CN111008902A - Method, device, equipment and medium for processing data of underwriting - Google Patents
Method, device, equipment and medium for processing data of underwriting Download PDFInfo
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- CN111008902A CN111008902A CN201911167329.6A CN201911167329A CN111008902A CN 111008902 A CN111008902 A CN 111008902A CN 201911167329 A CN201911167329 A CN 201911167329A CN 111008902 A CN111008902 A CN 111008902A
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- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
Abstract
The invention discloses an underwriting data processing method, device, equipment and medium, which are used for realizing the automation of secondary underwriting and improving the secondary underwriting efficiency of a policy. In the method, the information of the insured person is determined according to the acquired identification information of the policy; determining that past claim records of the insured person and past claim records of the insured person contain ICD codes of diseases; judging whether the ICD code is contained in a blacklist or not; if the ICD code is not contained in the blacklist, judging whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not; and if so, determining the identifier of the secondary underwriting conclusion of the policy as a refusal insurance identifier. According to the invention, the automatic processing of the policy warranty data is realized by setting the judgment condition of the policy warranty, and the secondary policy warranty efficiency of the policy warranty is improved.
Description
Technical Field
The present invention relates to the field of computer technologies, and in particular, to a method, an apparatus, a device, and a medium for processing underwriting data.
Background
In the existing policy underwriting business, a large number of policies requiring secondary underwriting exist in insurance companies, wherein primary underwriting fails, but the existing underwriting system does not support secondary underwriting operation of the policies, so that policies requiring secondary underwriting operation can only be underwritten manually by underwriting personnel, and as the number of the policies increases, the working pressure of the underwriting personnel increases, and the efficiency of secondary underwriting of the policies is low.
Disclosure of Invention
The embodiment of the invention provides an underwriting data processing method, device, equipment and medium, which are used for solving the problem of low efficiency of secondary underwriting of a policy in the prior art.
The embodiment of the invention provides an underwriting data processing method, which comprises the following steps:
determining the information of the insured person according to the acquired identification information of the policy;
determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases;
judging whether the ICD code is contained in a blacklist or not;
if the ICD code is not contained in the blacklist, judging whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not;
and if so, determining the identifier of the secondary underwriting conclusion of the policy as a refusal insurance identifier.
Further, the method further comprises:
and displaying the determined identifier of the secondary underwriting conclusion of the policy aiming at the policy of the identification information.
Further, the method further comprises:
if the number of past claim settlement records of which the claim settlement time is within a first set year range before the current time is not greater than a set number threshold value;
determining the identifier of the secondary underwriting conclusion of the policy as a self-core passing identifier.
Further, if the ICD codes are not included in the black list, before the determining whether the number of past claim records in a first set year range before the current time is greater than a set number threshold, the method further includes performing at least one of the following determinations:
judging whether the past claim settlement records with the insured life responsibility being serious disease responsibility exist in the past claim settlement records of the second set year range before the current time, or;
and judging whether the past claim settlement records of the insured person have past claim settlement records of which the claim settlement time is within the verification time of the policy.
Further, if the judgment result of the at least one judgment is yes, determining the identifier of the secondary underwriting conclusion of the policy as a rejection identifier.
Further, before determining that the past claims record of the insured life and the past claims record of the insured life contain ICD codes for diseases, the method further comprises:
determining product information of the policy;
judging whether the product information of the insurance policy exists in a product information configuration table capable of automatic underwriting;
and if so, executing the operation of determining that the past claim record of the insured person and the past claim record of the insured person contain ICD codes of diseases.
Further, the method further comprises:
and if the product information of the insurance policy does not exist in the product information configuration table capable of carrying out automatic insurance verification, determining the identifier of the secondary insurance conclusion of the insurance policy as the artificial insurance verification identifier.
The embodiment of the invention provides an underwriting data processing device, which comprises:
the determining module is used for determining the information of the insured person according to the acquired identification information of the policy; determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases;
the judging module is used for judging whether the ICD code is contained in a blacklist or not; if the ICD code is not contained in the blacklist, judging whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not;
and the conclusion module is used for determining the identifier of the secondary underwriting conclusion of the policy as the refusal insurance identifier if the number of the past claims records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold.
Further, the apparatus further comprises:
and the display module is used for displaying the determined identifier of the secondary underwriting conclusion of the policy aiming at the policy of the identification information.
Further, the conclusion module is further configured to determine whether the number of past claim records within a first set year range before the current time is greater than a set number threshold; determining the identifier of the secondary underwriting conclusion of the policy as a self-core passing identifier.
Further, the determining module is further configured to determine whether the ICD codes are not included in the blacklist, and before determining whether the number of past claim records in a first set year range before the current time is greater than a set number threshold; performing at least one of the following determinations:
judging whether the past claim settlement records with the insured life responsibility being serious disease responsibility exist in the past claim settlement records of the second set year range before the current time, or; and judging whether the past claim settlement records of the insured person have past claim settlement records of which the claim settlement time is within the verification time of the policy.
