CN107909232B - Claims case distribution method and device, storage medium and computer equipment - Google Patents

Claims case distribution method and device, storage medium and computer equipment Download PDF

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CN107909232B
CN107909232B CN201710751985.5A CN201710751985A CN107909232B CN 107909232 B CN107909232 B CN 107909232B CN 201710751985 A CN201710751985 A CN 201710751985A CN 107909232 B CN107909232 B CN 107909232B
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case
cases
management terminal
policy
user
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CN107909232A (en
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王雯
朱晓宇
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Ping An Technology Shenzhen Co Ltd
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Ping An Technology Shenzhen Co Ltd
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    • GPHYSICS
    • G06COMPUTING; CALCULATING; COUNTING
    • G06QDATA PROCESSING SYSTEMS OR METHODS, SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTING PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTING PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00Administration; Management
    • G06Q10/06Resources, workflows, human or project management, e.g. organising, planning, scheduling or allocating time, human or machine resources; Enterprise planning; Organisational models
    • G06Q10/063Operations research or analysis
    • G06Q10/0631Resource planning, allocation or scheduling for a business operation
    • G06Q10/06311Scheduling, planning or task assignment for a person or group
    • GPHYSICS
    • G06COMPUTING; CALCULATING; COUNTING
    • G06QDATA PROCESSING SYSTEMS OR METHODS, SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTING PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTING PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08Insurance, e.g. risk analysis or pensions

Abstract

The invention relates to a method for distributing claim cases, which comprises the following steps: receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used for uniquely identifying a user initiating the claim case audit request; searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in a claim case queue to be distributed; and distributing the first claim settlement case to the first management terminal corresponding to the first user identification. By adopting the method, the processing efficiency of the claim settlement case can be improved. In addition, a claim case distribution device, a storage medium and a computer device are also provided.

Description

Claims case distribution method and device, storage medium and computer equipment
Technical Field
The invention relates to the technical field of computers, in particular to a method and a device for allocating claim cases, a storage medium and computer equipment.
Background
The same client may relate to multiple types of insurance policies, for example, the same client purchases the same type of insurance of multiple underwriting institutions of the same company, for example, the client simultaneously purchases the medical insurance of Shanghai institution of the safety insurance company and the medical insurance of Shenzhen institution of the safety insurance company, so that the client has the personal medical insurance policies of Shanghai institution and Shenzhen institution respectively, or the enterprise where the client is located purchases the medical insurance for the employees uniformly, so that all the employees share one group policy, and each employee (including the employee) also corresponds to one group sub-policy.
Because the self-service claim settlement system provides 7 x 24 hours of service, the customer can apply for multiple claims in one day. When a customer frequently applies for a claim, the conventional method for processing the claim case distributes received claim cases concurrently, so that multiple types of claim cases related to the same customer are easily distributed to different auditors for auditing at the same time, and because of the relevance of the claim cases, for example, 2000 yuan is spent on hospitalization of the customer, 1000 yuan has been paid by Shanghai institutions of the safety insurance company, the claim amount of deep-impartial institutions of the safety insurance company cannot exceed 1000 yuan, and the accumulated claim amount of each institution cannot exceed the total guarantee amount, so that the claim cases are cross-interlocked, thereby causing low processing efficiency of the claim cases.
Disclosure of Invention
The embodiment of the invention provides a method and a device for allocating claim cases, a storage medium and computer equipment, which can improve the processing efficiency of the claim cases.
A method of claim case distribution, the method comprising:
receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used for uniquely identifying a user initiating the claim case audit request;
searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in a claim case queue to be distributed;
and distributing the first claim settlement case to the first management terminal corresponding to the first user identification.
In one embodiment, the allocating the first claim case to the first management terminal corresponding to the first user identifier includes: judging whether the number of the first claim cases is less than or equal to a preset case processing number or not; and if so, distributing the first claim settlement case to the first management terminal corresponding to the first user identification.
In one embodiment, the allocating the first claim case to the first management terminal corresponding to the first user identifier includes: acquiring the processing state of a second claim case, which is the same as the application type and the sponsor identification of the first claim case, in the distributed claim cases; and if the processing state of the second claim case is an end case, distributing the first claim case to the first management terminal corresponding to the first user identifier.
