CN111652581B

CN111652581B - Method and device for processing calculated data, storage medium and electronic equipment

Info

Publication number: CN111652581B
Application number: CN202010478048.9A
Authority: CN
Inventors: 刘云霞; 张星
Original assignee: Taikang Insurance Group Co Ltd
Current assignee: Taikang Insurance Group Co Ltd
Priority date: 2020-05-29
Filing date: 2020-05-29
Publication date: 2023-06-13
Anticipated expiration: 2040-05-29
Also published as: CN111652581A

Abstract

The disclosure belongs to the technical field of insurance claims, and relates to a method and a device for processing calculated data, a storage medium and electronic equipment. The method comprises the following steps: acquiring the claim data of the case to be claimed, and determining a target claim case according to the claim data; if the target claim case comprises a first target claim risk, acquiring a plurality of calculating sequences corresponding to the first target claim risk; acquiring a plurality of initial claim settlement amounts corresponding to the plurality of settlement sequences, and determining a plurality of first settlement sequences in the plurality of settlement sequences according to the plurality of initial claim settlement amounts; determining a plurality of second calculation orders in the plurality of first calculation orders according to preset conditions, and respectively acquiring the risk types of the claims in the plurality of second calculation orders; and acquiring the risk-clearing data corresponding to the risk-clearing seed, and determining a target calculation sequence in a plurality of second calculation sequences according to the risk-clearing data so as to determine the target claim amount. The method and the device realize automatic settlement of the amount of the claim, and improve the efficiency of the claim settlement and the accuracy of the claim settlement.

Description

Method and device for processing calculated data, storage medium and electronic equipment

Technical Field

The present disclosure relates to the field of insurance claim settlement technology, and in particular, to a settlement data processing method, a settlement data processing device, a computer readable storage medium, and an electronic apparatus.

Background

With the continuous improvement of the living standard of people, more and more people can put a part of funds into an insurance company so as to obtain the guarantee of future living. Therefore, the insurance companies need to deal with more and more claims cases. When the case of claim is generated, the insured person will claim the insurance company for compensation, the insurance company needs to perform the calculation and verification for each case of claim, and determines the corresponding amount of claim to be provided for the insured person.

Currently, when an insured person applies for insurance claims, a worker can establish tasks of insurance claim settlement cases in the system, input corresponding claim settlement bills into the system, and the special worker calculates and audits the insurance claim settlement cases. However, when more than two kinds of cost-type dangerous seeds are manually calculated, the consumed time is relatively long, great pressure is generated on business operation, the error rate is high, and the timeliness and the accuracy of insurance claim settlement are affected.

In view of this, there is a need in the art to develop a new method and apparatus for processing calculated data.

It should be noted that the information disclosed in the above background section is only for enhancing understanding of the background of the present disclosure and thus may include information that does not constitute prior art known to those of ordinary skill in the art.

Disclosure of Invention

The present disclosure aims to provide a method for processing a rational data, a rational data processing apparatus, a computer-readable storage medium, and an electronic device, and further to overcome at least some of the problems of long time consumption, high error rate, and the like due to the limitations of the related art.

Other features and advantages of the present disclosure will be apparent from the following detailed description, or may be learned in part by the practice of the disclosure.

According to a first aspect of an embodiment of the present invention, there is provided a method for processing rational data, the method including: acquiring the claim data of the case to be subjected to claim settlement, and determining a target claim settlement case according to the claim settlement data; if the target claim case comprises a first target claim risk, acquiring a plurality of calculating sequences corresponding to the first target claim risk; acquiring a plurality of initial claim settlement amounts corresponding to a plurality of settlement sequences, and determining a plurality of first settlement sequences in the plurality of settlement sequences according to the plurality of initial claim settlement amounts; determining a plurality of second calculation orders in the plurality of first calculation orders according to preset conditions, and respectively acquiring the risk settlement seeds in the plurality of second calculation orders; and acquiring the risk-clearing data corresponding to the risk-clearing seed, and determining a target calculation sequence in the second calculation sequences according to the risk-clearing data so as to determine a target claim amount.

In an exemplary embodiment of the present invention, the determining a plurality of second calculation orders among the plurality of first calculation orders according to a preset condition includes: determining a first order of the plurality of first orders including the first target risk seed as a first order of the first target risk seed; and if the number of the third calculation orders is a plurality of, determining the third calculation orders as the second calculation orders.

In an exemplary embodiment of the present invention, the determining a plurality of second calculation orders among the plurality of first calculation orders according to a preset condition includes: and if the first plurality of calculation orders do not include the second target risk settlement, determining the first calculation order as a second calculation order.

In an exemplary embodiment of the invention, the risk data includes a risk reason; the determining a target settlement order from the plurality of second settlement orders according to the risk-out data comprises: if the risk reasons are disease risk, determining a target calculation sequence according to the first calculation priority; and if the risk reasons are accidental injury risk, determining a target calculation sequence according to the second calculation priority.

In an exemplary embodiment of the present invention, the determining the target calculation order according to the first calculation priority includes: determining a first to-be-determined calculation order according to the first calculation priority, and acquiring the number of the first to-be-determined calculation order; and if the number of the first to-be-determined calculating sequences is a plurality of, determining one of the first to-be-determined calculating sequences as a target calculating sequence.

