CN116342298A - Claim settlement system for non-vehicle insurance - Google Patents
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Abstract
The application provides a claim settlement system for non-car insurance, which comprises a claim settlement rule module, a claim settlement flow module and a claim settlement case module; the claim settlement rule module is used for classifying business rules through claim settlement business to determine corresponding claim settlement processes; the claim settlement flow module is used for carrying out differentiated service configuration target claim settlement flow on cases of different business scenes according to the claim settlement flow; the claim settlement case module is used for managing the claim settlement flow in a case form and combining the claim case object to construct a case data model. The method can realize the service driving of claim settlement, the cooperation of the process and the rule engine, support flexible service adjustment and management and control strategies, support the configuration of the plug-in claim settlement process, and support the management and operation cooperation of different risks. The method supports the operation of different runways, provides the capability of completing transactions through multiple channels, and different runways can be flexibly switched, quickly and flexibly respond, adapt to more business scenes and diversified customer demands.
Description
Technical Field
The application relates to the field of information processing, in particular to a claim settlement system for non-car insurance.
Background
In recent years, with the rapid growth of domestic non-car insurance markets, external market competition is also becoming more and more intense, and businesses such as health insurance, trust insurance, traditional non-car and the like present diversified growth situations, and meanwhile, the requirements for supervision are becoming more and more strict, and higher and more urgent requirements are provided for the construction of a non-car insurance claim settlement system.
At present, a micro-service architecture system is adopted on the whole architecture of the non-vehicle insurance claim settlement system, front and rear ends are required to be separated, and service application not only supports independent deployment and operation, but also can flexibly combine deployment and operation; through distributed service support, distributed batch support and distributed database support.
The existing non-car insurance claim settlement system has higher requirements on the hardware configuration of the server when running; the service refinement management is accompanied with a plurality of system rules, and the operation and maintenance difficulty is high.
Disclosure of Invention
In view of the problem, the present application has been presented to provide a claims system for non-vehicle insurance that overcomes or at least partially solves the problem, comprising:
a claim settlement system for non-car insurance, the system comprising a claim settlement rule module, a claim settlement flow module and a claim settlement case module;
the claim rule module is used for classifying business rules through claim settlement business to determine corresponding claim settlement processes, wherein the business rules comprise runway splitting rules, business triggering rules, task scheduling rules and risk management and control rules;
the claim settlement flow module is used for carrying out differentiated service configuration target claim settlement flow on cases of different business scenes according to the claim settlement flow, wherein the cases comprise low-risk cases, complex cases and sudden cases;
the claim settlement case module is used for managing the claim settlement flow in a case form and constructing a case data model by combining claim case objects, wherein the case form comprises a product risk class, a service mode, a regional difference and a policy difference.
Further, when the case is the low risk case, a small fast claim case automation flow is configured.
Further, when the case is the complex case, the case of the claim is combined to generate a case-combining claim-settling process.
Further, when the case is the burst case, an online claim settlement flow is configured.
Further, when the business rule is the runway distribution rule, the claim settlement process is determined to be a simple claim settlement process according to the report receiving information in the claim settlement business.
Further, when the business rule is the business trigger rule, the business trigger rule includes a case trigger, an audit case setting, a survey trigger, an automatic processing and a claim rule, and the corresponding claim settlement process is respectively generated according to the case trigger, the audit case setting, the survey trigger, the automatic processing and the claim rule.
Further, when the business rule is the task scheduling rule, determining an executive according to the claim settlement business, and distributing the claim settlement business to the executive.
Further, when the business rule is the risk management rule, identifying whether the client is in a blacklist according to the telephone number of the claim receiving in the claim settlement business, and determining that the client is in the blacklist to generate a claim settlement flow with field investigation.
Further, the claim rule module further comprises a rule management unit;
the rule management unit is used for defining and managing the business rule and identifying risks.
Further, the system also comprises a risk management and control module, wherein the risk management and control module is used for checking clients in the black-gray list.