In one embodiment, if the processing status of the second claim case is unfinished, a second user identifier corresponding to the second claim case is acquired; and distributing the first claim settlement case to a second management terminal corresponding to a second user identification.
In one embodiment, acquiring a policy type corresponding to the head of line claim case; if the policy type is a group sub-policy, searching a third claim case with the policy type being a group sub-policy in the queue of claim cases to be distributed, wherein the third claim case has the same group policy as the group head claim case and has a difference with the claim application time of the group head claim case not more than a second preset time threshold; and distributing the third claim settlement case to a first user terminal corresponding to the first user identification.
A claim case distribution apparatus, the apparatus comprising:
the system comprises a claim case searching module, a file allocation module and a file allocation module, wherein the claim case searching module is used for searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has the claim application time difference not exceeding a first preset time threshold in a claim case queue to be allocated;
and the claim case distribution module is used for distributing the first claim case to the first management terminal corresponding to the first user identifier.
In one embodiment, the claim case allocation module is configured to determine whether the number of the first claim cases is less than or equal to a preset case processing number; and if so, distributing the first claim settlement case to the first management terminal corresponding to the first user identification.
In one embodiment, the claim case distribution module is used for acquiring the processing state of a second claim case which is distributed in the claim cases and has the same application type and the same sponsor identification as the first claim case; and if the processing state of the second claim case is an end case, distributing the first claim case to the first management terminal corresponding to the first user identifier.
A computer-readable storage medium, on which a computer program is stored which, when executed by a processor, carries out the steps of:
receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used for uniquely identifying a user initiating the claim case audit request;
searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in a claim case queue to be distributed;
and distributing the first claim settlement case to the first management terminal corresponding to the first user identification.
A computer device comprising a memory, a processor and a computer program stored on the memory and executable on the processor, the processor implementing the following steps when executing the computer program:
receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used for uniquely identifying a user initiating the claim case audit request;
searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in a claim case queue to be distributed;
and distributing the first claim settlement case to the first management terminal corresponding to the first user identification.
According to the method, the device, the storage medium and the computer equipment for allocating the claim cases, by receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, the first user identifier is used for uniquely identifying a user initiating the claim case audit request, searching a first claim case which has the same identity and application type as a sponsor of a first claim case and has a difference in claim application time not exceeding a first preset time threshold in a to-be-allocated claim case queue, and allocating the found first claim case to the first management terminal corresponding to the first user identifier. Because the found first claim case is a claim case with the same type of risk corresponding to the same insurer within the preset time range and different policy types, and then the cases are distributed to the same auditor for auditing, the probability of the mutual interlocking of the claim cases due to the concurrent distribution of the claim cases is effectively reduced, and the processing efficiency of the claim cases is improved.
Drawings
FIG. 1 is a diagram of an application environment of a method for assigning claims to cases in one embodiment;
FIG. 2 is an internal block diagram of a server in one embodiment;
FIG. 3 is a flow diagram of a method of claim case distribution in one embodiment;
FIG. 4 is a flowchart of a method of assigning the first claim case to the first management terminal corresponding to the first subscriber identity of FIG. 3 in one embodiment;
fig. 5 is a flowchart of a method for assigning the first claim case to the first management terminal corresponding to the first subscriber identity according to another embodiment in fig. 3;
FIG. 6 is a flowchart of a method of assigning claims cases in another embodiment;
fig. 7 is a block diagram of the structure of the device in one embodiment.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention is described in further detail below with reference to the accompanying drawings and embodiments. It should be understood that the specific embodiments described herein are merely illustrative of the invention and are not intended to limit the invention.
The transaction rollback method provided by the embodiment of the invention can be applied to the environment shown in fig. 1. Referring to fig. 1, the server 102 receives a request for examining the claim cases sent by the terminal 104, and distributes the found claim cases to the terminal 104. Specifically, the server 102 communicates with the terminal 104 through a network, the server 102 receives a claim case audit request sent by the terminal 104, searches a claim case in a to-be-distributed claim case queue, the claim case having the same application type and the same sponsor identifier as a first claim case and having a claim application time difference not exceeding a preset time threshold, and distributes the first claim case to the terminal 104. The terminal 104 is operated by an auditor, and is used for auditing the claim cases, where the auditor is a user with the authority for auditing the claim cases, where the terminal includes, but is not limited to, various personal computers, notebook computers, smart phones, tablet computers, portable wearable devices, and the like.