In an exemplary embodiment of the present invention, the determining the target rational order according to the second rational priority includes: determining a second to-be-determined rational order according to the second rational priority, and acquiring the number of the second to-be-determined rational order; and if the number of the second to-be-determined rational orders is a plurality of, determining one of the second to-be-determined rational orders as a target rational order.

In an exemplary embodiment of the invention, after the acquiring the plurality of initial claim amounts corresponding to the plurality of calculation orders, the method further comprises: comparing the plurality of initial claims amounts; and determining the target settlement sequence according to the comparison result so as to determine the target claim amount.

According to a second aspect of an embodiment of the present invention, there is provided a rational data processing apparatus, the apparatus including: the case determining module is configured to acquire the claim data of the case to be subjected to claim settlement and determine a target claim settlement case according to the claim settlement data; the dangerous seed judging module is configured to acquire a plurality of settlement sequences corresponding to the second target settlement dangerous seed if the second target settlement dangerous seed is included in the target settlement case; the data acquisition module is configured to acquire a plurality of initial claim settlement amounts corresponding to a plurality of settlement orders and determine a plurality of first settlement orders in the plurality of settlement orders according to the plurality of initial claim settlement amounts; the order screening module is configured to determine a plurality of second calculation orders in the plurality of first calculation orders according to preset conditions, and respectively acquire the risk of the claim in the plurality of second calculation orders; and the amount determining module is configured to acquire the risk escaping data corresponding to the risk depositing type and determine a target depositing order in the second depositing orders according to the risk escaping data so as to determine the target deposit amount.

According to a third aspect of an embodiment of the present invention, there is provided an electronic apparatus including: a processor and a memory; wherein the memory has stored thereon computer readable instructions which, when executed by the processor, implement the method of processing calculated data of any of the above-described exemplary embodiments.

According to a fourth aspect of embodiments of the present invention, there is provided a computer-readable storage medium having stored thereon a computer program which, when executed by a processor, implements the method of processing calculated data in any of the above-described exemplary embodiments.

As can be seen from the above technical solutions, the method for processing the calculated data, the apparatus for processing the calculated data, the computer storage medium and the electronic device according to the exemplary embodiments of the present invention have at least the following advantages and positive effects:

in the method and the device provided by the exemplary embodiment of the disclosure, the information such as the initial settlement amount and the risk-free data is used for screening a plurality of settlement sequences, so that the target settlement sequence and the target settlement amount can be determined. On the one hand, the whole settlement process does not need to be manually participated, the settlement amount of the case for automatically settling the claim can be realized, a great amount of manpower resources and the settlement and auditing time are saved, and the settlement efficiency is improved; on the other hand, errors caused by manual participation are avoided, the verification error rate of the verification is reduced, the verification accuracy of the verification is improved, and the benefit maximization of the insured is ensured.

It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the disclosure.

Drawings

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments consistent with the disclosure and together with the description, serve to explain the principles of the disclosure. It will be apparent to those of ordinary skill in the art that the drawings in the following description are merely examples of the disclosure and that other drawings may be derived from them without undue effort.

FIG. 1 schematically illustrates a flow chart of a method of processing of calculated data in an exemplary embodiment of the disclosure;

FIG. 2 schematically illustrates a flow diagram of a method of determining a target claim amount in an exemplary embodiment of the present disclosure;

FIG. 3 schematically illustrates a flow diagram of a method of determining a second order of adjustment in an exemplary embodiment of the present disclosure;

FIG. 4 schematically illustrates a flow diagram of a method of determining a target tally order in an exemplary embodiment of the present disclosure;

FIG. 5 schematically illustrates a flow diagram of a method of determining a target tally order based on a first tally priority in an exemplary embodiment of the present disclosure;

FIG. 6 schematically illustrates a flow diagram of a method of determining a target tally order based on a second tally priority in an exemplary embodiment of the present disclosure;

fig. 7 schematically illustrates a flowchart of a method for processing calculation data in an application scenario in an exemplary embodiment of the present disclosure;

fig. 8 schematically illustrates an effect diagram of a calculation order determination method in an application scenario in an exemplary embodiment of the present disclosure;

FIG. 9 schematically illustrates a schematic configuration of a rational data processing apparatus in an exemplary embodiment of the present disclosure;

FIG. 10 schematically illustrates an electronic device for implementing a method of processing calculated data in an exemplary embodiment of the disclosure;

fig. 11 schematically illustrates a computer-readable storage medium for implementing a method of processing of calculated data in an exemplary embodiment of the disclosure.

Detailed Description

Example embodiments will now be described more fully with reference to the accompanying drawings. However, the exemplary embodiments may be embodied in many forms and should not be construed as limited to the examples set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the concept of the example embodiments to those skilled in the art. The described features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. In the following description, numerous specific details are provided to give a thorough understanding of embodiments of the present disclosure. One skilled in the relevant art will recognize, however, that the aspects of the disclosure may be practiced without one or more of the specific details, or with other methods, components, devices, steps, etc. In other instances, well-known technical solutions have not been shown or described in detail to avoid obscuring aspects of the present disclosure.

The terms "a," "an," "the," and "said" are used in this specification to denote the presence of one or more elements/components/etc.; the terms "comprising" and "having" are intended to be inclusive and mean that there may be additional elements/components/etc. in addition to the listed elements/components/etc.; the terms "first" and "second" and the like are used merely as labels, and are not intended to limit the number of their objects.