The application has the following advantages:
in the embodiment of the application, compared with the prior art that the prior non-car insurance claim settlement system has higher requirement on the hardware configuration of the server during operation; the application provides a solution of 'claim rule module, claim process module and claim case module', which is characterized in that: the system comprises an claim rule module, an claim settlement flow module and an claim settlement case module; the claim rule module is used for classifying business rules through claim settlement business to determine corresponding claim settlement processes, wherein the business rules comprise runway splitting rules, business triggering rules, task scheduling rules and risk management and control rules; the claim settlement flow module is used for carrying out differentiated service configuration target claim settlement flow on cases of different business scenes according to the claim settlement flow, wherein the cases comprise low-risk cases, complex cases and sudden cases; the claim settlement case module is used for managing the claim settlement flow in a case form and constructing a case data model by combining the claim case objects, wherein the case form comprises a product risk class, a service mode, a regional difference and a policy difference. The problem that the requirement on the hardware configuration of a server is high when the existing non-car insurance claim settlement system operates is solved through a claim settlement rule module, a claim settlement flow module and a claim settlement case module; the service refinement management is accompanied with a plurality of system rules, the operation and maintenance difficulty is high, the operation and maintenance support of the claim settlement service driving, the cooperation of a flow and a rule engine is realized, the flexible service adjustment and management strategy is supported, the plug-in claim settlement flow configuration is supported, the role authorization of the organization attribution is broken, and the management and operation cooperation of different risks are supported. Different runway operations are supported, and based on multi-dimensions such as guest groups, products, channels, scenes, service types and the like, the capability of completing transactions through multiple channels is provided, different runways can be flexibly switched, and the method is fast and flexible in response, and adapts to more service scenes and diversified customer demands. The intelligent pushing and dynamic monitoring of the tasks are realized, the resource use is intensified and optimized, and the business data and the data information are synchronized.
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In order to more clearly illustrate the technical solutions of the present application, the drawings that are needed in the description of the present application will be briefly described below, it being obvious that the drawings in the following description are only some embodiments of the present application, and that other drawings may be obtained according to these drawings without inventive effort to a person skilled in the art.
Fig. 1 is a block diagram of a claim system for non-vehicle insurance according to an embodiment of the present application.
In the accompanying drawings: 110. a claim rule module; 120. a claim settlement flow module; 130. and (5) a case settlement module.
Detailed Description
In order to make the objects, features and advantages of the present application more comprehensible, the present application is described in further detail below with reference to the accompanying drawings and detailed description. It will be apparent that the embodiments described are some, but not all, of the embodiments of the present application. All other embodiments, which can be made by one of ordinary skill in the art based on the embodiments herein without making any inventive effort, are intended to be within the scope of the present application.
The inventors found by analyzing the prior art that: the existing non-car insurance claim settlement system has higher requirements on the hardware configuration of the server when running; the service refinement management is accompanied with a plurality of system rules, and the operation and maintenance difficulty is high.
Referring to FIG. 1, a block diagram of a claim settlement system for non-vehicle insurance is shown, provided in an embodiment of the present application;
a claims system for non-car insurance, the system comprising a claims rules module 110, a claims flow module 120, and a claims case module 130;
the claim rule module 110 is configured to determine a corresponding claim process by classifying service rules according to a claim service, where the service rules include a runway splitting rule, a service triggering rule, a task scheduling rule, and a risk management rule;
the claim settlement flow module 120 is configured to perform differentiated service configuration on cases of different business scenes according to the claim settlement flow, where the cases include low-risk cases, complex cases and sudden cases;
the claim case module 130 is configured to manage the claim process in a case form, and construct a case data model in combination with the claim case object, where the case form includes a product risk class, a service mode, a regional difference, and a policy difference.
In the embodiment of the application, compared with the prior art that the prior non-car insurance claim settlement system has higher requirement on the hardware configuration of the server during operation; the service refinement management is accompanied by a plurality of system rules with great operation and maintenance difficulty, and the application provides a solution of 'the claim rule module 110, the claim settlement flow module 120 and the claim settlement case module 130', specifically: the system includes an claims rules module 110, a claims flow module 120, and a claims case module 130; the claim rule module 110 is configured to determine a corresponding claim process by classifying service rules according to a claim service, where the service rules include a runway splitting rule, a service triggering rule, a task scheduling rule, and a risk management rule; the claim settlement flow module 120 is configured to perform differentiated service configuration on cases of different business scenes according to the claim settlement flow, where the cases include low-risk cases, complex cases and sudden cases; the claim settlement file module 130 is configured to manage the claim settlement flow in a file form, and construct a file data model in combination with claim objects, where the file form includes a product risk class, a service mode, a regional difference, and a policy difference. The problems that the requirement on the hardware configuration of a server is high when the existing non-car insurance claim settlement system operates are solved through the claim settlement rule module 110, the claim settlement flow module 120 and the claim settlement case module 130; the service refinement management is accompanied with a plurality of system rules, the operation and maintenance difficulty is high, the operation and maintenance support of the claim settlement service driving, the cooperation of a flow and a rule engine is realized, the flexible service adjustment and management strategy is supported, the plug-in claim settlement flow configuration is supported, the role authorization of the organization attribution is broken, and the management and operation cooperation of different risks are supported. Different runway operations are supported, and based on multi-dimensions such as guest groups, products, channels, scenes, service types and the like, the capability of completing transactions through multiple channels is provided, different runways can be flexibly switched, and the method is fast and flexible in response, and adapts to more service scenes and diversified customer demands. The intelligent pushing and dynamic monitoring of the tasks are realized, the resource use is intensified and optimized, and the business data and the data information are synchronized.