In one embodiment, as shown in fig. 2, there is further provided a server, where the server includes a processor, a non-volatile storage medium, an internal memory, and a network connection port, which are connected by a system bus, and the non-volatile storage medium stores therein an operating system and computer-executable instructions for implementing the medical service reservation method provided in this embodiment. The processor is used for improving the calculation and control capacity and supporting the operation of the whole server. The internal memory is used to provide an environment for the operating system and the execution of computer-executable instructions in the non-volatile storage medium. The network interface is used for network communication with the terminal. Those skilled in the art will appreciate that the architecture shown in fig. 2 is a block diagram of only a portion of the architecture associated with the subject application, and does not constitute a limitation on the servers to which the subject application applies, and in particular that a server may include more or fewer components than shown, or combine certain components, or have a different arrangement of components.
In one embodiment, as shown in fig. 3, there is provided a method of claim case distribution, including:
step 302, receiving a claim case audit request initiated by the first management terminal, where the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used to uniquely identify a user initiating the claim case audit request.
The claim settlement case is a case for performing compensation processing according to claim settlement materials provided by a client and the purchased insurance; the first management terminal is a terminal used by an auditor for sending a request for checking the claim cases stored in the database to the server; the first user identification is used for uniquely identifying the user who initiates the claim case audit request.
In this embodiment, the claim case audit request received by the server is a claim case audit request sent by the first management terminal to the server through the first user identifier.
Step 304, searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in the claim case queue to be distributed.
In this embodiment, the claim case to be distributed is a claim case waiting for review among the received claim cases; the first-queue claim case is a claim case located at the head-queue position of the queue of claim cases to be allocated; the application type is the type of the dangerous type on the policy corresponding to the claim case, for example, the application type of the claim case is property insurance or personal insurance; the identifier of the insurer is used for uniquely identifying the insurer of the claim case, specifically, the identifier can be formed by a self-defined character string, and also can be an identity card number of a user and the like; the first preset time threshold is a time interval, such as 5 hours, calculated by analyzing data such as application time of a large number of received claims, when the same client frequently applies for claims.
In the first claim cases which are the same as the sponsor identification and the application type of the first claim case and have the difference of the claim application time not exceeding a first preset time threshold value are searched in the claim case queue to be allocated, the search sequence is that the first claim cases are searched backwards in sequence from the head of the claim case queue to be allocated until the tail of the claim case queue to be allocated, that is, the searched first claim cases comprise the first claim case.
And step 306, distributing the first claim settlement case to a first management terminal corresponding to the first user identification.
In this embodiment, after different claim cases associated with the same insurer are found out, the found claim cases are allocated to the management terminal where the same user identifier is located, so that the management terminal can sequentially audit the allocated claim cases through the user identifier.
In this embodiment, because the found claim cases are claim cases of the same type of risk corresponding to the same insurer within the preset time range and of different policy types, and then the cases are allocated to the same auditor for auditing, the probability that the claim cases associated with each other are interlocked due to concurrent allocation of the claim cases is effectively reduced, thereby improving the processing efficiency of the claim cases.
In one embodiment, step 306 includes: and if the number of the first claim cases is less than or equal to the preset case processing number, distributing the first claim cases to a first management terminal corresponding to the first user identification.
The preset number of cases is the maximum number of cases for which auditors process claims, and specifically, the preset number of cases for which claims are processed by auditors may be the same value shared by all auditors, for example, the preset number of cases for which auditors are configured as first to third 80, or may be dynamically set according to the preset average number of auditors for cases within a preset time range, for example, the average number of auditors for first to third 100 per day in the first quarter, the average number of auditors for second to third 90 per day in the first quarter, and the average number of auditors for third to third 80 per day in the first quarter, and then the preset number of cases for which claims are configured as second to third 100, 90, and 80, respectively.
In the embodiment, the number of the claim cases distributed to the auditors is limited, so that the efficiency of auditing the claim cases is improved.
In one embodiment, as shown in FIG. 4, step 306 comprises:
and step 316, acquiring the processing state of a second claim case, which is the same as the application type and the sponsor identification of the first claim case, in the distributed claim cases.