Furthermore, the drawings are merely schematic illustrations of the present disclosure and are not necessarily drawn to scale. The same reference numerals in the drawings denote the same or similar parts, and thus a repetitive description thereof will be omitted. Some of the block diagrams shown in the figures are functional entities and do not necessarily correspond to physically or logically separate entities.

Aiming at the problems in the related art, the disclosure provides a method for processing the calculated data. Fig. 1 shows a flow chart of a method for processing calculated data, which, as shown in fig. 1, at least comprises the following steps:

s110, acquiring the claim settlement data of the case to be claiming, and determining the target claim settlement case according to the claim settlement data.

And S120, if the target claim case comprises the first target claim risk, acquiring a plurality of calculating sequences corresponding to the first claim risk.

S130, acquiring a plurality of initial claim settlement amounts corresponding to the plurality of settlement sequences, and determining a plurality of first settlement sequences in the plurality of settlement sequences according to the plurality of initial claim settlement amounts.

And S140, determining a plurality of second calculation orders in the plurality of first calculation orders according to preset conditions, and respectively acquiring the risk settlement seeds in the plurality of second calculation orders.

S150, acquiring the risk-clearing data corresponding to the risk-clearing seeds, and determining a target calculation sequence in a plurality of second calculation sequences according to the risk-clearing data so as to determine the target claim settlement amount.

In an exemplary embodiment of the present disclosure, the target settlement order and the target settlement amount may be determined by filtering the plurality of settlement orders through information such as the initial settlement amount and the risk-out data. On the one hand, the whole settlement process does not need to be manually participated, the settlement amount of the case for automatically settling the claim can be realized, a great amount of manpower resources and the settlement and auditing time are saved, and the settlement efficiency is improved; on the other hand, errors caused by manual participation are avoided, the verification error rate of the verification is reduced, the verification accuracy of the verification is improved, and the benefit maximization of the insured is ensured.

The following describes each step of the method for processing the calculated data in detail.

In step S110, the claim data of the claim case to be claimed is obtained, and the target claim case is determined according to the claim data.

In exemplary embodiments of the present disclosure, the claim data may include claim bill data, policy data, and the like. Wherein the claim bill data comprises medical institutions, personal information and the like; the policy data includes policy risk information, policy type information, policy applied amount information, policy responsibility detail information including responsibility detail identification, pay proportion, pay range, pay limit, pay condition, and the like. According to the claim data, whether the claim calculation of the case to be claimed needs manual intervention or not can be judged. When the case to be claiming needs manual intervention, the claiming calculation can be calculated manually, and the target claiming amount is determined; when the case to be claiming does not need manual intervention, the case to be claiming can be determined as the target case to be claiming.

In step S120, if the target case includes the first target risk, a plurality of calculation orders corresponding to the first risk are obtained.

In an exemplary embodiment of the present disclosure, after determining the target claim case, a determination may be made as to whether the target claim case contains the first target claim risk. The first target claim risk includes cost type risk, and the first target claim risk may be medical insurance based on the medical expense of the insured person and the agreed standard. In addition, the first target claim risk may be another risk, and the present exemplary embodiment is not particularly limited thereto.

Further, the number of first target claim risk seeds in the target claim case may also be determined. For example, when the first target risk of the target risk case is plural, plural kinds of calculation orders corresponding to the first risk may be acquired.

In the present exemplary embodiment, by determining the dangerous seed in the case to be clashed, a function of acquiring multiple claiming orders of the target claiming case may be implemented, and two or more kinds of cost dangerous seed may be automatically claiming, which saves manpower and material resources and improves claiming efficiency.

In step S130, a plurality of initial claim amounts corresponding to the plurality of calculation orders are acquired, and a plurality of first calculation orders among the plurality of calculation orders are determined according to the plurality of initial claim amounts.

In exemplary embodiments of the present disclosure, there may be a variety of order of calculation for more than two cost-type hazards, for example. If there are A, B and C three cost risks, there may be ABC, ACB, BAC, BCA, CAB and CBA in total six rational orders. Further, since the amount of the claim is determined by taking the result of the claim of the first hazard as the input of the second hazard, the result of the claim of the first two hazards as the input of the third hazard, and so on, the amount of the claim is affected by the order of the claims.

In view of this, it is possible to determine a plurality of settlement orders according to the settlement risk kinds and acquire initial settlement amounts corresponding to the settlement orders. After the initial claim amount is obtained, a first order of the plurality of orders may be determined. For example, the first order of the calculation may be determined by comparison, and then when the initial amounts of the claims agree, there may be a plurality of orders of the calculation, and the plurality of orders of the calculation may be determined as a plurality of first orders of the calculation; when it is determined that the initial claims amount is inconsistent, there may be no multiple order of settlement, at which point the target order of settlement and the target claims amount may be determined.

In an alternative embodiment, FIG. 2 shows a flow chart of a method of determining a target claim amount, as shown in FIG. 2, the method comprising at least the steps of: in step S210, a plurality of initial claims amounts are compared. The initial claims corresponding to the different calculation orders are compared, for example, the comparison criteria may be whether the initial claims are consistent, other comparison criteria may be available, and the present exemplary embodiment is not limited thereto.

