 is further configured to match the target insurance type with each insurance type in a preset main configuration table.
In an embodiment, the policy claims determining device further includes: updating a module;
and the updating module is used for sending out configuration table updating prompt information when the matching fails.
In an embodiment, the updating module is further configured to obtain an updated insurance type and a corresponding updated claim rule set, and update the preset primary configuration table and the preset secondary configuration table according to the updated insurance type and the corresponding updated claim rule set.
Other embodiments or specific implementation manners of the policy claim judgment device of the present invention may refer to the above method embodiments, and are not described herein.
It should be noted that, in this document, the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or system that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or system. Without further limitation, an element defined by the phrase "comprising one … …" does not exclude the presence of other like elements in a process, method, article, or system that comprises the element.
The foregoing embodiment numbers of the present invention are merely for the purpose of description, and do not represent the advantages or disadvantages of the embodiments. In the unit claims enumerating several means, several of these means may be embodied by one and the same item of hardware. The use of the terms first, second, third, etc. do not denote any order, but rather the terms first, second, third, etc. are used to interpret the terms as names.
From the above description of the embodiments, it will be clear to those skilled in the art that the above-described embodiment method may be implemented by means of software plus a necessary general hardware platform, but of course may also be implemented by means of hardware, but in many cases the former is a preferred embodiment. Based on such understanding, the technical solution of the present invention may be embodied essentially or in a part contributing to the prior art in the form of a software product stored in a storage medium (e.g. read only memory mirror (Read Only Memory image, ROM)/random access memory (Random Access Memory, RAM), magnetic disk, optical disk), comprising instructions for causing a terminal device (which may be a mobile phone, a computer, a server, an air conditioner, or a network device, etc.) to perform the method according to the embodiments of the present invention.
The foregoing description is only of the preferred embodiments of the present invention, and is not intended to limit the scope of the invention, but rather is intended to cover any equivalents of the structures or equivalent processes disclosed herein or in the alternative, which may be employed directly or indirectly in other related arts.
Claims (7)
1. The method for judging the insurance policy claims is characterized by comprising the following steps of:
acquiring a to-be-processed policy set, traversing the to-be-processed policy set, and taking the traversed to-be-processed policy as a target policy;
extracting a target insurance type and target claim settlement content from the target insurance policy, and matching the target insurance type with each insurance type in a preset main configuration table;
searching a target claim rule set corresponding to the target insurance type from a preset auxiliary configuration table when the matching is successful;
judging whether the target claim settlement content meets the target claim settlement rule set, and if so, determining that the target policy meets the claim settlement condition;
the determining whether the target claim content meets the target claim rule set, if yes, determining that the target policy meets the claim condition comprises:
Traversing each item of target claim rule in the target claim rule set, and taking the traversed target claim rule as the current claim rule;
judging whether the target claim settlement content meets the current claim settlement rule;
if the target claim settlement content meets the current claim settlement rules, traversing each item of target claim settlement rules in the target claim settlement rule set, and taking the traversed target claim settlement rules as new current claim settlement rules;
repeating the traversing and judging operations until each target claim rule in the target claim rule set is traversed;
if the target claim settlement rules meet the traversed current claim settlement rules, the target policy is determined to meet the claim settlement conditions;
the method for judging the insurance policy claims further comprises the steps of:
obtaining an effective historical policy in a preset time from a database, and performing duplication removal processing on the effective historical policy to obtain a duplication removal policy;
analyzing the duplicate removal policy through a preset analysis model to obtain the insurance type and the corresponding claim settlement content of the duplicate removal policy;
Splitting the claim content into a plurality of claim rules, wherein the plurality of claim rules form a claim rule set;
generating the preset main configuration table and the preset auxiliary configuration table according to the insurance type and the claim rule set;
the extracting the target insurance type and the target claim content from the target policy, and matching the target insurance type with each insurance type in a preset main configuration table, includes:
analyzing the target policy through the preset analysis model to obtain the target insurance type and the corresponding target claim settlement content of the target policy, wherein the preset analysis model is an Xpath path expression corresponding to the document structure type of the target policy;
and matching the target insurance type with each insurance type in a preset main configuration table.
