CN117408821A

CN117408821A - Insurance claim verification method, apparatus, computer device and storage medium

Info

Publication number: CN117408821A
Application number: CN202311323804.0A
Authority: CN
Inventors: 徐振博
Original assignee: Ping An Property and Casualty Insurance Company of China Ltd
Current assignee: Ping An Property and Casualty Insurance Company of China Ltd
Priority date: 2023-10-11
Filing date: 2023-10-11
Publication date: 2024-01-16

Abstract

The application discloses an insurance claim settlement responsibility checking method, an insurance claim settlement responsibility checking device, computer equipment and a storage medium, and belongs to the technical field of artificial intelligence and the technical field of finance. According to the method, the system and the device, the check point of the target insurance product is obtained through analyzing insurance contract clauses, wherein the check point is the minimum responsibility unit in the insurance contract clauses, the check point of the target insurance product is packaged to obtain a check package, a check tree is built based on the check point and/or the check package, four-quadrant configuration is defined in tree nodes of the check tree, the check point and/or the check package is mapped into the four-quadrant configuration, the check tree completing the four-quadrant configuration is imported into a preset check rule engine, check waiting data are obtained, and the check waiting data are imported into the check rule engine to obtain a claim settlement check result. The application also relates to blockchain technology, and the data to be verified is stored on the blockchain node. The method and the device realize automatic insurance claim settlement responsibility, reduce artificial subjective factors and improve consistency and accuracy of the responsibility.

Description

Insurance claim verification method, apparatus, computer device and storage medium

Technical Field

The application belongs to the technical field of artificial intelligence and the field of financial science and technology, and particularly relates to an insurance claim settlement responsibility checking method, an insurance claim settlement responsibility checking device, computer equipment and a storage medium.

Background

In the process of claim settlement, responsibility verification is an important link, and the responsibility verification refers to verifying responsibility of the insured person in the process of risk emergence one by one according to agreements in insurance clauses, determining the part of the clause agreements which is or is not established, and taking the part as the basis of the subsequent claim settlement process. The insurance claim settlement is a process of determining accident responsibility and reimbursement responsibility, and when an accident or loss occurs and a claim is required to be issued to an insurance company, the insurance company performs a responsibility investigation to determine the responsible party of the accident and the reimbursement amount.

Currently, there is no standardized set of solutions in the security industry for how to perform the process of checking, and different insurance companies or individuals may use different methods in the process of checking, and rely mainly on manual experience and judgment. The decision of the responsibility depends on personal experience and judgment of a person who processes the claim, and is not based on a unified set of criteria or rules, so that subjective factors are involved in the responsibility process, objectivity and fairness of the responsibility are affected, consistency of the responsibility is insufficient, and uncertainty of a claim settlement result is caused.

Disclosure of Invention

An object of the embodiments of the present application is to provide an insurance claim settlement method, apparatus, computer device and storage medium, so as to solve the technical problems of the existing insurance claim settlement scheme that the influence of subjective factors is large, the consistency of the responsibility is insufficient, and the result of claim settlement is not fair and objective.

In order to solve the above technical problems, the embodiments of the present application provide an insurance claim settlement method, which adopts the following technical scheme:

a method of insurance claim validation, comprising:

acquiring insurance contract terms of a target insurance product, analyzing the insurance contract terms to obtain a check point of the target insurance product, wherein the check point is a minimum responsibility unit in the insurance contract terms;

grouping the responsibility points of the target insurance products based on a preset combination mode to obtain a responsibility grouping;

importing the responsibility points and/or the responsibility packets into a preset tree-shaped hierarchical structure to obtain a responsibility tree;

identifying tree nodes of the kernel tree, defining four-quadrant configuration in the tree nodes, and mapping kernel points and/or kernel packets into the four-quadrant configuration;

importing the responsibility tree with four-quadrant configuration into a preset responsibility rule engine;

And receiving a claim settlement responsibility instruction, acquiring to-be-verified responsibility data, and importing the to-be-verified responsibility data into a responsibility rule engine to obtain a claim settlement responsibility result.

Further, the step of obtaining insurance contract terms of the target insurance product, analyzing the insurance contract terms to obtain the check point of the target insurance product specifically comprises the following steps:

acquiring insurance contract terms of a target insurance product, analyzing the insurance contract terms, and identifying responsibility keywords in the insurance contract terms;

dividing responsibility of insurance contract clauses according to the responsibility keywords, and constructing a minimum responsibility unit to obtain a responsibility point of a target insurance product;

after the step of dividing responsibility of insurance contract terms according to the responsibility keywords and constructing the minimum responsibility unit to obtain the responsibility point of the target insurance product, the method further comprises the following steps:

the method comprises the steps of identifying types of core responsibility points, wherein the types of the core responsibility points comprise fixed core responsibility points and configurable core responsibility points.