Further, the conclusion module is configured to determine, if a determination result of at least one of the determinations in the determination module is yes, an identifier of the secondary underwriting conclusion of the policy as a refusal identifier.
Further, the determining module is further configured to determine product information of the policy;
the judging module is further configured to judge whether the product information of the policy exists in a product information configuration table capable of automatic underwriting, and if the product information of the policy exists in the product information configuration table capable of automatic underwriting, trigger the determining module to perform determination of the past claim settlement record of the insured person and the past claim settlement record of the insured person.
Further, the conclusion module is further configured to determine, if the product information of the policy does not exist in the product information configuration table capable of automatic underwriting, an identifier of a secondary underwriting conclusion of the policy as an artificial underwriting identifier.
An embodiment of the present invention provides an electronic device, where the electronic device includes a processor and a memory, where the memory is used to store program instructions, and the processor is used to implement the steps of any one of the above-mentioned underwriting data processing methods when executing a computer program stored in the memory.
An embodiment of the present invention provides a computer-readable storage medium, which stores a computer program, and when the computer program is executed by a processor, the computer program implements the steps of any one of the above-mentioned underwriting data processing methods.
The embodiment of the invention provides an underwriting data processing method, device, equipment and medium, based on underwriting data in an insurance policy of secondary underwriting, whether the underwriting data of the secondary underwriting meets the condition that ICD codes containing diseases in past claim records of an insured person are not in a blacklist and the number of claim records of the insured person in the past claim records within a set insurance year before the current time is greater than a set number threshold value is judged, whether a secondary underwriting conclusion of the insurance policy is refused to be underwriting is judged, so that the automation of underwriting data processing is realized, and the secondary underwriting efficiency of the insurance policy is improved.
Drawings
In order to more clearly illustrate the technical solutions in the embodiments of the present invention, the drawings needed to be used in the description of the embodiments will be briefly introduced below, and it is obvious that the drawings in the following description are only some embodiments of the present invention, and it is obvious for those skilled in the art to obtain other drawings based on these drawings without inventive exercise.
Fig. 1 is a schematic process diagram of a method for processing underwriting data according to an embodiment of the present invention;
fig. 2 is a schematic process diagram of another method for processing the underwriting data according to the embodiment of the present invention;
fig. 3 is a schematic process diagram of another method for processing the underwriting data according to the embodiment of the present invention;
fig. 4 is a schematic structural diagram of an underwriting data processing apparatus according to an embodiment of the present invention;
fig. 5 is a schematic structural diagram of an electronic device according to an embodiment of the present invention.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention clearer, the present invention will be described in further detail with reference to the accompanying drawings, and it is apparent that the described embodiments are only a part of the embodiments of the present invention, not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
In order to improve the efficiency of secondary underwriting of a policy, embodiments of the present invention provide an underwriting data processing method, apparatus, device, and medium.
Example 1:
fig. 1 is a schematic process diagram of a method for processing underwriting data according to an embodiment of the present invention, where the process includes the following steps:
s101: and determining the information of the insured life according to the acquired identification information of the policy.
The policy is a policy requiring secondary underwriting, and in order to distinguish each policy, identification information of the policy is determined when underwriting data in the policy is recorded, wherein the identification information of the policy is information capable of uniquely identifying the policy, and can be a policy number of the policy, or the policy number and a number of a insured person of the policy; preferably, to accurately identify the policy, the identification information of the policy includes a public number, a policy number and an insured person number.
When recording, the product information of each policy, the information of the insured person, and the underwriting data such as other information are stored for the identification information of each policy. Because the identification information of the policy is unique information for identifying the policy, the insurance data such as product information of the policy and information of the insured person can be determined from the storage space for storing the insurance policy insurance data according to the identification information of the policy.
The information of the insured person in the underwriting data refers to the stored information related to the insured person, and specifically may be a fixed client number and personal information of the insured person distributed by the insured person in the insurance company, that is, personal information such as the type and number of the insured person.
S102: and determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases.
The past claim records of the insured life refer to the claim records of all claims applied by the insured life before the current time, and the past claim records are the claims of all insurable policy of the insured life and do not distinguish the risk types of the policy.
The ICD code is an international disease classification code, which is a code for classifying diseases according to the characteristics of the diseases and rules. The past claim records of the insured life include claim records which are carried out according to diseases, and ICD codes corresponding to the diseases are determined.
After the information of the insured person of the policy in the underwriting data is determined, the past claim settlement records of the insured person and ICD codes containing diseases in the past claim settlement records are determined according to the information of the insured person in the underwriting data; specifically, after the information of the insured person in the policy underwriting data is determined, the information is inquired in the claim system through the past claim settlement record inquiry interface.