In step S220, a target calculation order is determined according to the comparison result to determine an initial claim amount corresponding to the target calculation order as a target claim amount. For example, when the target order is determined by whether the initial amounts of claims agree, the order in which the amounts of claims agree most is determined as the target order, and the corresponding amount of claims is determined as the target amount of claims, in the case where there are no more than one agreement of the initial amounts of claims.

In the present exemplary embodiment, a method for determining a target claim amount is provided, the determination method is simple, the influence of the claim amount by the calculation sequence is avoided, and the benefit maximization of the insured life is ensured, so that the method is a determination method with extremely strong practicability.

In step S140, a plurality of second calculation orders are determined among the plurality of first calculation orders according to the preset condition, and the risk seeds of the claims in the plurality of second calculation orders are obtained, respectively.

In an exemplary embodiment of the present disclosure, further screening may be performed after determining the plurality of first order of adjustment.

In an alternative embodiment, fig. 3 shows a flow chart of a method of determining a second order of calculation, as shown in fig. 3, the method comprising at least the steps of: in step S310, a third calculation order is determined as a calculation order including the second target risk seed among the plurality of first calculation orders. The second target claim risk may be a lifetime-free risk, but may be another risk, and the exemplary embodiment is not limited thereto. The first order of settlement may be screened by the second target risk, and the order of settlement corresponding to the non-life-long risk is determined as a third order of settlement.

In step S320, if the number of the third calculation orders is plural, the third calculation order is determined as the second calculation order. Further, the number of the third calculation orders is counted, and the second calculation orders can be determined according to the counted results. Specifically, the number of the third calculation orders may be compared with a target value, and if the number of the third calculation orders is greater than the target value, the third calculation orders may be determined as the second calculation orders. Wherein, the target value may be 1, that is, when the number of the third calculation orders is plural, the second calculation order is determined, and the next screening is performed; if the number of the third calculation orders is one, the target calculation orders and the corresponding target claim amounts can be directly determined.

In an alternative embodiment, if the second target claim risk is not included in the plurality of first order of calculation, the first order of calculation is determined to be the second order of calculation. The determination of the second order by the second target claim risk may also include a case where the second target claim risk is not included in the first order of settlement. At this time, the first rational order may be directly determined as the second rational order.

In this exemplary embodiment, two methods for determining the second order according to the first order are provided, and the determination is performed according to whether the first order includes the first target risk seed, so that the determination mode is simple and accurate, the condition of determining the second order is perfected, and the practicability is stronger.

After the second order of settlement is determined, the risk of settlement included in the plurality of second orders of settlement may be obtained. And, at this time, after the claim risk in the second calculation sequence is screened by the preset condition, the claim risk is the life-free risk.

In step S150, the risk data corresponding to the risk seed of the claim is acquired, and the target calculation order is determined in the plurality of second calculation orders according to the risk data, so as to determine the target claim amount.

In an exemplary embodiment of the present disclosure, the risk data includes a risk reason, and in an alternative embodiment, fig. 4 shows a flow chart of a method for determining a target reason sequence, as shown in fig. 4, the method at least includes the following steps: in step S410, if the risk factor is a disease risk, the target calculation order is determined according to the first calculation priority. Wherein, the disease risk may be the loss of income, expense or death or disability of the insured person caused by disease or delivery, and the insurer undertakes reimbursement of insurance money according to the insurance contract. At this time, the target calculation order may be determined according to the first calculation priority.

In an alternative embodiment, fig. 5 shows a flow chart of a method for determining a target calculation order according to a first calculation priority, as shown in fig. 5, the method at least comprises the following steps: in step S510, a first to-be-determined order is determined according to the first order of calculation priority, and the number of first to-be-determined orders is obtained. The first calculation priority may be a preset calculation order priority when the risk factor is a disease risk. For example, when the risk-out source of the case to be claiming is a disease risk-out, the case to be claiming may have two kinds of responsibilities, one is only general inpatient responsibilities and the other is two responsibilities including general inpatient and unexpected simultaneously, and the corresponding first calculation priority may be a higher priority than the priority including only general inpatient responsibilities. Therefore, the first to-be-determined order can be determined according to the responsibility source of the case to be claiming. At this time, the number of first to-be-determined rational orders determined according to the first rational priority may be acquired. The number of the first to-be-determined calculation order may be one or more. When there is only one of the first to-be-determined order, it may be determined as the target order.

In step S520, if the number of the first to-be-determined calculation orders is plural, one of the first to-be-determined calculation orders is determined as the target calculation order. When the first to-be-determined calculation order determined according to the first calculation priority is a plurality of, one of the first to-be-determined calculation orders can be arbitrarily selected as the target calculation order.

In the present exemplary embodiment, a method for determining a target settlement order according to a first settlement priority is provided, and a function of determining a target settlement order can be implemented through dangerous seed responsibility control, so that the influence of the dangerous seed settlement calculation order is reduced, the claim settlement efficiency is improved, and manpower and material resources are saved.

In step S420, if the risk factor is accidental injury risk, the target calculation order is determined according to the second calculation priority. The accident injury risk can be to pay insurance money for the insured person by accident, disabled or property loss. At this time, the target calculation order may be determined according to the second calculation priority.