Further, the step of grouping the responsibility points of the target insurance product based on a preset combination mode to obtain a responsibility group comprises the following steps:

identifying association relations among the nuclear responsibility points, wherein the association relations comprise logic relations, sequence relations and importance degrees;

Determining a combination mode of the nuclear responsibility points based on the association relation;

grouping the responsibility points of the target insurance product based on the combination mode of the responsibility points to obtain a responsibility packet;

after the step of grouping the responsibility points of the target insurance product based on the combination mode of the responsibility points to obtain the responsibility packets, the method further comprises the following steps:

the attributes of the responsibility packet are defined, wherein the attributes of the responsibility packet include name, description, and responsibility type.

Further, the tree hierarchy structure includes a product hierarchy, a clause hierarchy and a responsibility hierarchy, and the step of importing the responsibility points and/or the responsibility packets into a preset tree hierarchy structure to obtain a responsibility tree specifically includes:

acquiring attribute information of a nuclear responsibility point and/or a nuclear responsibility packet, wherein the attribute information of the nuclear responsibility point and/or the nuclear responsibility packet comprises a name, a description and a responsibility type;

hierarchical division is carried out on the core responsibility points and/or the core responsibility packets according to the attribute information;

and importing the core responsibility points and/or the core responsibility packets which finish the hierarchical division into the matching hierarchy of the tree-shaped hierarchical structure to obtain the core responsibility tree.

Further, the steps of identifying tree nodes of the kernel tree, defining a four-quadrant configuration in the tree nodes, and mapping the kernel points and/or kernel packets into the four-quadrant configuration specifically include:

Identifying tree nodes of the kernel tree, and defining four-quadrant configuration in each tree node;

acquiring historical responsibility checking data matched with insurance contract clauses;

executing the corresponding nuclear responsibility conditions of the nuclear responsibility points and/or the nuclear responsibility packets to process the history nuclear responsibility data so as to obtain the execution results of the nuclear responsibility points and/or the nuclear responsibility packets;

the core responsibility points and/or core responsibility packets are mapped into a four-quadrant configuration based on the execution results.

Further, the four-quadrant configuration is used for representing different nuclear responsibility requirements, the four-quadrant configuration comprises a first quadrant, a second quadrant, a third quadrant and a fourth quadrant, and the step of mapping the nuclear responsibility points and/or the nuclear responsibility packets into the four-quadrant configuration based on the execution result specifically comprises the following steps:

analyzing the execution result, and matching the execution result with the responsibility requirement in the four-quadrant configuration to obtain a responsibility matching result;

mapping the execution result to different quadrants of the four-quadrant configuration according to the kernel-responsibility matching result to obtain a kernel-responsibility mapping result;

obtaining the responsibility mapping results in different quadrants, and carrying out logic operation on the responsibility mapping results in different quadrants based on a preset logic operation rule to obtain a logic operation result;

and mapping the core responsibility points and/or the core responsibility packets into the four-quadrant configuration according to the logic operation result.

Further, the steps of receiving a claim settlement responsibility instruction, acquiring to-be-clawed responsibility data, importing the to-be-clawed responsibility data into a clawed responsibility rule engine, and obtaining a claim settlement result include:

acquiring to-be-checked responsibility data, and importing the to-be-checked responsibility data into a checking responsibility rule engine;

determining the type of the insurance product matched with the to-be-verified data, and calling a verification tree matched with the type of the insurance product matched with the to-be-verified data in a verification rule engine to obtain a target verification tree;

classifying the to-be-checked responsibility data, respectively importing the to-be-checked responsibility data into tree nodes of the target kernel responsibility trees according to the data types, and acquiring initial kernel responsibility results output by the tree nodes of each target kernel responsibility tree;

and integrating initial responsibility checking results output by the tree nodes to obtain a claim settlement responsibility checking result.