S103: and judging whether the ICD code is contained in a blacklist or not.
The blacklist is pre-stored in the storage space, and the blacklist comprises ICD codes of diseases which seriously affect human life, such as the ICD codes of diseases of leukemia, lung cancer and the like; after determining the ICD codes corresponding to the past claim records of the insured person, in order to determine the physical condition of the insured person, it is necessary to determine whether the ICD codes are included in the blacklist.
S104: if the ICD code is not contained in the blacklist, whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not is judged.
Upon determining that the ICD code for the illness in the past claims record for the insured person is not included in the blacklist, the insured person may be determined to be physically healthy and thus underwriting of the policy may continue.
When the physical health condition of the insured person is ensured to be good, in order to reduce the risk, the past claim records of the insured person are required to be as few as possible, if the past claim records of the insured person in a period of time are many, the possibility that the insured person is in a condition of requiring claim during the validation period of the policy is high, and therefore, whether the number of the past claim records of the insured person in the first set year range before the current time is greater than the set number threshold value or not needs to be judged.
The claim settling time may be a filing time of a claim after the applicant applies for the claim, or may be any day from the application of the claim to the filing of the claim, and specifically, the embodiment of the present invention is not limited thereto.
The first set year range is preset, and may be a policy year range, such as 3 policy year ranges, 5 policy year ranges, or other set specific year ranges; the policy year refers to the time from the date when the insurance contract is effective or the time zero corresponding to the time zero when the insurance contract is effective in the next year. For example, the policy that takes effect in 2018, 2 and 6 months is a policy year from 2018, 2 and 6 months to 2019, 2 and 6 months, namely one policy year is equivalent to a natural year; the number threshold is preset, and the size of the number threshold is related to a set annual range, and the wider the annual range is, the larger the set number threshold is. Specifically, the embodiment of the present invention does not limit the specific annual range and the number threshold.
For example, when the first set annual range is 5 policy annual ranges, the number of past claim records of the insured person in the past claim records of the insured person whose claim time is within 5 policy annual ranges before the current time is determined, and the number of past claim records of the insured person in the time range from 11/7/2014 to 11/7/2019 is determined, taking the current time as 11/7/2019 as an example.
S105: and if so, determining the identifier of the secondary underwriting conclusion of the policy as a refusal insurance identifier.
And when the number of past claim records of which the claim time is within the set annual range before the current time in the past claim records of the insured person is greater than the set number threshold, determining the identifier of the secondary underwriting conclusion of the policy as the security refusal identifier.
Wherein, the mark is used for marking the secondary underwriting conclusion of the policy, and the mark can be a digital mark or a symbol mark; preferably, the mark is a text mark; and different secondary underwriting conclusions correspond to different identifiers.
For example, if the set policy year is 5 policy years and the set number threshold is 15, if the number of past claim records in the past claim record of the insured person within 5 policy years before the current time is 17, the number is greater than the set number threshold 15, so the identifier of the secondary underwriting conclusion of the policy is determined as the identifier of refusal to protect.
S106: and if the number of the past claim records of which the claim time is within a first set year range before the current time is not greater than a set number threshold, determining the identifier of the secondary verification conclusion of the policy as a self-verification passing identifier.
If the number of past claim records of the insured person in a period of time before the insurance policy is approved is within a certain range, the risk that the insured person has a condition needing claim in the period of the policy validation is within a controllable range, and the identification of the secondary insurance result of the policy can be determined as the self-approval pass identification.
Therefore, if the number of past claim records in the first set year range before the current time is not greater than the set number threshold, the identification of the secondary underwriting conclusion of the policy is determined as the self-underwriting pass identification. Wherein, the first set year range and the number threshold are preset.
For example, if the first set year range is 3 years and the set quantity threshold is 10, if the quantity of past claim records in the past claim records of the insured person whose claim time is within 3 years before the current time is 10, the quantity value is equal to the set quantity threshold 10, and therefore, the identification of the secondary underwriting conclusion of the policy is the self-approval passing identification.
The embodiment of the invention provides an automatic underwriting method, device, equipment and medium, wherein in the method, based on underwriting data in an insurance policy of secondary underwriting, whether the underwriting data in the insurance policy of the secondary underwriting meets the condition that ICD codes containing diseases in the past claim records of an insured person are not in a blacklist and the number of claim records of the insured person in the past claim records within a set insurance policy year before the current time is greater than a set number threshold value is judged, and whether a secondary underwriting conclusion of the insurance policy is refused to be underwritten or not is judged. By using the automatic judgment method, the working pressure of the underwriting personnel is reduced, and the secondary underwriting efficiency of the policy is improved.