In this embodiment, the processing status of the claim case includes: and 5, five states of to-be-audited, auditing, accounting and final planning are realized. When the server receives a claim case input by a user, marking the claim case as a state to be checked, placing the claim case in a task pool, and placing the claim case in a queue of claim cases to be distributed by the server according to application time; an auditor sends an audit request of a claim case, the server distributes a case set comprising the claim case to the auditor according to the method from the step 304 to the step 306, and the auditor sends the audit request to the claim case, so that the audit state of the claim case is changed into audit; when the server receives an audit result (such as whether audit materials are complete and effective, whether a policy corresponding to a claim case has a payable amount, and the like) sent by a terminal where an auditor is located, if the audit materials are all clustered and effective, the policy corresponding to the claim case has the payable amount, and the like), the processing state of the claim case is modified to be settled; the server regularly detects a claim case to be settled, when the claim case is detected, the server settles the claim case according to preset claim rules corresponding to the application type of the claim case, and changes the auditing state of the claim case into settlement; when the settlement result is successfully calculated (namely the settlement amount is calculated), the audit state of the settlement case is changed into the settlement.
In step 326, if the processing status of the second claim case is an end, the first claim case is assigned to the first management terminal corresponding to the first user identifier.
If the processing state of the claim case in the distributed claim cases is an end case, which is the same as the application type and the sponsor identifier of the found claim case, it indicates that no claim case related to the found claim case is currently processed, and the found claim case can be distributed to the management terminal corresponding to the user identifier.
In this embodiment, on the premise of ensuring that the assigned claims associated with the claims to be assigned are processed completely, it is ensured that the mutually associated claims to be assigned are assigned to the same person within the preset time range, so that the problem of cross-interlocking of the mutually associated claims is completely avoided, and the processing efficiency of the claims is further improved.
In one embodiment, after step 326, further comprising: if the processing state of the second claim case is unfinished, acquiring a second user identifier corresponding to the second claim case; and distributing the first claim case to a second management terminal corresponding to the second user identification.
The second user identification is used for uniquely identifying the auditors of the distributed claim cases with the same application types and the identical sponsor identifications of the found claim cases; the second management terminal is a terminal used by auditors of distributed claim cases, wherein the auditors of the distributed claim cases have the same application type and the same sponsor identification of the found claim cases for auditing the distributed claim cases; the non-pending processing state refers to any one of three processing states of auditing, pending calculation and accounting.
In this embodiment, when it is known that the assigned claim case associated with the claim case to be assigned is in an unfinished state (in processing), the claim case to be assigned associated within a preset time range is assigned to the auditor that is auditing the claim case, so that the problem of cross-interlocking of the claim cases associated with each other is also completely avoided, and the processing efficiency of the claim case is further improved.
In one embodiment, after step 306, further comprising: detecting whether an audit result of the first claim case is received within a third preset time threshold value; if yes, the checking result is stored in the database, and if not, the first claim settlement case is recycled to the task pool to be redistributed.
If the preset time range is 1 day, detecting whether the server receives an audit result of the assigned claims within 24 hours after the searched claims are assigned to the auditor by the server, if so, storing the audit result in the database, if not, recovering the claims to the task pool, then placing the claims into a queue of the claims to be assigned according to the sequence of application time of the claims in the task pool, and then assigning the claims according to the methods of the steps 302 to 306.
In one embodiment, as shown in fig. 5, after step 306, the method further includes:
step 502, obtaining the policy type corresponding to the first claim case in the queue of claim cases to be distributed.
In this embodiment, the policy types include individual policies, group policies, and group child policies. Wherein, the personal insurance policy is the insurance policy corresponding to the insurance purchased by the customer on the name of the individual, for example, if three people purchase a medical insurance for the customer, the insurance policy corresponding to the medical insurance purchased by three people is the personal insurance policy; group insurance policy, i.e. the policy corresponding to the insurance purchased by the client on the group name, for example, if the company purchases a commercial insurance for each employee, all employees of the company share a group insurance policy differentiated by the company; the group sub-policy is a policy owned by each individual corresponding to the group policy, such as a policy owned by each employee of the company for a business insurance.