In order to solve the above technical problems, the embodiments of the present application further provide an insurance claim settlement device, which adopts the following technical scheme:

an insurance claim validation apparatus comprising:

the clause analysis module is used for acquiring insurance contract clauses of the target insurance product, analyzing the insurance contract clauses and obtaining a check point of the target insurance product, wherein the check point is the minimum responsibility unit in the insurance contract clauses;

The system comprises a verification point grouping module, a verification point grouping module and a verification point grouping module, wherein the verification point grouping module is used for grouping verification points of a target insurance product based on a preset combination mode to obtain verification packages;

the kernel responsibility tree construction module is used for importing kernel responsibility points and/or kernel responsibility packages into a preset tree-shaped hierarchical structure to obtain kernel responsibility trees;

the four-quadrant configuration module is used for identifying tree nodes of the kernel tree, defining four-quadrant configuration in the tree nodes and mapping kernel points and/or kernel packets into the four-quadrant configuration;

the rule engine module is used for importing the responsibility tree which completes the four-quadrant configuration into a preset responsibility rule engine;

and the claimation checking module is used for receiving the claimation checking instruction, acquiring the data to be checked, and importing the data to be checked into the claimation rule engine to obtain a claimation checking result.

In order to solve the above technical problems, the embodiments of the present application further provide a computer device, which adopts the following technical schemes:

a computer device comprising a memory having stored therein computer readable instructions which when executed by a processor implement the steps of the insurance claim validation method of any of the above claims.

In order to solve the above technical problems, embodiments of the present application further provide a computer readable storage medium, which adopts the following technical solutions:

A computer readable storage medium having stored thereon computer readable instructions which when executed by a processor perform the steps of the insurance claim validation method of any of the above claims.

Compared with the prior art, the embodiment of the application has the following main beneficial effects:

the application discloses an insurance claim settlement responsibility checking method, an insurance claim settlement responsibility checking device, computer equipment and a storage medium, and belongs to the technical field of artificial intelligence and the technical field of finance. According to the method, the insurance contract clause of the target insurance product is acquired, the insurance contract clause is analyzed to obtain the core responsibility point of the target insurance product, wherein the core responsibility point is the minimum responsibility unit in the insurance contract clause, the core responsibility point of the target insurance product is packed based on a preset combination mode to obtain the core responsibility packet, the core responsibility point and/or the core responsibility packet are imported into a preset tree hierarchy structure to obtain a core responsibility tree, the tree node of the core responsibility tree is identified, four-quadrant configuration is defined in the tree node, the core responsibility point and/or the core responsibility packet is mapped into the four-quadrant configuration, the core responsibility tree completing the four-quadrant configuration is imported into a preset core responsibility rule engine, a claim settlement core responsibility instruction is received, to-be-core responsibility data is acquired, and the to-be-core responsibility data is imported into the core responsibility rule engine to obtain a claim settlement core responsibility result. According to the method and the system, the insurance contract clauses are analyzed, the check points and the check packets in the insurance contract clauses are combined and mapped, the check judgment and decision are carried out by using the check tree and the check rule engine, automatic insurance claim settlement check is realized, artificial subjective factors are reduced, and consistency and accuracy of check are improved.

Drawings

For a clearer description of the solution in the present application, a brief description will be given below of the drawings that are needed in the description of the embodiments of the present application, it being obvious that the drawings in the following description are some embodiments of the present application, and that other drawings may be obtained from these drawings without inventive effort for a person of ordinary skill in the art.

FIG. 1 illustrates an exemplary system architecture diagram in which the present application may be applied;

FIG. 2 illustrates a flow chart of one embodiment of a method of insurance claim validation in accordance with the present application;

FIG. 3 illustrates a schematic diagram of one embodiment of an insurance claim validation apparatus according to the present application;

fig. 4 shows a schematic structural diagram of one embodiment of a computer device according to the present application.

Detailed Description

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this application belongs; the terminology used in the description of the applications herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the application; the terms "comprising" and "having" and any variations thereof in the description and claims of the present application and in the description of the figures above are intended to cover non-exclusive inclusions. The terms first, second and the like in the description and in the claims or in the above-described figures, are used for distinguishing between different objects and not necessarily for describing a sequential or chronological order.

Reference herein to "an embodiment" means that a particular feature, structure, or characteristic described in connection with the embodiment may be included in at least one embodiment of the present application. The appearances of such phrases in various places in the specification are not necessarily all referring to the same embodiment, nor are separate or alternative embodiments mutually exclusive of other embodiments. Those of skill in the art will explicitly and implicitly appreciate that the embodiments described herein may be combined with other embodiments.

In order to better understand the technical solutions of the present application, the following description will clearly and completely describe the technical solutions in the embodiments of the present application with reference to the accompanying drawings.

As shown in fig. 1, a system architecture 100 may include terminal devices 101, 102, 103, a network 104, and a server 105. The network 104 is used as a medium to provide communication links between the terminal devices 101, 102, 103 and the server 105. The network 104 may include various connection types, such as wired, wireless communication links, or fiber optic cables, among others.