Example 2:
in order to improve the accuracy of secondary underwriting of an insurance policy, in an embodiment of the present invention, on the basis of the above embodiment, if the ICD codes are not included in the blacklist, before the determining whether the number of past claim records in a first set year range before the current time is greater than a set number threshold, the method further includes performing at least one of the following determinations:
judging whether the past claim settlement records with the insured life responsibility being serious disease responsibility exist in the past claim settlement records of the second set year range before the current time, or;
and judging whether the past claim settlement records of the insured person have past claim settlement records of which the claim settlement time is within the verification time of the policy.
In order to improve the accuracy of secondary underwriting of the policy, before judging whether the number of past claim settlement records of the claim time in the first set year range before the current time is greater than the set number threshold, other aspects of judgment can be carried out on the past claim settlement records of the insured person.
In order to reduce the risk, the physical health condition of the insured person needs to be determined, in the past claim record of the insured person, if the claim record with the risk liability of being serious illness exists in the past claim record of the insured person, the physical health condition of the insured person is not good, and if the policy of the insured person is received, the insured person bears a larger risk. Therefore, whether the past claim records with the insurance liability being serious illness liability exist in the past claim records with the claim time in the second set year range before the current time needs to be judged.
The second set year range is preset, and the size of the second set year range is related to the size of the policy risk, and the second set year range may be set to be larger if the policy risk is low, and may be set to be smaller if a certain degree of risk can be borne.
The serious disease responsibility is determined according to the claim responsibility codes corresponding to the insurance policy risk species, and particularly, the claim responsibility codes corresponding to the serious disease responsibility comprise A1, A2, A3, A4, A5, F3, F4, F7, F8, F9, H1, H2, H3, R0, R1, S1, M1 and J3; if any one of the codes appears in the responsibility codes of the past claim record of the insured person, the responsibility of the claim of the insured person is serious responsibility, and the physical health state of the insured person is not good.
If the past claim settlement records with the insured person insurance liability being the serious disease liability exist in the past claim settlement records in the second set year range before the current time, determining the identifier of the secondary underwriting conclusion of the policy as the identifier for refusal insurance; if the past claim records with the risk liability of the insured person being serious liability do not exist in the past claim records in the second set year range before the current time, the policy is operated to judge whether the number of the past claim records in the first set year range before the current time is greater than the set number threshold value.
For example, the second set year range is 1 policy year, if a past claim record with claim responsibility code a1 exists in all past claim records in the past claim record of the insured person, the claim time is in 1 policy year range before the current time, it indicates that a past claim record with the insured person being responsible for serious illness exists in the past claim records in the second set year range before the current time, and at this time, the identifier of the secondary verification conclusion of the insured person is determined as the anti-insurance identifier; if the past claim records of the insured person do not contain past claim records including any one of the claim responsibility codes corresponding to the serious disease responsibility in all the past claim records of which the claim time is within 1 policy year before the current time in the past claim records of the insured person, the policy is operated to judge whether the number of the past claim records of which the claim time is within the first set year before the current time is greater than the set number threshold value.
Or, in the checking time of the policy, if the insured person has an accident, the insurance company bears a greater risk, and therefore, in order to reduce the risk, it is necessary to determine whether there is a past claim record in the past claim record of the insured person, wherein the claim time is within the checking time of the policy.
In the determination condition, the claim settlement time is specifically a time of occurrence, that is, the day of occurrence of the insured life accident. The verification time is the time period from the time the user's application is received to the time it is present. If the past claim settlement records of the insured person have the past claim settlement records of which the claim settlement time is within the verification time of the policy, the insured person is indicated to have an accident within the verification time of the policy.
If the past claim records of which the claim time is within the verification time of the insurance policy exist in the past claim records of the insured person, determining the identifier of the secondary verification conclusion of the insurance policy as a rejection identifier, and if the past claim records of the insured person do not have the past claim records of which the claim time is within the verification time of the insurance policy, performing operation on the insurance policy for judging whether the number of the past claim records of which the claim time is within a first set year range before the current time is greater than a set number threshold value.
For example, the insurance policy has an application date of 10 and 15 days in 2019 and a current time of 11 and 7 days in 2019, the verification time is from 10 and 15 days in 2019 to 11 and 7 days in 2019, if an accident occurs in 11 and 1 days in 2019, the insurance date is within the verification time of the insurance policy, it indicates that past claim records of the insured person have past claim records with claim time within the verification time of the insurance policy, and at this time, the identifier of the secondary verification conclusion of the insurance policy is determined as an identifier for refusal to protect; if the insured life has an accident in 2019, 10 and 14 days, because the insurance date is not in the verification time of the policy, the policy is operated to judge whether the number of past claim settlement records in the first set year range before the current time is greater than the set number threshold value.