2. The policy claim 1, wherein after determining whether the target claim content satisfies the current claim rules, the policy claim determining method further comprises:
and if the target claim settlement content does not meet the current claim settlement rule, stopping traversing the target claim settlement rule set, and recognizing that the target policy does not meet the claim settlement condition.
3. The policy claim 2, wherein after the target insurance type is matched with each insurance type in a preset main configuration table, the policy claim determining method further comprises:
and when the matching fails, sending out configuration table updating prompt information.
4. The policy claim 3, wherein the policy claim determining method includes, after issuing a configuration table update prompt message when the matching fails:
and acquiring an updated insurance type and a corresponding updated claim rule set, and updating the preset main configuration table and the preset auxiliary configuration table according to the updated insurance type and the corresponding updated claim rule set.
5. A policy claims judging device, characterized in that the policy claims judging device comprises: a memory, a processor, and a policy claim judgement program stored on the memory and executable on the processor, which when executed by the processor, implements the steps of the policy claim judgement method as claimed in any one of claims 1 to 4.
6. A storage medium having stored thereon a policy claim judgment program which, when executed by a processor, implements the steps of the policy claim judgment method according to any one of claims 1 to 4.
7. A policy claims determining device, characterized in that the policy claims determining device comprises: the device comprises a traversing module, a matching module, a searching module and a judging module;
the traversing module is used for acquiring a to-be-processed policy set, traversing the to-be-processed policy set and taking the traversed to-be-processed policy as a target policy;
the matching module is used for extracting a target insurance type and target claim settlement content from the target policy and matching the target insurance type with each insurance type in a preset main configuration table;
the searching module is used for searching a target claim rule set corresponding to the target insurance type from a preset auxiliary configuration table when the matching is successful;
the judging module is used for judging whether the target claim settlement content meets the target claim settlement rule set, and if yes, the target policy is determined to meet the claim settlement condition;
the judging module is further used for traversing each item of the target claim rule set and taking the traversed target claim rule as the current claim rule; judging whether the target claim settlement content meets the current claim settlement rule; if the target claim settlement content meets the current claim settlement rules, traversing each item of target claim settlement rules in the target claim settlement rule set, and taking the traversed target claim settlement rules as new current claim settlement rules; repeating the traversing and judging operations until each target claim rule in the target claim rule set is traversed; if the target claim settlement rules meet the traversed current claim settlement rules, the target policy is determined to meet the claim settlement conditions;
The traversal module is further used for acquiring an effective historical policy in a preset time from the database, and performing deduplication processing on the effective historical policy to obtain a deduplication policy; analyzing the duplicate removal policy through a preset analysis model to obtain the insurance type and the corresponding claim settlement content of the duplicate removal policy; splitting the claim content into a plurality of claim rules, wherein the plurality of claim rules form a claim rule set; generating the preset main configuration table and the preset auxiliary configuration table according to the insurance type and the claim rule set;
the matching module is further configured to parse the target policy through the preset parsing model to obtain a target insurance type and corresponding target claim settlement content of the target policy, where the preset parsing model is an Xpath path expression corresponding to a document structure type of the target policy; and matching the target insurance type with each insurance type in a preset main configuration table.
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| CN112488850A (en) * | 2020-11-20 | 2021-03-12 | 中国人寿保险股份有限公司 | Method and device for prepositive checking of insurance policy and electronic equipment |
| CN114049227A (en) * | 2021-11-09 | 2022-02-15 | 北京优全智汇信息技术有限公司 | On-line settlement system and settlement method for insurance claims |
| CN114372890B (en) * | 2022-01-12 | 2023-03-07 | 中国人民健康保险股份有限公司深圳分公司 | Insurance self-service claim settlement management method and system |
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