CN113139791A - Insurance claim settlement service management system - Google Patents
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- CN113139791A CN113139791A CN202110453057.7A CN202110453057A CN113139791A CN 113139791 A CN113139791 A CN 113139791A CN 202110453057 A CN202110453057 A CN 202110453057A CN 113139791 A CN113139791 A CN 113139791A
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Abstract
The invention relates to an insurance claim settlement service management system which comprises an insurance policy module and a claim module, wherein the insurance policy module is used for inquiring and displaying all insurance policies thrown by a client, the insurance policy module is connected with the claim module, the claim module is used for acquiring insurance items in the insurance policy module and is provided with a unit for the client to report and an entrance for processing insurance companies, a reporting unit, a processing unit and an ending unit are arranged in the claim module, the reporting unit is used for reporting insurance material data, the processing unit is used for processing the material data uploaded by the reporting unit, and the ending unit is used for displaying a reporting claim settlement result to the client according to the judgment of the processing unit. Through the claim settlement service management system, the case processing progress is clear and definite, clients and claim settlers can communicate, feed back and guide in real time conveniently, and the claim settlement efficiency and the claim settlement rate are greatly improved.
Description
Technical Field
The invention relates to the technical field of insurance claim settlement systems, in particular to an insurance claim settlement service management system.
Background
At present, regarding claim settlement reports, a client is mostly required to search for telephone reports of corresponding insurance companies, but after the reports are reported, the cases need to be provided with materials, and the client is unclear and relatively passive about the case processing progress. Therefore, a claim settlement service management system which is convenient for clients to report cases independently and upload claim settlement materials by self and can see the processing progress of claim cases all the time is needed, so that the efficiency of effective communication between the clients and the claim settlers is improved, and the case processing speed can also be improved.
Disclosure of Invention
The present invention is directed to an insurance claim settlement service management system, which solves the above-mentioned problems encountered in the background art.
In order to achieve the purpose, the technical scheme of the invention is as follows:
an insurance claim settlement service management system comprises an insurance policy module and a claim module, wherein the insurance policy module is used for inquiring and displaying all insurance policies thrown by a client, the insurance policy module is connected with the claim module, the claim module is used for acquiring insurance items in the insurance policy module and is provided with a unit for the client to report and an entrance for processing insurance companies, a reporting unit, a processing unit and an settlement unit are arranged in the claim module, the reporting unit is used for reporting insurance material data, the processing unit is used for processing the material data uploaded by the reporting unit, and the settlement unit is used for displaying a reporting claim settlement result to the client according to the judgment of the processing unit.
In the above scheme, the case reporting unit includes a case reporting registration module, a claim settlement classification module, a material uploading module and a matching module, the case reporting registration module is configured to register the identity information of the client, and perform correlation matching on the policy information of the registered client through the matching module, the claim settlement classification module is configured to perform automatic classification according to the policy information matched by the matching module, and the material uploading module is configured to upload the claim settlement material to the client.
Further, the matching module is also used for automatically matching proper claim settlement insurers to perform one-to-one service on the client according to the background service condition of the insurance company.
In the scheme, the processing unit comprises an auditing module, a responsibility determination module, a loss determination module, an accounting module and a payment module, wherein the auditing module is used for auditing the insurance reporting materials uploaded by the reporting unit, the responsibility determination module is used for determining responsibility of the insurance accident of the client according to the auditing result of the auditing module, the loss determination module is used for combining the accounting module to determine the actual loss of the client according to the responsibility determination of the responsibility determination module, and the payment module is used for informing the client according to the calculation result of the accounting module and informing an insurance company of paying corresponding materials.
In the above scheme, a compensated query module and a claim rejection query module are arranged in the settlement unit, the compensated query module is used for querying data of successfully settled claims in real time, and the claim rejection query module is used for querying data of rejected claims in real time.
In the scheme, the claim module is internally provided with a substitute reporting module, the substitute reporting module is used for helping a client report when the client can not report by self, and the substitute reporting module is used for butting a report unit and filling the insurance information of an applicant.
In the above scheme, the system further comprises a claim material management unit, wherein the claim material management unit is connected with the claim module and is used for managing each functional unit in the claim module.
Further, the claim settlement material management unit comprises a claim settlement material classification module, a claim settlement material configuration module and a creation and editing module, wherein the claim settlement material classification module is used for assisting the claim settlement material configuration module to search corresponding policy product information according to materials configured by a claimant, the claim settlement material configuration module is used for configuring claim settlement data for products according to different risk types and materials required for claim settlement of different policy products, so that the processing unit can conveniently perform a claim settlement task, and the creation and editing module is used for creating a new template according to the requirement of claim settlement service and performing background editing operation on the existing modules.