If both judgment conditions exist, whether the past claim record with the insured person's risk liability being serious disease liability exists in the past claim records in a second set year range before the current time can be judged, and if the judgment result is yes, the secondary underwriting conclusion identifier of the policy is determined as the security refusal identifier; if the judgment result is negative, judging whether the past claim settlement record of the insured person has a past claim settlement record of which the claim settlement time is within the verification time of the policy or not; and if the judgment result is yes, determining the secondary underwriting conclusion mark of the policy as an insurance refusing mark, and if the judgment result is no, performing operation on the policy to judge whether the number of the past claim records of the claim settlement time in a first set year range before the current time is greater than a set number threshold value.
Or whether the past claim settlement record of which the claim settlement time is within the verification time of the policy exists in the past claim settlement record of the insured person can be judged firstly, and if the judgment result is yes, the secondary verification conclusion identifier of the policy is determined as the security refusal identifier; and if the judgment result is negative, judging whether the past claim records with the insured person's risk liability being serious liability exist in the past claim records in a second set year range before the current time, if so, determining the secondary check and guarantee conclusion identifier of the policy as a rejection identifier, and if not, performing operation on the policy to judge whether the number of the past claim records in a first set year range before the current time is greater than a set number threshold value.
Still by way of example, if a past claim record with a claim responsibility code of a1 exists in all past claim records in the past claim record of the insured person within 1 policy year range before the current time, determining a secondary claim conclusion identifier of the insured form as a claim rejection identifier, if a past claim record does not exist in all past claim records in the past claim record of the insured person within 1 policy year range before the current time, determining whether a claim record exists in all past claim records in the past claim record of the insured person within 1 policy year range before the current time and including any one of the claim responsibility codes corresponding to the serious disease responsibility codes, and if an accident occurs in 11 th day of 2019 year 11/7 year, determining a secondary claim conclusion identifier of the insured form as a claim rejection identifier; if the insured life has no accident from 2019, 10, 15 to 2019, 11, 7, the policy is operated to judge whether the number of past claim settlement records in a first set year range before the current time is greater than a set number threshold value.
In order to improve the efficiency of policy underwriting, in the embodiment of the present invention, if the judgment result of the at least one judgment is yes, the secondary underwriting conclusion identifier of the policy is determined as the refusal identifier.
Fig. 2 is a flowchart of another method for processing underwriting data according to an embodiment of the present invention, where the method includes the following steps:
s201: and determining the information of the insured person in the policy underwriting data according to the acquired identification information of the policy.
S202: determining that the past claims record of the insured life and the past claims record of the insured life contain ICD codes of diseases.
S203: determining whether the ICD code is included in the blacklist, if not, entering S204, and if so, entering S209.
S204: and judging whether the past claim record with the insurance liability being the serious disease liability exists in the past claim records in the second set year range before the current time, if so, entering S207, and if not, entering S205.
S205: judging whether the past claim settlement records of the insured person have past claim settlement records with the claim settlement time within the verification time of the policy, if so, entering S207; if not, the process proceeds to S206.
S206: judging whether the number of past claim records in a first set year range before the current time of the claim time is greater than a set number threshold value or not, and if so, entering S207; if not, the process proceeds to S208.
S207: and determining the identifier of the secondary underwriting conclusion of the policy as the refusal insurance identifier.
S208: and determining the identity of the secondary underwriting conclusion of the policy as a self-core passing identity.
S209: and determining the identifier of the secondary underwriting conclusion of the policy as the artificial underwriting identifier.
S210: and displaying the determined identification of the secondary underwriting conclusion of the policy.
Example 3:
in order to accurately identify the policy that can be automatically subjected to secondary underwriting by the electronic device, on the basis of the foregoing embodiments, in an embodiment of the present invention, before determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases, the method further includes:
determining product information of the policy;
judging whether the product information of the insurance policy exists in a product information configuration table capable of automatic underwriting;
and if so, executing the operation of determining that the past claim record of the insured person and the past claim record of the insured person contain ICD codes of diseases.
In order to accurately identify the policy capable of automatically performing secondary underwriting through the electronic device, before the policy starts secondary underwriting, whether the policy can be automatically underwriting needs to be judged according to the product information configuration table and the product information in the policy underwriting data, and if the policy can be automatically underwriting, the secondary underwriting of the policy is performed.
The product information configuration table refers to the relevant configuration information of each insurance product existing in the insurance company, and the insurance policy can be automatically verified only if the product information in the insurance policy verification data exists in the product information configuration table.
Specifically, before determining that the past claim record of the insured life and the ICD codes of the disease contained in the past claim record of the insured life, whether the policy can be subjected to secondary underwriting needs to be judged; that is, it is necessary to determine whether the product information in the policy and insurance data exists in the product information configuration table capable of automatic underwriting, and only when the product information in the policy and insurance data exists in the product information configuration table capable of automatic underwriting, it is determined that the policy can be underwritten automatically, and a secondary underwriting operation of the policy is executed.