Step 504, if the policy type is a group sub-policy, a third claim case is searched in the queue of claim cases to be distributed, wherein the third claim case has the policy type of the group sub-policy, has the same group policy as the first claim case, and has a difference of no more than a second preset time threshold with the claim applying time of the first claim case.
The second preset time threshold is a time interval, such as 8 hours, calculated in advance according to the claim settlement application time data of different claim settlement cases of the same type corresponding to a large number of different insurers with the same group policy, for carrying out the claim settlement application by the different insurers under the same group policy.
And step 506, distributing the third claim settlement case to the first user terminal corresponding to the first user identification.
After finding out the claim cases corresponding to other insurers on the insurance policy corresponding to the first-queue claim case in the queue of claim cases to be distributed, distributing the claim cases corresponding to the other insurers and the found out claim cases related to the first-queue claim case to the same auditor.
In the embodiment, the claim settlement cases of the same type corresponding to different insurers under the same group insurance policy are distributed to the same auditor for auditing within a preset time range, and because the material checking method and the claim settlement calculating method of the claim settlement cases of the same type corresponding to different insurers under the same group insurance policy are the same, the auditor can quickly complete the auditing of the claim settlement cases, and the processing efficiency of the claim settlement cases is improved.
In one embodiment, as shown in fig. 6, there is further provided another method for allocating a claim case, including:
step 602, receiving a claim case audit request initiated by a first management terminal, where the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used to uniquely identify a user initiating the claim case audit request.
Similarly, the first management terminal is a terminal used by an auditor for sending a request for checking the claim cases stored in the database to the server; the first user identification is used for uniquely identifying the user who initiates the claim case audit request.
In this embodiment, the claim case audit request received by the server is a claim case audit request sent by the first management terminal to the server through the first user identifier.
Step 604, searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in the queue of claim cases to be distributed.
Similarly, in this embodiment, the claim case to be distributed is a claim case waiting for review among the received claim cases; the first-queue claim case is a claim case located at the head-queue position of the queue of claim cases to be allocated; the application type is the type of the dangerous type on the policy corresponding to the claim case, for example, the application type of the claim case is property insurance or personal insurance; the identifier of the insurer is used for uniquely identifying the insurer of the claim case, specifically, the identifier can be formed by a self-defined character string, and also can be an identity card number of a user and the like; the first preset time threshold is a time interval calculated by analyzing data such as application time of a large number of received claims, wherein the data is the time interval at which the same client frequently applies for claims.
Step 606, acquiring the processing state of the second claim case which is the same as the application type and the sponsor identification of the first claim case in the distributed claim cases,
likewise, the processing status of a claim case includes: and 5, five states of to-be-audited, auditing, accounting and final planning are realized.
Step 608, determine whether the processing status of the second claim case is an end case, if yes, go to step 610, otherwise go to step 611.
In this embodiment, the processing state of the claim case is unfinished, which means that the current processing state of the claim case is any one of an examination state, a pending state and an settlement state.
Step 610, if the number of the first claim cases is less than the preset case processing number, obtaining the policy type corresponding to the first-in-line claim case.
Likewise, in the present embodiment, the policy types include individual policies, group policies, and group child policies. Wherein, the personal insurance policy is the insurance policy corresponding to the insurance purchased by the customer on the name of the individual, for example, if three people purchase a medical insurance for the customer, the insurance policy corresponding to the medical insurance purchased by three people is the personal insurance policy; group insurance policy, i.e. the policy corresponding to the insurance purchased by the client on the group name, for example, if the company purchases a commercial insurance for each employee, all employees of the company share a group insurance policy differentiated by the company; the group sub-policy is a policy owned by each individual corresponding to the group policy, such as a policy owned by each employee of the company for a business insurance.
Step 611, obtain a second user identifier corresponding to the second claim settlement case, and allocate the first claim settlement case to a second management terminal corresponding to the second user identifier.
Similarly, the second user identification is used for uniquely identifying the auditors of the distributed claim cases with the same application types and the identical sponsor identifications of the found claim cases; the second management terminal is a terminal used by auditors of distributed claim cases, wherein the auditors of the distributed claim cases have the same application type and the same sponsor identification of the found claim cases, and the audit personnel of the distributed claim cases audit personnel review the distributed claim cases.