In an alternative embodiment, fig. 6 shows a flow chart of a method for determining a target rational order according to a second rational priority, as shown in fig. 6, the method at least comprises the following steps: in step S610, a second to-be-determined order is determined according to the second order priority, and the number of second to-be-determined orders is obtained. The second calculation priority may be a preset calculation order priority when the risk factor is accidental injury risk. For example, when the risk source of the case to be clawed is out of danger due to accidental injury, the case to be clawed may have two kinds of responsibilities, one is only the accidental responsibilities, and the other is the two responsibilities including general inpatients and accidental simultaneously, and the corresponding second calculation priority may be the priority of only the accidental responsibilities higher than the priority of both general inpatients and accidental responsibilities. At this time, the number of second to-be-determined rational orders determined according to the second rational priority may be acquired. The number of the second to-be-determined calculation order may be one or more. When there is only one second order to be determined, it may be determined as the target order.

In step S620, if the number of the second to-be-determined calculation orders is plural, one of the second to-be-determined calculation orders is determined as the target calculation order. When the second to-be-determined adjustment order determined according to the second adjustment priority is a plurality of, one of the second to-be-determined adjustment orders can be arbitrarily selected as the target adjustment order.

In the present exemplary embodiment, another method for determining the target calculation order according to the second calculation priority is provided, and the function of determining the target calculation order can be implemented by dangerous seed responsibility control, so that the influence of the dangerous seed calculation order is reduced, the claim settlement efficiency is improved, and the manpower and material resources are saved.

After determining the target calculation order, that is, determining a claim settlement scheme, the final target claim settlement amount can be obtained by calculating according to the claim settlement scheme.

The following describes the method for processing the calculated data in the embodiment of the present disclosure in detail in connection with an application scenario.

Fig. 7 shows a flow chart of a method for processing the settlement data in the application scenario, as shown in fig. 7, in step S710, the settlement data of the case to be settled is acquired and enters the settlement flow.

In step S720, according to the claim data, determining a case without manual intervention as a target claim case among the cases to be claimed; if the case is manually interfered, the claim settlement calculation can be manually performed.

In step S730, it is determined whether two or more fee-type risk types are included in the target claim case. And when the system does not contain the calculation parameters, entering a branch of normal calculation of the system, and carrying out automatic calculation.

In step S740, when the target claim case contains multiple cost-type risk types, the automatic calculating function may be triggered to calculate all the calculating orders in the target claim case, and obtain multiple initial claim amounts corresponding to the multiple calculating orders.

In step S750, it is determined whether or not the initial claims amounts of the different calculation orders agree. When there is no condition that the initial claim amounts corresponding to the plurality of the calculating orders are consistent, the calculating order with the largest initial claim amount is determined as the target calculating order, and the initial claim amount is obtained as the target claim amount.

In step S760, when there is a case where the initial claims amounts corresponding to the plurality of types of calculation orders agree, the calculation order including no lifetime-free deposit risk and the plurality of types of lifetime-free deposit risk may be determined as the second calculation order, and the determination of the deposit liability system may be performed.

In step S770, the risk seed of the claim in the second calculation order is obtained, and the corresponding risk occurrence is determined. When the risk source is a disease risk, the risk containing only general hospitalization responsibilities is preferentially calculated, and the risk containing both general hospitalization responsibilities and unexpected responsibilities is calculated. When the danger source is in danger of accidental injury, the danger species which only contain accidental responsibilities are preferentially calculated, and the danger species which contain both general hospitalization responsibilities and accidental responsibilities are calculated.

In step S780, after the dangerous seed responsibility control, it is also possible to acquire a plurality of calculation orders, at which time one of the calculation orders may be randomly selected as a target calculation order, and a target claim amount may be determined.

Fig. 8 shows an effect schematic diagram of a method for determining a calculation sequence in an application scenario, as shown in fig. 8, in a case a001 to be calculated, two risk types, namely a risk type a and a risk type B, are included, and a risk reason is a disease risk. Wherein, the dangerous seed A does not contain life-free insurance seed, and the dangerous seed responsibility type is that only general hospitalization responsibility is contained, the dangerous seed B does not contain life-free insurance seed, and the dangerous seed responsibility type is that both general hospitalization responsibility and accidental responsibility are contained. When the settlement sequence is the first dangerous seed A and then the second dangerous seed B, the initial claim settlement amount can be determined to be 500 yuan; when the settling order is first risk B and then risk A, the initial claim amount can be determined to be 600 yuan. Because the initial claim amount of the two calculation modes is not consistent, the most one of the claim amounts, namely 600 yuan, can be directly determined as the target claim amount, and the corresponding calculation sequence, namely B and A, can be determined as the target calculation sequence.

The case A002 to be clashed contains two dangerous seeds, namely a dangerous seed A and a dangerous seed B, and the dangerous occurrence reason is the disease dangerous occurrence. The dangerous seed A is provided with a life insurance dangerous seed, and the dangerous seed responsibility type comprises two kinds of responsibilities of general hospitalization and accidents at the same time; the dangerous seed B does not contain lifeless insurance dangerous seeds, and the dangerous seed responsibility type is that only general hospitalization responsibility is contained. When the settlement sequence is the first dangerous seed A and then the second dangerous seed B, the initial claim settlement amount can be determined to be 500 yuan; when the settling order is first risk B and then risk A, the initial claim amount can be determined to be 500 yuan. It can be seen that the initial claims amount of the two calculation orders are consistent, so that the second calculation order, namely, the order B and the order a, can be further determined as the target calculation order, and the corresponding initial claims amount is determined as the target claims amount.