Example 4:
in order to improve the accuracy of the secondary underwriting of the policy, on the basis of the foregoing embodiments, in an embodiment of the present invention, the method further includes:
and if the product information of the insurance policy does not exist in the product information configuration table capable of carrying out automatic insurance verification, determining the identifier of the secondary insurance conclusion of the insurance policy as the artificial insurance verification identifier.
If the product information in the insurance policy data does not exist in the product information configuration table capable of automatic insurance verification, the insurance policy is proved to be incapable of automatic insurance verification, and at the moment, the insurance policy carries out manual insurance verification, so that the identifier of the secondary insurance verification conclusion of the insurance policy is determined as the manual insurance verification identifier.
Example 5:
for convenience of an underwriting worker to know a secondary underwriting conclusion of the policy in time, on the basis of the above embodiments, in the embodiment of the present invention, the method further includes:
and displaying the determined identifier of the secondary underwriting conclusion of the policy aiming at the policy of the identification information.
And after the identifier of the secondary underwriting conclusion of the policy is determined, displaying the identifier of the secondary underwriting conclusion of the policy.
For example, after the identifier of the secondary underwriting conclusion of the policy is determined as the refusal identifier, the refusal identifier of the secondary underwriting conclusion of the policy is displayed; after the identifier of the secondary underwriting conclusion of the policy is determined as the self-approval passing identifier, displaying the self-approval passing identifier of the secondary underwriting conclusion of the policy; and after the identifier of the secondary underwriting conclusion of the policy is determined to be the artificial underwriting identifier, displaying the artificial underwriting identifier of the secondary underwriting conclusion of the policy.
Example 6:
the following describes the underwriting data processing method according to a specific embodiment, taking the policy as a health insurance policy as an example, and fig. 3 is a schematic process diagram of another underwriting data processing method according to an embodiment of the present invention, where the method includes the following steps:
s301: and determining product information and insured person information in the insurance data of the health insurance policy according to the official number, the policy number and the insured person number of the health insurance policy acquired from the health insurance entry pool.
The product information includes the name of the product and the information of the dangerous species to which the product belongs, and the information of the insured person includes the fixed client number distributed by the insured person in the insurance company and the personal information of the insured person.
S302: and judging whether the product information in the health insurance policy underwriting data exists in the product information configuration table capable of automatic underwriting, if so, entering S303, and if not, entering S310.
S303: matching message information, sending a query request to a claim settlement system through a past claim settlement query interface based on the message information, wherein the query request comprises the information of the insured person in the health insurance policy underwriting data, and determining that the past claim settlement record of the insured person and the past claim settlement record of the insured person contain ICD codes of diseases according to the query request.
The message information comprises a public number, a policy effective date, a payment expiry date, a insured person client number, a insured person name, a insured person certificate type, a insured person certificate number, a main risk code and an insurance code effective date of the policy.
S304: determining whether the ICD code is included in the blacklist, if not, entering S305, and if so, entering S310.
S305: judging whether past claim records with insurable persons having serious risk liability exist in the past claim records within the previous policy year range before the current time, if so, entering S308; if not, the process proceeds to S306.
S306: and judging whether the past claim settlement record of the insured person has a past claim settlement record with the insurance time within the verification time of the health insurance policy, if so, entering S308, and if not, entering S307.
S307: and judging whether the number of past claim records in the previous 5 policy year ranges before the current time of the plan setting time is greater than 15, if so, entering S308, and if not, entering S309.
S308: and determining the identifier of the secondary underwriting conclusion of the health insurance policy as the refusal insurance identifier.
S309: and determining the identity of the secondary underwriting conclusion of the health insurance policy as a self-core passing identity.
S310: and determining the identifier of the secondary underwriting conclusion of the health insurance policy as the artificial underwriting identifier.
S311: and displaying the determined identification of the secondary underwriting conclusion of the health insurance policy.
Example 7:
fig. 4 is a schematic structural diagram of an underwriting data processing apparatus according to an embodiment of the present invention, and on the basis of the foregoing embodiments, an underwriting data processing apparatus according to an embodiment of the present invention is further provided, where the apparatus includes:
a determining module 401, configured to determine information of an insured person according to the obtained identification information of the policy; determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases;
a determining module 402, configured to determine whether the ICD code is included in a blacklist; if the ICD code is not contained in the blacklist, judging whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not;
a conclusion module 403, configured to determine, if the number of past claim records in a first set year range before the current time is greater than a set number threshold, an identifier of a secondary underwriting conclusion of the policy as an identifier of refusal to protect.
The device further comprises:
a display module 404, configured to display, for the policy of the identification information, an identification of the determined secondary underwriting conclusion of the policy.