Step 612, if the policy type is a group sub-policy, searching a third claim case, in which the policy type is the group sub-policy, in the queue of claim cases to be distributed, the third claim case has the same group policy as the first claim case and has a difference of no more than a second preset time threshold from the claim applying time of the first claim case.
The second preset time threshold is the time interval of claim settlement application of different insurers under the same group policy, which is calculated in advance according to the claim settlement application time data of different claim settlement cases of the same type corresponding to a large number of different insurers with the same group policy.
And 614, if the sum of the number of the first claim case and the third claim case is less than or equal to the preset case processing number, distributing the first claim case and the third claim case to the first user terminal corresponding to the first user identifier.
After finding out the claim cases corresponding to other insurers on the insurance policy corresponding to the first-queue claim case in the queue of claim cases to be distributed, distributing the claim cases corresponding to the other insurers and the found out claim cases related to the first-queue claim case to the same auditor.
In step 616, if the number of the first claim cases is equal to the preset case processing number, the first claim cases are distributed to the first management terminal corresponding to the first user identifier.
And if the number of the found claims cases associated with the first-in-line claims case in the queue of claims cases to be distributed reaches the preset case processing number, directly distributing the found claims cases to the management terminal initiating the case audit request.
In the embodiment, on the premise of ensuring that the assigned claim cases associated with the claim cases to be assigned are processed, the mutually associated claim cases to be assigned within the preset time range are ensured to be assigned to the same auditor, so that the problem of cross interlocking of the mutually associated claim cases is completely avoided, and the processing efficiency of the claim cases is effectively improved; the number of claim cases distributed to auditors is limited, and the processing efficiency of claim cases is further improved; meanwhile, the number of the claim cases distributed to the auditors is ensured to be within the auditing tolerance of the auditors, the claim cases corresponding to other group sub-insurance policies (and other insurers) with the same group insurance policy as the mutually-related claim cases are distributed to the same auditors, and the processing efficiency of the claim cases is further improved because the material auditing method and the claim operation rule of the two are the same.
In one embodiment, as shown in fig. 7, there is provided a claim case distribution apparatus including:
a claim case audit request receiving module 702, configured to receive a claim case audit request initiated by a first management terminal, where the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used to uniquely identify a user initiating the claim case audit request;
the claim case searching module 704 is used for searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in the claim case queue to be distributed;
the claim case distributing module 706 is configured to distribute the first claim case to the first management terminal corresponding to the first user identifier.
In one embodiment, the claim case allocation module 706 is configured to determine whether the number of the first claim cases is less than or equal to a preset case processing number; and if so, distributing the first claim settlement case to a first management terminal corresponding to the first user identification.
In one embodiment, the claim case allocation module 706 is configured to obtain the processing status of a second claim case in the allocated claim cases, wherein the second claim case is the same as the first claim case in application type and the sponsor identification; and if the processing state of the second claim case is an end case, distributing the first claim case to a first management terminal corresponding to the first user identification.
In one embodiment, the claim case allocation module 706 is configured to, if the processing status of the second claim case is unfit, obtain a second user identifier corresponding to the second claim case; and distributing the first claim case to a second management terminal corresponding to the second user identification.
In one embodiment, the claim case allocation module 706 is configured to obtain a policy type corresponding to the first-in-queue claim case; if the policy type is a group sub-policy, searching a third claim case, of which the policy type is the group sub-policy, in the queue of claim cases to be distributed, wherein the third claim case has the same group policy as the group head claim case and has a difference of no more than a second preset time threshold with the claim application time of the group head claim case;
and distributing the third claim settlement case to the first user terminal corresponding to the first user identification.
In one embodiment, a computer-readable storage medium is provided, on which a computer program is stored which, when executed by a processor, performs the steps of:
receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used for uniquely identifying a user initiating the claim case audit request;
searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in a claim case queue to be distributed;
and distributing the first claim settlement case to a first management terminal corresponding to the first user identification.
In one embodiment, the assigning of the first claim case to the first management terminal corresponding to the first subscriber identity, performed by the processor, includes: judging whether the number of the first claim cases is less than or equal to the preset case processing number or not; and if so, distributing the first claim settlement case to a first management terminal corresponding to the first user identification.