In the scheme, the system further comprises a message reminding module, wherein the message reminding module is used for reminding the customer to report the updated claim settlement message and informing the matched insurance company to urge the matched insurance company to complete the auditing work as soon as possible.
Compared with the prior art, the invention has the beneficial effects that: through the claim settlement service management system, the case processing progress is clear and definite, clients and claim settlers can communicate, feed back and guide in real time conveniently, and the claim settlement efficiency and the claim settlement rate are greatly improved. The claims settlement case is online, so that the claims settlement rate is convenient to count, and data support is provided for wind control; the case processing overtime reminding is realized through the message reminding module, so that the case settlement rate is improved; the matching module enables the claim settlement materials to be pushed more flexibly, after the materials are selected, the system automatically pushes the materials to a client, each case is provided with a dedicated claim settlement person, one-to-one service is achieved, and the service quality is improved.
Drawings
The disclosure of the present invention is illustrated with reference to the accompanying drawings. It is to be understood that the drawings are designed solely for the purposes of illustration and not as a definition of the limits of the invention. In the drawings, like reference numerals are used to refer to like parts. Wherein:
FIG. 1 is a schematic diagram of the framework structure of the working principle of the present invention;
FIG. 2 is a schematic structural diagram of a reporting unit according to the present invention;
FIG. 3 is a schematic diagram of a processing unit according to the present invention;
Detailed Description
In order to make the technical means, the creation features, the achievement purposes and the effects of the invention easy to understand, the invention is further described in detail with reference to the attached drawings. These drawings are simplified schematic views illustrating only the basic structure of the present invention in a schematic manner, and thus show only the constitution to which the present invention relates.
According to the technical scheme of the invention, a plurality of alternative structural modes and implementation modes can be provided by a person with ordinary skill in the art without changing the essential spirit of the invention. Therefore, the following detailed description and the accompanying drawings are merely illustrative of the technical aspects of the present invention, and should not be construed as all of the present invention or as limitations or limitations on the technical aspects of the present invention.
The technical solution of the present invention is further described in detail with reference to the accompanying drawings and examples.
As shown in fig. 1, an insurance claim settlement service management system includes a policy module 1 and a claim module 2, wherein the policy module 1 is used for inquiring and displaying all policies thrown by a client, for personal policies, the names and identity numbers of insurance providers can be used for quickly positioning insurance policies, and for product policies, the names or identity numbers of insurance companies and other effective certificates can be used for inquiring related policies. The policy module 1 may display information such as the client's policy number, guarantee time, premium amount, whether it is within the validity period, etc.
The insurance policy module 1 is connected with the claim module 2, the claim module 2 is used for obtaining insurance items in the insurance policy module 1 and has a unit for clients to report and an entrance for insurance company processing, the claim module 2 is internally provided with a reporting unit 21, a processing unit 22 and an ending unit 23, the reporting unit 21 is used for reporting insurance material data, the insurance material comprises a cleaned text scanning piece, a field photo and the like, the processing unit 22 is used for processing the material data uploaded by the reporting unit 21, and the ending unit 23 is used for displaying the report and settlement result to the clients according to the judgment of the processing unit 22. The claim module 2 is located at the client, and the client can find the insurance policy for insurance through the claim module 2, and fill in the application information for application. After the case is successfully reported, the system and the claimant can push the materials to be uploaded, and after the materials are uploaded by the client, the client waits for the examination and verification of the claimant, and the client can see the processing progress of the case in the processing process.
Specifically, referring to fig. 2, the entry unit 21 includes an entry registration module 211, a claim settlement classification module 212, a material uploading module 213, and a matching module 214; the report registration module 211 is used for registering the identity information of the client, performing association matching on the policy information of the registered client through the matching module 214, and selecting whether to perform report registration after the client checks the policy information; the claim classification module 212 is used for automatically classifying according to the policy information matched by the matching module 214, and the material uploading module 213 is used for uploading claim materials to the client. The customer should carefully fill in the pop-up information filling form, such as data of time to take an insurance, place to take an insurance, accident type (injury, death, property loss, etc.), accident description, contact information, wounded information, property loss information, etc., by using the registration form module 211. When the provided materials are insufficient or unclear, the client is reminded to upload again, in order to better assist the client to upload the materials, an example module can be arranged for the client to refer to, and the example module has written description and can be explained in the forms of video, audio and the like.
Preferably, the matching module 214 is further configured to automatically match the suitable insurance claim settling person for one-to-one service to the client according to the background service condition of the insurance company. The matching module 214 can also push claim settlement materials, so that after the customer selects the materials, the customer can conveniently provide support for claim settlement evidences, check and check by claim settlers are facilitated, and the claim settlement dispute between the customer and an insurance company is reduced.