The case A003 to be clashed contains two dangerous seeds, namely a dangerous seed A and a dangerous seed B, and the dangerous occurrence reason is the disease dangerous occurrence. The dangerous seed A is provided with a life insurance dangerous seed, and the dangerous seed responsibility type comprises two kinds of responsibilities of general hospitalization and accidents at the same time; the dangerous seed B has life insurance dangerous seed or not, and the dangerous seed responsibility type is that only general hospitalization responsibility is contained. When the settlement sequence is the first dangerous seed A and then the second dangerous seed B, the initial claim settlement amount can be determined to be 500 yuan; when the settling order is first risk B and then risk A, the initial claim amount can be determined to be 500 yuan. It can be seen that the initial claims corresponding to the two calculation orders are consistent, so that the second calculation order, that is, the order of first B and then a is the target calculation order, and the corresponding initial claims are determined as the target claims.

The case A004 to be clashed contains two dangerous seeds, namely a dangerous seed A and a dangerous seed B, and the risk is caused by disease risk. Wherein, the dangerous seed A has life insurance dangerous seed and the dangerous seed responsibility type is that only general hospitalization responsibility is contained; the dangerous seed B has life insurance dangerous seed or not, and the dangerous seed responsibility type is that only general hospitalization responsibility is contained. When the settlement sequence is the first dangerous seed A and then the second dangerous seed B, the initial claim settlement amount can be determined to be 500 yuan; when the settling order is first risk B and then risk A, the initial claim amount can be determined to be 500 yuan. It can be seen that the initial claims amount corresponding to the two calculation orders are consistent, so that it can be further determined that one of the two calculation orders is selected randomly as the target calculation order, and the corresponding target claims amount is 500 yuan.

The case A005 to be clashed contains two dangerous seeds, namely a dangerous seed A and a dangerous seed B, and the risk is caused by disease risk. Wherein, the dangerous seed A does not contain lifeless insurance dangerous seed, and the dangerous seed responsibility type is that only general hospitalization responsibility is contained; the dangerous seed B does not contain lifeless insurance dangerous seeds, and the dangerous seed responsibility types comprise two kinds of responsibility of general hospitalization and accidents. When the settlement sequence is the first dangerous seed A and then the second dangerous seed B, the initial claim settlement amount can be determined to be 500 yuan; when the settling order is first risk B and then risk A, the initial claim amount can be determined to be 500 yuan. It can be seen that the initial claims corresponding to the two calculation orders are consistent, so that the first final calculation order, namely a and B, can be further determined as the target calculation order, and correspondingly, 500 yuan is determined as the target claims.

The target settlement sequence and the target settlement amount can be determined by screening a plurality of settlement sequences through the information such as the initial settlement amount, the risk-free data and the like. On the one hand, the whole settlement process does not need to be manually participated, the settlement amount of the case for automatically settling the claim can be realized, a great amount of manpower resources and the settlement and auditing time are saved, and the settlement efficiency is improved; on the other hand, errors caused by manual participation are avoided, the verification error rate of the verification is reduced, the verification accuracy of the verification is improved, and the benefit maximization of the insured is ensured.

It should be noted that while the implementations of the above exemplary embodiments describe the steps of the methods in this disclosure in a particular order, this does not require or imply that the steps must be performed in that particular order or that all of the steps must be performed in order to achieve desirable results. Additionally or alternatively, certain steps may be omitted, multiple steps combined into one step to perform, and/or one step decomposed into multiple steps to perform, etc.

In addition, in an exemplary embodiment of the present disclosure, a rational data processing apparatus is also provided. Fig. 9 shows a schematic structural diagram of a calculation data processing apparatus, and as shown in fig. 9, a calculation data processing apparatus 900 may include: case determination module 910, risk determination module 920, data acquisition module 930, order screening module 940, and amount determination module 950. Wherein:

A case determination module 910 configured to acquire the claim data of the case to be claimed and determine a target claim case according to the claim data; the dangerous seed judging module 920 is configured to obtain multiple settling orders corresponding to the second target claim risk seed if the target claim case includes the second target claim risk seed; a data acquisition module 930 configured to acquire a plurality of initial claim amounts corresponding to the plurality of calculation orders, and determine a first calculation order among the plurality of calculation orders according to the plurality of initial claim amounts; a sequence screening module 940 configured to determine the first calculation sequence satisfying the preset condition as a second calculation sequence, and obtain the risk seed of the claim in the second calculation sequence; the amount determining module 950 is configured to obtain the risk data corresponding to the risk seed of the claim and determine a target calculation order in the second calculation order according to the risk data to determine a target claim amount.

The details of the above-mentioned calculation data processing apparatus 900 are already described in detail in the corresponding calculation data processing method, and thus will not be described herein.

It should be noted that although several modules or units of the rational data processing apparatus 900 are mentioned in the above detailed description, this division is not mandatory. Indeed, the features and functionality of two or more modules or units described above may be embodied in one module or unit in accordance with embodiments of the present disclosure. Conversely, the features and functions of one module or unit described above may be further divided into a plurality of modules or units to be embodied.