In one embodiment, the assigning of the first claim case to the first management terminal corresponding to the first subscriber identity, performed by the processor, includes: acquiring the processing state of a second claim case, which is the same as the application type and the sponsor identification of the first claim case, in the distributed claim cases; and if the processing state of the second claim case is an end case, distributing the first claim case to a first management terminal corresponding to the first user identification.
In one embodiment, if the processing status of the second claim case is unfinished, the processor acquires a second user identifier corresponding to the second claim case; and distributing the first claim case to a second management terminal corresponding to the second user identification.
In one embodiment, the obtaining performed by the processor of the policy type corresponding to the head-of-line claim case; if the policy type is a group sub-policy, searching a third claim case, of which the policy type is the group sub-policy, in the queue of claim cases to be distributed, wherein the third claim case has the same group policy as the group head claim case and has a difference of no more than a second preset time threshold with the claim application time of the group head claim case; allocating the third claim settlement case to the first user terminal corresponding to the first user identification
In one embodiment, a computer device is provided, the computer device comprising a memory, a processor and a computer program stored on the memory and executable on the processor, the processor implementing the following steps when executing the computer program:
receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used for uniquely identifying a user initiating the claim case audit request;
searching a first claim case which has the same application type and the same sponsor identification as the first claim case and has a claim application time difference not exceeding a first preset time threshold in a claim case queue to be distributed;
and distributing the first claim settlement case to a first management terminal corresponding to the first user identification.
In one embodiment, the assigning of the first claim case to the first management terminal corresponding to the first subscriber identity, performed by the processor, includes: judging whether the number of the first claim cases is less than or equal to the preset case processing number or not; and if so, distributing the first claim settlement case to a first management terminal corresponding to the first user identification.
In one embodiment, the assigning of the first claim case to the first management terminal corresponding to the first subscriber identity, performed by the processor, includes: acquiring the processing state of a second claim case, which is the same as the application type and the sponsor identification of the first claim case, in the distributed claim cases; and if the processing state of the second claim case is an end case, distributing the first claim case to a first management terminal corresponding to the first user identification.
In one embodiment, if the processing status of the second claim case is unfinished, the processor acquires a second user identifier corresponding to the second claim case; and distributing the first claim case to a second management terminal corresponding to the second user identification.
In one embodiment, the obtaining performed by the processor of the policy type corresponding to the head-of-line claim case; if the policy type is a group sub-policy, searching a third claim case, of which the policy type is the group sub-policy, in the queue of claim cases to be distributed, wherein the third claim case has the same group policy as the group head claim case and has a difference of no more than a second preset time threshold with the claim application time of the group head claim case; and distributing the third claim settlement case to the first user terminal corresponding to the first user identification.
It should be noted that "first", "second", and "third" in the embodiments of the present invention are used for distinction only, and are not used as limitations on the size, dependency, sequence, and the like. For example, the first management terminal and the second management terminal are merely used to distinguish different management terminals, and the first management terminal may be referred to as the second management terminal, and similarly, the second management terminal may be referred to as the first management terminal, and the first management terminal and the second management terminal are both management terminals, but not the same management terminal, without departing from the scope of the present invention.
The technical features of the embodiments described above may be arbitrarily combined, and for the sake of brevity, all possible combinations of the technical features in the embodiments described above are not described, but should be considered as being within the scope of the present specification as long as there is no contradiction between the combinations of the technical features.
The above-mentioned embodiments only express several embodiments of the present invention, and the description thereof is more specific and detailed, but not construed as limiting the scope of the invention. It should be noted that, for a person skilled in the art, several variations and modifications can be made without departing from the inventive concept, which falls within the scope of the present invention. Therefore, the protection scope of the present patent shall be subject to the appended claims.