Next, a claim system for non-vehicle insurance in the present exemplary embodiment will be further described.
In an embodiment of the invention, an open type claim settlement platform with service, cost and operation efficiency management requirements of a claim settlement service manager as a core is realized by surrounding customer and user requirements and operation experience, and the open type claim settlement platform is provided with service general and plug-in flow nodes, can realize modularized flexible configuration according to subsequent service requirements, and forms a new dynamically configurable flow; the power-assisted enterprises build the core competitiveness of the claim settlement service and promote the transformation of the claim settlement business mode centering on clients; in a specific embodiment, an online mode taking WeChat applet as a carrier is built around a service concept taking a customer as a center, a front end is in butt joint with a plurality of inlets of CC drainage, customer self-service and third party APP, a rear end outputs a push package, a system is automatic and self-processing, and a plurality of processing modes are realized, so that an online claim settlement service mode of B2B, B C and 2B2C is realized; supporting the claim information record and the claim information inquiry which are centered by clients; supporting customer-centered claim settlement service and risk management and control, and aiming at health risks and intention health risks product claim settlement, supporting cross-insurance policy and accident responsibility clearing with insured human dimension in the loss assessment link by the system, and associating accident persons with claim settlement events; supporting self-help claim settlement processes of internet channel clients, such as: and the claims support of small micro-products such as e-commerce return insurance and aviation insurance.
In an embodiment of the invention, the intelligent multi-channel design, unified user experience design, rule-based intelligent scheduling, unified processing workbench, customer self-help process support of internet small-amount low-risk tasks and the like are all around improving the operation experience of internal and external users and customers. Effectively helping users to improve office efficiency.
In an embodiment of the present invention, the claim settlement flow module 120 is configured to perform differentiated service configuration on cases of different service scenarios according to the claim settlement flow, where the cases include low-risk cases, complex cases and sudden cases; in a specific embodiment, based on multiple dimensions, a differentiated case processing channel is designed, the business process change and business function adjustment are responded quickly, the links which are frequently changed can be modified and configured, and the process execution efficiency and the automatic processing capability are ensured; the method can respond to the claim settlement service requirements under different service scenes and provide different claim settlement service modes such as customer self-service, disaster management and the like; the method takes workflow as support, customer experience design and business management and control rules as input, designs a multi-channel claim settlement operation flow based on multiple dimensions, supports flexible switching of general flow and simple flow channels, supports small-amount claim case automation flow, supports differentiated flow setting of branch companies and the like.
In an embodiment of the present invention, when the case is the low risk case, configuring a small express claim case automation flow; in one embodiment, for low risk cases, the automated process of small fast claim cases can be supported in a mobile/self-service manner, so that the claim settlement operation is simplified, and clients participate in the process.
In an embodiment of the present invention, when the case is the complex case, the case of claim settlement is combined to generate a process of claim settlement; in a specific embodiment, for complex cases, the claim settlement and case combination processing is realized, multiple users can process the contents of the cases in different links in parallel, and the system performs overall flow and risk management and control.
In an embodiment of the present invention, when the case is the sudden case, an online claim settlement process is configured; in a specific embodiment, the emergency case is an emergency event such as a disaster, and for the emergency event such as the disaster, the rapid response and the on-line operation and management are supported, so that project management for the group emergency claim case is realized, and the efficiency, the service quality and the risk in the processing process are tracked.
In an embodiment of the present invention, the claim case module 130 is configured to manage the claim settlement process in a case form, and construct a case data model in combination with a claim case object, where the case form includes a product risk class, a service mode, a regional difference, and a policy difference; in a specific embodiment, the case tagging, task allocation intellectualization, flow configuration flexibility, unified case management and the like are used for supporting the requirements of agile claim settlement operation; wherein, the case is labeled: the method comprises the steps of classifying cases, defining case labels of claims, automatically identifying clients and case types, and supporting agile business process configuration; unified file management: the method and the device realize structural presentation of the claim information, and element configuration based on management requirements, realize that information which is required to be input and queried by different users can be managed and controlled through configuration, and ensure good user experience.