Furthermore, although the steps of the methods in the present disclosure are depicted in a particular order in the drawings, this does not require or imply that the steps must be performed in that particular order or that all illustrated steps be performed in order to achieve desirable results. Additionally or alternatively, certain steps may be omitted, multiple steps combined into one step to perform, and/or one step decomposed into multiple steps to perform, etc.

From the above description of embodiments, those skilled in the art will readily appreciate that the example embodiments described herein may be implemented in software, or may be implemented in software in combination with the necessary hardware. Thus, the technical solution according to the embodiments of the present disclosure may be embodied in the form of a software product, which may be stored in a non-volatile storage medium (may be a CD-ROM, a U-disk, a mobile hard disk, etc.) or on a network, including several instructions to cause a computing device (may be a personal computer, a server, a mobile terminal, or a network device, etc.) to perform the method according to the embodiments of the present disclosure.

In addition, in an exemplary embodiment of the present disclosure, an electronic device capable of implementing the above method is also provided.

An electronic device 1000 according to such an embodiment of the invention is described below with reference to fig. 10. The electronic device 1000 shown in fig. 10 is merely an example and should not be construed as limiting the functionality and scope of use of embodiments of the present invention.

As shown in fig. 10, the electronic device 1000 is embodied in the form of a general purpose computing device. Components of electronic device 1000 may include, but are not limited to: the at least one processing unit 1010, the at least one memory unit 1020, a bus 1030 connecting the various system components (including the memory unit 1020 and the processing unit 1010), and a display unit 1040.

Wherein the storage unit stores program code that is executable by the processing unit 1010 such that the processing unit 1010 performs steps according to various exemplary embodiments of the present invention described in the above section of the "exemplary method" of the present specification.

The memory unit 1020 may include readable media in the form of volatile memory units such as Random Access Memory (RAM) 1021 and/or cache memory unit 1022, and may further include Read Only Memory (ROM) 1023.

Storage unit 1020 may also include a program/utility 1024 having a set (at least one) of program modules 1025, such program modules 1025 including, but not limited to: an operating system, one or more application programs, other program modules, and program data, each or some combination of which may include an implementation of a network environment.

Bus 1030 may be representing one or more of several types of bus structures including a memory unit bus or memory unit controller, a peripheral bus, an accelerated graphics port, a processing unit, or a local bus using any of a variety of bus architectures.

The electronic device 1000 can also communicate with one or more external devices 1200 (e.g., keyboard, pointing device, bluetooth device, etc.), with one or more devices that enable a user to interact with the electronic device 1000, and/or with any device (e.g., router, modem, etc.) that enables the electronic device 1000 to communicate with one or more other computing devices. Such communication may occur through an input/output (I/O) interface 1050. Also, electronic device 1000 can communicate with one or more networks such as a Local Area Network (LAN), a Wide Area Network (WAN), and/or a public network, such as the Internet, through network adapter 1060. As shown, the network adapter 1040 communicates with other modules of the electronic device 1000 via the bus 1030. It should be appreciated that although not shown, other hardware and/or software modules may be used in connection with the electronic device 1000, including, but not limited to: microcode, device drivers, redundant processing units, external disk drive arrays, RAID systems, tape drives, data backup storage systems, and the like.

From the above description of embodiments, those skilled in the art will readily appreciate that the example embodiments described herein may be implemented in software, or in combination with the necessary hardware. Thus, the technical solution according to the embodiments of the present disclosure may be embodied in the form of a software product, which may be stored in a non-volatile storage medium (may be a CD-ROM, a U-disk, a mobile hard disk, etc.) or on a network, and includes several instructions to cause a computing device (may be a personal computer, a server, a terminal device, or a network device, etc.) to perform the method according to the embodiments of the present disclosure.

In an exemplary embodiment of the present disclosure, a computer-readable storage medium having stored thereon a program product capable of implementing the method described above in the present specification is also provided. In some possible embodiments, the various aspects of the invention may also be implemented in the form of a program product comprising program code for causing a terminal device to carry out the steps according to the various exemplary embodiments of the invention as described in the "exemplary methods" section of this specification, when said program product is run on the terminal device.

Referring to fig. 11, a program product 1100 for implementing the above-described method according to an embodiment of the present invention is described, which may employ a portable compact disc read only memory (CD-ROM) and include program code, and may be run on a terminal device, such as a personal computer. However, the program product of the present invention is not limited thereto, and in this document, a readable storage medium may be any tangible medium that can contain, or store a program for use by or in connection with an instruction execution system, apparatus, or device.

The program product may employ any combination of one or more readable media. The readable medium may be a readable signal medium or a readable storage medium. The readable storage medium can be, for example, but is not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or a combination of any of the foregoing. More specific examples (a non-exhaustive list) of the readable storage medium would include the following: an electrical connection having one or more wires, a portable disk, a hard disk, random Access Memory (RAM), read-only memory (ROM), erasable programmable read-only memory (EPROM or flash memory), optical fiber, portable compact disk read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing.

The computer readable signal medium may include a data signal propagated in baseband or as part of a carrier wave with readable program code embodied therein. Such a propagated data signal may take any of a variety of forms, including, but not limited to, electro-magnetic, optical, or any suitable combination of the foregoing. A readable signal medium may also be any readable medium that is not a readable storage medium and that can communicate, propagate, or transport a program for use by or in connection with an instruction execution system, apparatus, or device.