Claims (10)

1. A method of claim case distribution, the method comprising:
when a claim case input by a user is received, marking the claim case as a state to be checked, placing the claim case in a task pool, and placing the claim case in a queue of claim cases to be distributed according to application time; receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used for uniquely identifying a user initiating the claim case audit request;
in a claim case queue to be distributed, sequentially searching backwards from the head of the claim case queue to be distributed to the tail of the claim case queue to be distributed, and searching a first claim case which is composed of a plurality of related claim cases, wherein the application type and the identifier of a sponsor of the first claim case are the same, and the difference of claim application time does not exceed a first preset time threshold;
distributing the first claim settlement case to the first management terminal corresponding to the first user identification;
acquiring a policy type corresponding to the first-team claim case;
if the policy type is a group sub-policy, searching a third claim case with the policy type being a group sub-policy in the queue of claim cases to be distributed, wherein the third claim case has the same group policy as the group head claim case and has a difference with the claim application time of the group head claim case not more than a second preset time threshold;
distributing the third claim settlement case to a first user terminal corresponding to a first user identification;
detecting whether an audit result of the first claim case is received within a third preset time threshold value; if yes, the checking result is stored in the database, and if not, the first claim settlement case is recycled to the task pool to be redistributed.
2. The method of claim 1, wherein the assigning the first claim case to the first management terminal corresponding to the first subscriber identity comprises:
judging whether the number of the first claim cases is less than or equal to a preset case processing number or not;
and if so, distributing the first claim settlement case to the first management terminal corresponding to the first user identification.
3. The method of claim 1, wherein the assigning the first claim case to the first management terminal corresponding to the first subscriber identity comprises:
acquiring the processing state of a second claim case, which is the same as the application type and the sponsor identification of the first claim case, in the distributed claim cases;
and if the processing state of the second claim case is an end case, distributing the first claim case to the first management terminal corresponding to the first user identifier.
4. The method of claim 3, further comprising:
if the processing state of the second claim case is unfinished, acquiring a second user identifier corresponding to the second claim case;
and distributing the first claim settlement case to a second management terminal corresponding to a second user identification.
5. A claim case distribution apparatus, the apparatus comprising:
the system comprises a claim case auditing request receiving module, a task pool and a file distributing module, wherein the claim case auditing request receiving module is used for marking a claim case to be in an auditing state when receiving the claim case input by a user, placing the claim case in the task pool, and then placing the claim case in a claim case queue to be distributed according to application time; receiving a claim case audit request initiated by a first management terminal, wherein the claim case audit request carries a first user identifier corresponding to the first management terminal, and the first user identifier is used for uniquely identifying a user initiating the claim case audit request;
the system comprises a claims case searching module, a file processing module and a file processing module, wherein the claims case searching module is used for sequentially searching backwards from the head of a to-be-distributed claims case queue to the tail of the to-be-distributed claims case queue in the to-be-distributed claims case queue, and searching a first claim case which is formed by a plurality of related claims cases, wherein the related claims cases have the same application type and the same sponsor identification as the first claim case and have the claim application time difference not exceeding a first preset time threshold;
the claim case distribution module is used for distributing the first claim case to the first management terminal corresponding to the first user identifier; acquiring a policy type corresponding to the first-team claim case; if the policy type is a group sub-policy, searching a third claim case with the policy type being a group sub-policy in the queue of claim cases to be distributed, wherein the third claim case has the same group policy as the group head claim case and has a difference with the claim application time of the group head claim case not more than a second preset time threshold; distributing the third claim settlement case to a first user terminal corresponding to a first user identification; detecting whether an audit result of the first claim case is received within a third preset time threshold value; if yes, the checking result is stored in the database, and if not, the first claim settlement case is recycled to the task pool to be redistributed.
6. The apparatus of claim 5, wherein the claim case allocation module is configured to determine whether the number of first claim cases is less than or equal to a preset case processing number; and if so, distributing the first claim settlement case to the first management terminal corresponding to the first user identification.
7. The apparatus according to claim 5, wherein the claim case allocation module is configured to obtain the processing status of a second claim case of the allocated claim cases, which is the same as the first claim case in application type and the sponsor identification; and if the processing state of the second claim case is an end case, distributing the first claim case to the first management terminal corresponding to the first user identifier.
8. The apparatus according to claim 7, wherein the claim case allocation module is configured to obtain a second user identifier corresponding to the second claim case if the processing status of the second claim case is unfit; and distributing the first claim settlement case to a second management terminal corresponding to a second user identification.
9. A computer-readable storage medium, on which a computer program is stored which, when being executed by a processor, carries out the steps of the method according to any one of claims 1 to 4.
10. A computer device comprising a memory, a processor and a computer program stored on the memory and executable on the processor, the processor implementing the steps of the method according to any one of claims 1 to 4 when executing the computer program.
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