Referring to fig. 3, the processing unit 22 includes an auditing module 221, a liability assignment module 222, a loss assignment module 223, a calculation module 224, and a payment module 225, where the auditing module 221 is configured to audit the issued and reported materials uploaded by the reporting unit 21; the liability assignment module 222 performs liability assignment judgment on the accident of the client according to the auditing result of the auditing module 221, and determines whether the accident reporting situation of the client is in the liability of insurance; the loss assessment module 223 is used for calculating the actual loss of the customer according to the responsibility judgment of the responsibility assessment module 222; the payment module 225 is used for informing the customer according to the calculation result of the settlement module 224 and informing the insurance company to pay the corresponding material. The settlement module 224 is added with the settlement explanation, the settlement amount and the settlement time for the convenience of the customer confirmation, and the payment module 225 displays information such as the payment time, the name and the bank of the insurance company, the name and the card number of the customer, the payment amount, the payment explanation and the like.
The settlement unit 23 is internally provided with a compensated query module and a claim rejection query module, wherein the compensated query module is used for querying data which is successfully claimed in real time, and the claim rejection query module is used for querying data which is rejected in real time.
As a preferable scheme, the claim module 2 is internally provided with a reporting module 24, the reporting module 24 is used for assisting the client in reporting when the client cannot report by himself, and the reporting module 24 is used for butting the reporting unit 21 to fill in the insurance information of the insured. The reporting module 24 is mainly used for reporting the customer who cannot report himself, and after the customer reports the report online, the claimant reports the report in the system according to the information provided by the customer.
With continued reference to fig. 1, in one embodiment, the above solution further includes a claim material management unit 3, and the claim material management unit 3 is connected to the claim module 2 and is used for managing each functional unit in the claim module 2.
The claim material management unit 3 comprises a claim material classification module 31, a claim material configuration module 32 and a creation and editing module 33, wherein the claim material classification module 31 is used for assisting the claim material configuration module 32 to search corresponding insurance policy product information according to the materials configured by the claimant. The claim settlement material configuration module 32 is configured to configure data such as a claim template, claim settlement materials, claim free amount, claim free rate and the like for the product according to materials required for claim settlement of different insurance types and different policy products, so that the processing unit 22 can conveniently perform a task of claim settlement accounting. The claim settlement material configuration module 32 can facilitate the customer to report and upload claims, and also facilitate the claimant to process claim settlement cases (fix responsibility, damage, settlement) in the processing unit 22. The creating and editing module 33 is used for creating a new template according to the requirement of the claim settlement service and performing background editing operation on each existing module, and when an insurance product is newly added, the corresponding claim settlement module is correspondingly created or edited to adapt to the newly added insurance product.
In the implementation process, the reporting templates with different risk types and different charging modes are designed according to the requirements of various insurance companies, the contents comprise insurance policy information, the time of taking out the insurance, the place, the accident type, the reporting person information, the wounded information, the damage assessment information, the work order information, the goods storage address and the like, and different data modules are displayed according to the selected accident type. The claim settlement material configuration module 32 is used for setting a claim template, pushing claim settlement materials, claim amount exemption, claim rate exemption, disability proportion and the like for each product, and the information configuration is mainly applied to the uploading of the claims and materials of client-side customers and the post-processing claim settlement of administrators. The claim material can be created by creating or editing the claim material by the creation and editing module 33, and the created data can be applied to the claim material in the product claim material management.
In one embodiment, the system further comprises a message reminding module 4, wherein the message reminding module 4 is used for reminding the customer to report the updated claim settlement message, and further used for informing the matched insurance company to urge the matched insurance company to complete the auditing work as soon as possible. The message reminding module 4 can be used for processing data of all cases every day, wherein the cases are new cases, cases needing emergency processing or cases currently being processed, and message reminding is provided when new cases or existing cases need to be checked. In each case, the system distributes a claim holder to each state, the remaining processing time length can be shown in the processing process of the claim holder, and the system can automatically remind a user of the remaining processing time length after the remaining processing time length exceeds the time length.
The invention relates to an claim settlement service scheme, which is characterized in that an claimant configures a claim template for each product, a client reports a case, a system generates a claim record and distributes the claimant to the case, the claimant pushes claim materials to be uploaded to the client after knowing the case, the client uploads the claim materials to the client, the claimant audits the case in a management background, the client can see the audit result of each material at the client, the audit is not passed, the reason can be checked and is uploaded again, after the audit is passed, the claimant can perform the following processes of fixing responsibility, damage, settlement and payment until settlement of the claim, and the client can see the processing progress of the whole case.