The conclusion module 403 is further configured to determine whether the number of past claim records in a first set year range before the current time is less than a set number threshold; determining the identifier of the secondary underwriting conclusion of the policy as a self-core passing identifier.
The determining module 402 is further configured to determine whether the ICD codes are not included in the blacklist, before determining whether the number of past claim records in a first set year range before the current time is greater than a set number threshold; performing at least one of the following determinations:
judging whether the past claim settlement records with the insured life responsibility being serious disease responsibility exist in the past claim settlement records of the second set year range before the current time, or; and judging whether the past claim settlement records of the insured person have past claim settlement records of which the claim settlement time is within the verification time of the policy.
The conclusion module 403 is configured to determine, if a determination result of at least one of the determinations in the determination module is yes, an identifier of a secondary underwriting conclusion of the policy as a security refusal identifier.
The determining module 401 is further configured to determine product information of the policy;
the determining module 402 is further configured to determine whether product information of the policy exists in a product information configuration table capable of performing automatic underwriting; if the product information of the policy exists in the product information configuration table capable of automatic underwriting, the determining module 401 is triggered to determine the past claim settlement record of the insured person and the past claim settlement record of the insured person.
The conclusion module 403 is further configured to determine, if the product information of the policy does not exist in the product information configuration table capable of performing automatic underwriting, an identifier of a secondary underwriting conclusion of the policy as an artificial underwriting identifier.
Example 8:
fig. 5 is a schematic structural diagram of an electronic device according to an embodiment of the present invention, and on the basis of the foregoing embodiments, an embodiment of the present invention further provides an electronic device, which includes a processor 501 and a memory 502, where the processor 501 is configured to implement the steps of the above-mentioned underwriting data processing method when executing a computer program stored in the memory 502.
Alternatively, the processor 501 may be a CPU (central processing unit), an ASIC (Application specific integrated Circuit), an FPGA (Field Programmable Gate Array), or a CPLD (Complex Programmable Logic Device).
A processor 501 for executing the following steps when following the computer program stored in the memory 502:
determining the information of the insured person according to the acquired identification information of the policy;
determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases;
judging whether the ICD code is contained in a blacklist or not;
if the ICD code is not contained in the blacklist, judging whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not;
and if so, determining the identifier of the secondary underwriting conclusion of the policy as a refusal insurance identifier.
Further, the method further comprises:
and displaying the determined identifier of the secondary underwriting conclusion of the policy aiming at the policy of the identification information.
If the number of past claim settlement records of which the claim settlement time is within a first set year range before the current time is not greater than a set number threshold value;
determining the identifier of the secondary underwriting conclusion of the policy as a self-core passing identifier.
If the ICD codes are not included in the black list, before the determining whether the number of past claim records in a first set year range before the current time is greater than a set number threshold, the method further includes performing at least one of the following determinations:
judging whether the past claim settlement records with the insured life responsibility being serious disease responsibility exist in the past claim settlement records of the second set year range before the current time, or;
and judging whether the past claim settlement records of the insured person have past claim settlement records of which the claim settlement time is within the verification time of the policy.
And if the judgment result of the at least one judgment is yes, determining the identifier of the secondary underwriting conclusion of the policy as a refusal insurance identifier.
Before determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes for a disease, the method further comprises:
determining product information of the policy;
judging whether the product information of the insurance policy exists in a product information configuration table capable of automatic underwriting;
and if so, executing the operation of determining that the past claim record of the insured person and the past claim record of the insured person contain ICD codes of diseases.
And if the product information of the insurance policy does not exist in the product information configuration table capable of carrying out automatic insurance verification, determining the identifier of the secondary insurance conclusion of the insurance policy as the artificial insurance verification identifier.
Example 9:
on the basis of the foregoing embodiments, an embodiment of the present invention further provides a computer-readable storage medium, which stores a computer program, where the computer program is executed by a processor to perform the following steps:
determining the information of the insured person according to the acquired identification information of the policy;
determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases;
judging whether the ICD code is contained in a blacklist or not;
if the ICD code is not contained in the blacklist, judging whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not;
and if so, determining the identifier of the secondary underwriting conclusion of the policy as a refusal insurance identifier.
Further, the method further comprises:
and displaying the determined identifier of the secondary underwriting conclusion of the policy aiming at the policy of the identification information.
If the number of past claim settlement records of which the claim settlement time is within a first set year range before the current time is not greater than a set number threshold value;
determining the identifier of the secondary underwriting conclusion of the policy as a self-core passing identifier.
If the ICD codes are not included in the black list, before the determining whether the number of past claim records in a first set year range before the current time is greater than a set number threshold, the method further includes performing at least one of the following determinations:
judging whether the past claim settlement records with the insured life responsibility being serious disease responsibility exist in the past claim settlement records of the second set year range before the current time, or;
and judging whether the past claim settlement records of the insured person have past claim settlement records of which the claim settlement time is within the verification time of the policy.