Program code embodied on a readable medium may be transmitted using any appropriate medium, including but not limited to wireless, wireline, optical fiber cable, RF, etc., or any suitable combination of the foregoing.

Program code for carrying out operations of the present invention may be written in any combination of one or more programming languages, including an object oriented programming language such as Java, C++ or the like and conventional procedural programming languages, such as the "C" programming language or similar programming languages. The program code may execute entirely on the user's computing device, partly on the user's device, as a stand-alone software package, partly on the user's computing device, partly on a remote computing device, or entirely on the remote computing device or server. In the case of remote computing devices, the remote computing device may be connected to the user computing device through any kind of network, including a Local Area Network (LAN) or a Wide Area Network (WAN), or may be connected to an external computing device (e.g., connected via the Internet using an Internet service provider).

Other embodiments of the disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the disclosure disclosed herein. This application is intended to cover any adaptations, uses, or adaptations of the disclosure following, in general, the principles of the disclosure and including such departures from the present disclosure as come within known or customary practice within the art to which the disclosure pertains. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the disclosure being indicated by the following claims.

Claims

1. A method of processing calculated data, the method comprising:

acquiring the claim data of the case to be subjected to claim settlement, and determining a target claim settlement case according to the claim settlement data;

if the target claim case comprises a first target claim risk, acquiring a plurality of calculating sequences corresponding to the first target claim risk;

acquiring a plurality of initial claim settlement amounts corresponding to the plurality of settlement sequences, and determining a plurality of first settlement sequences in the plurality of settlement sequences according to the plurality of initial claim settlement amounts;

determining a plurality of second calculation orders in the plurality of first calculation orders according to preset conditions, and respectively acquiring the risk settlement seeds in the plurality of second calculation orders;

Acquiring the risk-clearing data corresponding to the risk-clearing seed, and determining a target calculation sequence in the second calculation sequences according to the risk-clearing data so as to determine a target claim amount;

the determining a plurality of second calculation orders from the plurality of first calculation orders according to a preset condition includes:

determining a first order of the plurality of first orders including the first target risk seed as a first order of the first target risk seed;

and if the number of the third calculation orders is a plurality of, determining the third calculation orders as the second calculation orders.

2. The method of claim 1, wherein determining a plurality of second order of the plurality of first orders according to a preset condition includes:

and if the first plurality of calculation orders do not include the second target risk settlement, determining the first calculation order as a second calculation order.

3. A method of processing calculated data as claimed in claim 1, wherein the risk-exposure data includes a risk-exposure cause;

the determining a target settlement order from the plurality of second settlement orders according to the risk-out data comprises:

if the risk reasons are disease risk, determining a target calculation sequence according to the first calculation priority;

And if the risk reasons are accidental injury risk, determining a target calculation sequence according to the second calculation priority.

4. A method of processing calculation data as in claim 3 wherein said determining a target calculation order based on a first calculation priority comprises:

determining a first to-be-determined calculation order according to the first calculation priority, and acquiring the number of the first to-be-determined calculation order;

and if the number of the first to-be-determined calculating sequences is a plurality of, determining one of the first to-be-determined calculating sequences as a target calculating sequence.

5. A method of processing calculation data as in claim 3 wherein said determining a target calculation order based on the second calculation priority comprises:

determining a second to-be-determined rational order according to the second rational priority, and acquiring the number of the second to-be-determined rational order;

and if the number of the second to-be-determined rational orders is a plurality of, determining one of the second to-be-determined rational orders as a target rational order.

6. The method of claim 1, further comprising, after the obtaining a plurality of initial claim amounts corresponding to a plurality of calculation orders:

Comparing the plurality of initial claims amounts;

and determining the target settlement sequence according to the comparison result so as to determine the initial claim amount corresponding to the target settlement sequence as a target claim amount.

7. A rational data processing apparatus, comprising:

the case determining module is configured to acquire the claim data of the case to be subjected to claim settlement and determine a target claim settlement case according to the claim settlement data;

the dangerous seed judging module is configured to acquire a plurality of settlement sequences corresponding to the first target settlement dangerous seed if the target settlement case comprises the first target settlement dangerous seed;

a data acquisition module configured to acquire a plurality of initial claim amounts corresponding to the plurality of calculation orders, and determine a plurality of first calculation orders among the plurality of calculation orders according to the plurality of initial claim amounts;

the order screening module is configured to determine a plurality of second calculation orders in the plurality of first calculation orders according to preset conditions, and respectively acquire the risk of the claim in the plurality of second calculation orders;

an amount determining module configured to acquire risk-clearing data corresponding to the risk-clearing seed, and determine a target calculation order among the plurality of second calculation orders according to the risk-clearing data, so as to determine a target risk-clearing amount;

8. A computer-readable storage medium, on which a computer program is stored, characterized in that the computer program, when being executed by a processor, implements the method of processing calculated data as claimed in any one of claims 1-6.

9. An electronic device, comprising:

a processor;

a memory for storing executable instructions of the processor;

wherein the processor is configured to perform the rational data processing method as claimed in any one of claims 1-6 via execution of the executable instructions.