In an embodiment of the present invention, when the service rule is the runway splitting rule, the claim settlement process is determined to be a simple claim settlement process according to the report receiving information in the claim settlement service; in a specific embodiment, the runway splitting rules include a splitting policy rule of a claim settlement service, for example, according to the information of the receiving report, judging that the service enters into a simple claim settlement process, a general claim settlement process, and the like; .
In an embodiment of the present invention, when the service rule is the service trigger rule, where the service trigger rule includes a case trigger, an audit case setting, an investigation trigger, an automatic processing, and a claim rule, and the corresponding claim settlement process is generated according to the case trigger, the audit case setting, the investigation trigger, the automatic processing, and the claim rule; in a specific embodiment, the task scheduling rules include rules related to distributing the claim settlement business to appropriate personnel, and rules for automatically distributing and distributing the tasks.
In an embodiment of the present invention, when the service rule is the task scheduling rule, an executive is determined according to the claim settlement service, and the claim settlement service is distributed to the executive.
In an embodiment of the present invention, when the service rule is the risk management rule, identifying whether a client is in a blacklist according to a telephone number of a receiving report in the claim settlement service, and determining that the client is in the blacklist, generating a claim settlement process with field investigation; in one embodiment, the risk management rules include risk identification and control rules, such as identifying the customer as a blacklist customer and initiating a live survey based on the submitted telephone number.
In an embodiment of the present invention, the claim rule module 110 further includes a rule management unit; the rule management unit is used for defining and managing the business rule and identifying risks; in a specific embodiment, rule definition supports identifying risk based on rules. And establishing a risk factor and a risk rule base, and identifying risks according to rules in the whole process of risk identification through business processing, and reminding risk processing or management and control.
In an embodiment of the present invention, the system further includes a risk management and control module, where the risk management and control module is used to verify clients in the black-gray list; in a specific embodiment, risk points of the claim settlement key business process links are comprehensively combed, and targeted control measures are implemented into the system rigid management and control function. The method solves the problems that the traditional rules are scattered in various places of the system, and the system is managed, regulated and controlled in a unified way; meets the supervision requirements and internal control requirements, such as: black gray list verification, money back washing management and the like.
Example 1
A claim settlement system for non-car insurance mainly uses a modern computer theory and man-machine cooperation theory, a new generation of digital non-car claim settlement system is built through computer control modes such as an algorithm, a framework, control and storage, and a boosting company realizes strategic targets and prospects of a client-centered, data technology-driven and open sharing platform.
A system for settling claim of non-car insurance realizes fusion of cross-product data and resources, supports the settlement flow of processing large insurance policy newspaper of combined product, falls to the ground on the visual configuration of settlement flow, case and rule in system design, and supports multiplexing system architecture system (technical architecture, data architecture), service components, technical components and the like.
Based on a plurality of dimensions, a differentiated case processing channel is designed, the business process change and business function adjustment are responded quickly, the links which are frequently changed can be modified and configured, and the process execution efficiency and the automatic processing capability are ensured. And responding to the claim settlement service requirements under different service scenes, and providing different claim settlement service modes such as customer self-service, disaster management and the like. The method takes workflow as support, customer experience design and business management and control rules as input, designs a multi-channel claim settlement operation flow based on multiple dimensions, supports flexible switching of general flow and simple flow channels, supports small-amount claim case automation flow, supports differentiated flow setting of branch companies and the like.
For low-risk cases, the automatic flow of small-amount fast-claim cases can be supported in a mobile self-service mode, the claim settlement operation is simplified, and clients participate in the process.
Aiming at complex cases, the method realizes the processing of claims and cases, wherein multiple users can process the contents of the cases in different links in parallel, and the system performs overall flow and risk management and control.
For sudden events such as a disaster, quick response and on-line operation and management are supported, project management aiming at 'group sudden claim cases' is realized, and efficiency, service quality and risks in the processing process are tracked.
The method has the advantages that the construction follows the construction principle of a 'claim settlement' system, the 'claim settlement' takes a case engine as a core, a rule engine and a flow engine are combined to form a control center, a claim settlement multi-channel operation mode and a differential multi-flow process are driven to be combined together to provide technical support for the 'claim settlement', and the 'case engine+rule engine+flow engine' is used for realizing quick circulation and flexible switching of different claim settlement flows under different scenes, so that the operation efficiency and the operation experience of a user are improved.