Through the claim settlement service management system, the case processing progress is clear and definite, clients and claim settlers can communicate, feed back and guide in real time conveniently, and the claim settlement efficiency and the claim settlement rate are greatly improved. The claims settlement case is online, so that the claims settlement rate is convenient to count, and data support is provided for wind control; the case processing overtime reminding is realized through the message reminding module 4, so that the case settlement rate is improved; the matching module 214 enables the pushing of claim settlement materials to be more flexible, after the materials are selected, the system automatically pushes the materials to a client, and each case is provided with a dedicated claim settlement person, so that one-to-one service is achieved, and the service quality is improved.
The above-mentioned embodiments, objects, technical solutions and advantages of the present invention are further described in detail, it should be understood that the above-mentioned embodiments are only specific embodiments of the present invention, and are not intended to limit the scope of the present invention, and any modifications, equivalent substitutions, improvements and the like made within the spirit and principle of the present invention should be included in the scope of the present invention.
Claims (9)
1. An insurance claim settlement service management system, characterized by: the insurance policy system comprises an insurance policy module (1) and a claim module (2), wherein the insurance policy module (1) is used for inquiring and displaying all insurance policies thrown by a client, the insurance policy module (1) is connected with the claim module (2), the claim module (2) is used for obtaining insurance items in the insurance policy module (1) and is provided with a unit for the client to report and an entrance for processing insurance companies, a reporting unit (21), a processing unit (22) and an settlement unit (23) are arranged in the claim module (2), the reporting unit (21) is used for reporting insurance material data, the processing unit (22) is used for processing material data uploaded by the reporting unit (21), and the settlement unit (23) is used for displaying a report and claim settlement result to the client according to the judgment of the processing unit (22).
2. The insurance claim settlement service management system according to claim 1, wherein: the case reporting unit (21) comprises a case reporting registration module (211), a claim settlement classification module (212), a material uploading module (213) and a matching module (214), wherein the case reporting registration module (211) is used for registering identity information of a client and performing correlation matching on policy information of the registered client through the matching module (214), the claim settlement classification module (212) is used for performing automatic classification according to the policy information matched by the matching module (214), and the material uploading module (213) is used for uploading claim settlement materials to the client.
3. The insurance claim settlement service management system according to claim 2, wherein: the matching module (214) is also used for automatically matching the suitable claim settlement insurers according to the background service condition of the insurance company to perform one-to-one service on the client.
4. The insurance claim settlement service management system according to claim 1, wherein: the processing unit (22) comprises an auditing module (221), a liability assignment module (222), a loss assessment module (223), a calculation module (224) and a payment module (225), wherein the auditing module (221) is used for auditing the reported materials uploaded by the reporting unit (21), the liability assignment module (222) performs liability assignment judgment on the reported accident of the client according to the auditing result of the auditing module (221), the loss assessment module (223) is used for combining the liability judgment of the liability assignment module (222) by the calculation module (224) to calculate the actual loss of the client, and the payment module (225) is used for informing the client according to the calculation result of the calculation module (224) and informing an insurance company of paying corresponding materials.
5. The insurance claim settlement service management system according to claim 1, wherein: the settlement unit (23) is internally provided with a compensated query module and a claim rejection query module, the compensated query module is used for querying data which are successfully claimed in real time, and the claim rejection query module is used for querying the claim rejection data in real time.
6. The insurance claim settlement service management system according to claim 1, wherein: the claim module (2) is internally provided with a reporting module (24), the reporting module (24) is used for helping the client report when the client can not report by self, and the reporting module (24) is used for butting a reporting unit (21) and filling the insurance information of the applicant.
7. The insurance claim settlement service management system according to claim 1, wherein: the system also comprises a claim material management unit (3), wherein the claim material management unit (3) is connected with the claim module (2) and is used for managing each functional unit in the claim module (2).
8. The insurance claim settlement service management system of claim 7, wherein: the claim material management unit (3) comprises a claim material classification module (31), a claim material configuration module (32) and a creation and editing module (33), wherein the claim material classification module (31) is used for assisting the claim material configuration module (32) to search corresponding policy product information according to materials configured by a claimant, the claim material configuration module (32) is used for configuring claim data for products according to materials required for claim settlement of different insurance policy and different policy products, a processing unit (22) is convenient to make a claim settlement calculation task, and the creation and editing module (33) is used for creating a new template according to the claim settlement service requirement and performing background editing operation on the existing modules.
9. The insurance claim settlement service management system according to claim 1, wherein: the system also comprises a message reminding module (4), wherein the message reminding module (4) is used for reminding the customer reporting person to check and receive the updated claim settlement message and informing the matched insurance company to urge the matched insurance company to complete the auditing work as soon as possible.
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| CN202110453057.7A CN113139791A (en) | 2021-04-26 | 2021-04-26 | Insurance claim settlement service management system |
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| CN202110453057.7A CN113139791A (en) | 2021-04-26 | 2021-04-26 | Insurance claim settlement service management system |
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Cited By (1)
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| 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 |
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