And if the judgment result of the at least one judgment is yes, determining the identifier of the secondary underwriting conclusion of the policy as a refusal insurance identifier.
Before determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes for a disease, the method further comprises:
determining product information of the policy;
judging whether the product information of the insurance policy exists in a product information configuration table capable of automatic underwriting;
and if so, executing the operation of determining that the past claim record of the insured person and the past claim record of the insured person contain ICD codes of diseases.
And if the product information of the insurance policy does not exist in the product information configuration table capable of carrying out automatic insurance verification, determining the identifier of the secondary insurance conclusion of the insurance policy as the artificial insurance verification identifier.
As will be appreciated by one skilled in the art, embodiments of the present application may be provided as a method, system, or computer program product. Accordingly, the present application may take the form of an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects. Furthermore, the present application may take the form of a computer program product embodied on one or more computer-usable storage media (including, but not limited to, disk storage, CD-ROM, optical storage, and the like) having computer-usable program code embodied therein.
The present application is described with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems), and computer program products according to the application. It will be understood that each flow and/or block of the flow diagrams and/or block diagrams, and combinations of flows and/or blocks in the flow diagrams and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, embedded processor, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.
These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the flowchart flow or flows and/or block diagram block or blocks.
These computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.
It will be apparent to those skilled in the art that various changes and modifications may be made in the present application without departing from the spirit and scope of the application. Thus, if such modifications and variations of the present application fall within the scope of the claims of the present application and their equivalents, the present application is intended to include such modifications and variations as well.
Claims (10)
1. A method for processing underwriting data, the method comprising:
determining the information of the insured person according to the acquired identification information of the policy;
determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases;
judging whether the ICD code is contained in a blacklist or not;
if the ICD code is not contained in the blacklist, judging whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not;
and if so, determining the identifier of the secondary underwriting conclusion of the policy as a refusal insurance identifier.
2. The method of claim 1, further comprising:
if the number of past claim settlement records of which the claim settlement time is within a first set year range before the current time is not greater than a set number threshold value;
determining the identifier of the secondary underwriting conclusion of the policy as a self-core passing identifier.
3. The method of claim 1, wherein if the ICD codes are not included in the blacklist, prior to the determining whether the number of past claim records in a first set year range before the current time is greater than a set number threshold, the method further comprises performing at least one of:
judging whether the past claim settlement records with the insured life responsibility being serious disease responsibility exist in the past claim settlement records of the second set year range before the current time, or;
and judging whether the past claim settlement records of the insured person have past claim settlement records of which the claim settlement time is within the verification time of the policy.
4. The method according to claim 3, wherein if the at least one determination is yes, determining the identity of the secondary underwriting conclusion of the policy as a rejection identity.
5. The method of claim 1, wherein prior to determining that the past claims record of the insured life and the past claims record of the insured life contain ICD codes for a disease, the method further comprises:
determining product information of the policy;
judging whether the product information of the insurance policy exists in a product information configuration table capable of automatic underwriting;
and if so, executing the operation of determining that the past claim record of the insured person and the past claim record of the insured person contain ICD codes of diseases.
6. The method of claim 5, further comprising:
and if the product information of the insurance policy does not exist in the product information configuration table capable of carrying out automatic insurance verification, determining the identifier of the secondary insurance conclusion of the insurance policy as the artificial insurance verification identifier.
7. The method according to any one of claims 1-6, further comprising:
and displaying the determined identifier of the secondary underwriting conclusion of the policy aiming at the policy of the identification information.
8. An apparatus for processing underwriting data, the apparatus comprising:
the first determining module is used for determining the information of the insured person according to the acquired identification information of the policy; determining that the past claims record of the insured person and the past claims record of the insured person contain ICD codes of diseases;
the judging module is used for judging whether the ICD code is contained in a blacklist or not; if the ICD code is not contained in the blacklist, judging whether the number of past claim records of which the claim settlement time is within a first set year range before the current time is greater than a set number threshold value or not;
and the conclusion module is used for determining the identifier of the secondary underwriting conclusion of the policy as the refusal insurance identifier if the number of the past claim records of which the first claim time is within the first set year range before underwriting is greater than a set number threshold.
9. An electronic device, characterized in that the electronic device comprises a processor and a memory for storing program instructions, the processor being adapted to carry out the steps of the method according to any of claims 1-7 when executing a computer program stored in the memory.
10. A computer-readable storage medium, characterized in that it stores a computer program which, when being executed by a processor, carries out the steps of the method according to any one of claims 1 to 7.
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| CN201911167329.6A CN111008902B (en) | 2019-11-25 | 2019-11-25 | Nuclear protection data processing method, device, equipment and medium |
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