1. Rule engine: the configurable claim service rules are uniformly managed, and service personnel realize flexible service change through each management system and service rule configuration. The unified management of the business rules is realized through the technical modes of decision trees and the like, the configuration of the business rules directly by a business department is supported, and the speed of realizing business adjustment and change is increased.
2. The flow engine: triggering different flow runways according to event setting rules; implementation using currently mainstream flow engine products; differentiated runway engine dispatch: aiming at the combination of different products, guest groups, scenes and channels, prefabricating a plurality of different claim settlement runways, and providing a self-adaptive differentiated claim settlement flow link through a configuration mode; the workflow management mode of the claim event driven or preconfigured flow is supported, various complex claim workflow modes are realized, and the rapid change of the business flow or the claim settlement runway management of the business flow is supported.
3. A case engine: the traditional transverse table storage is changed into longitudinal table storage through the case engine, the whole claim settlement process is managed in a case mode, and the traditional claim settlement management process is broken. The supporting case data model is configurable; supporting the structural difference of the files, for example, realizing the file configuration function according to different product risk types, service modes, regional differences, policy differences and the like, and forming file data models for the file objects of the claims of different file types; pages, rules and flows are flexible and can be rapidly configured.
In this specification, each embodiment is described in a progressive manner, and each embodiment is mainly described by differences from other embodiments, and identical and similar parts between the embodiments are all enough to be referred to each other.
While preferred embodiments of the present embodiments have been described, additional variations and modifications in those embodiments may occur to those skilled in the art once they learn of the basic inventive concepts. It is therefore intended that the following claims be interpreted as including the preferred embodiments and all such alterations and modifications as fall within the scope of the embodiments of the present application.
Finally, it is further noted that relational terms such as first and second, and the like are used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship or order between such entities or actions. Moreover, the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or terminal 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 terminal. 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 terminal device comprising the element.
The foregoing has outlined a detailed description of a claim system for non-vehicle insurance applications, wherein specific examples are provided herein to illustrate the principles and embodiments of the application, the description of the examples being only for the purpose of aiding in the understanding of the method and core ideas of the application; meanwhile, as those skilled in the art will have modifications in the specific embodiments and application scope in accordance with the ideas of the present application, the present description should not be construed as limiting the present application in view of the above.
Claims (10)
1. A claim settlement system for non-car insurance, which is characterized by comprising a claim settlement rule module, a claim settlement flow module and a claim settlement case module;
the claim rule module is used for classifying business rules through claim settlement business to determine corresponding claim settlement processes, wherein the business rules comprise runway splitting rules, business triggering rules, task scheduling rules and risk management and control rules;
the claim settlement flow module is used for carrying out differentiated service configuration target claim settlement flow on cases of different business scenes according to the claim settlement flow, wherein the cases comprise low-risk cases, complex cases and sudden cases;
the claim settlement case module is used for managing the claim settlement flow in a case form and constructing a case data model by combining claim case objects, wherein the case form comprises a product risk class, a service mode, a regional difference and a policy difference.
2. The system of claim 1, wherein a small claim case automation flow is configured when the case is the low risk case.
3. The system of claim 1, wherein when the case is the complex case, the claim case is combined to generate and claim a claim process.
4. The system of claim 1, wherein an online claim process is configured when the case is the emergency case.
5. The system of claim 1, wherein when the business rule is the runway splitting rule, the claim settlement process is determined to be a simple claim settlement process according to the claim receiving information in the claim settlement business.
6. The system of claim 1, wherein when the business rule is the business trigger rule, wherein the business trigger rule comprises a case trigger, an audit case, a survey trigger, an automatic processing, and a claim rule, and wherein the claim settlement process is generated according to the case trigger, the audit case, the survey trigger, the automatic processing, and the claim rule, respectively.
7. The system of claim 1, wherein when the business rule is the task scheduling rule, an executive is determined from the claim settlement business and the claim settlement business is assigned to the executive.
8. The system of claim 1, wherein when the business rule is the risk management rule, identifying whether the customer is in a blacklist based on a submitted telephone number in the claims settlement business, and determining that the customer is in the blacklist generates a claims settlement process with a field survey.
9. The system of claim 1, wherein the claims rules module further comprises a rules management unit;
the rule management unit is used for defining and managing the business rule and identifying risks.
10. The system of claim 1, further comprising a risk management module for verifying clients within the blacklist.
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| CN117372177A (en) * | 2023-10-13 | 2024-01-09 | 国任财产保险股份有限公司 | Novel non-vehicle underwriting core system |
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