The user may interact with the server 105 via the network 104 using the terminal devices 101, 102, 103 to receive or send messages or the like. Various communication client applications, such as a web browser application, a shopping class application, a search class application, an instant messaging tool, a mailbox client, social platform software, etc., may be installed on the terminal devices 101, 102, 103.

The terminal devices 101, 102, 103 may be various electronic devices having a display screen and supporting web browsing, including but not limited to smartphones, tablet computers, electronic book readers, MP3 players (Moving Picture Experts Group Audio Layer III, dynamic video expert compression standard audio plane 3), MP4 (Moving Picture Experts Group Audio Layer IV, dynamic video expert compression standard audio plane 4) players, laptop and desktop computers, and the like.

The server 105 may be a server that provides various services, such as a background server that provides support for pages displayed on the terminal devices 101, 102, 103, and may be a stand-alone server, or may be a cloud server that provides cloud services, cloud databases, cloud computing, cloud functions, cloud storage, network services, cloud communications, middleware services, domain name services, security services, content delivery networks (Content Delivery Network, CDN), and basic cloud computing services such as big data and artificial intelligence platforms.

It should be noted that, the insurance claim settlement and responsibility verification method provided in the embodiments of the present application is generally executed by a server, and accordingly, the insurance claim settlement and responsibility verification device is generally disposed in the server.

It should be understood that the number of terminal devices, networks and servers in fig. 1 is merely illustrative. There may be any number of terminal devices, networks, and servers, as desired for implementation.

With continued reference to FIG. 2, a flow chart of one embodiment of an insurance claim validation method according to the present application is shown. The embodiment of the application can acquire and process the related data based on the artificial intelligence technology. Among these, artificial intelligence (Artificial Intelligence, AI) is the theory, method, technique and application system that uses a digital computer or a digital computer-controlled machine to simulate, extend and extend human intelligence, sense the environment, acquire knowledge and use knowledge to obtain optimal results.

Artificial intelligence infrastructure technologies generally include technologies such as sensors, dedicated artificial intelligence chips, cloud computing, distributed storage, big data processing technologies, operation/interaction systems, mechatronics, and the like. The artificial intelligence software technology mainly comprises a computer vision technology, a robot technology, a biological recognition technology, a voice processing technology, a natural language processing technology, machine learning/deep learning and other directions.

In order to solve the technical problems, the application discloses an insurance claim settlement and responsibility checking method, device, computer equipment and storage medium, which belong to the technical field of artificial intelligence and the field of financial science and technology.

The insurance claim liability settlement method comprises the following steps:

s201, acquiring insurance contract terms of the target insurance product, and analyzing the insurance contract terms to obtain a verification point of the target insurance product, wherein the verification point is a minimum responsibility unit in the insurance contract terms.

The point of responsibility is the minimum unit of responsibility in the insurance contract terms, obtained by parsing the insurance contract terms, is an atomic unit that is not subdivided, representing a specific condition or requirement of insurance responsibility, and is typically used to determine whether an insurance claim should be made under specific circumstances. Acquiring the point of responsibility is a key step in the automated insurance claim settlement process, involving extracting the minimum unit of responsibility from the insurance contract terms for subsequent logical judgment and calculation.

In a specific embodiment of the present application, it is assumed that there is an automobile insurance contract in which insurance responsibilities relating to vehicle collision losses, in terms of the contract, there may be the following points of responsibility:

crash incident responsibility point: this is a point of responsibility for determining whether or not insurance benefits should be borne at the time of occurrence of a vehicle collision accident, and the conditions include: when an accident occurs, an insured person drives a vehicle, the accident occurs on a road, and traffic regulations and the like are not violated.

Maintenance history point of responsibility: this is a point of responsibility for determining whether the maintenance history of the vehicle should be considered in the claims, the conditions of which include: whether the vehicle is maintained before the accident, whether the maintenance meets the requirements of manufacturers, and the like.

Vehicle age check point: this is a point of responsibility for determining whether the age of the vehicle should be considered when the vehicle is lost, and the conditions include: the age of the vehicle, whether it is in warranty period, etc.

Claim declaration verification point: this is a point of responsibility for determining whether or not an insured life declares a claim in time following contractual regulations after a loss of the vehicle, and the conditions include: claims claim a time limit, preparation of the required file, etc.

Each point of trust represents a particular condition or requirement for determining whether an insurance claim should be made under different circumstances, and the combination of points of trust and determination constitutes an important logic in the process of insurance claim settlement.

In an embodiment of the present application, insurance contract terms for a target insurance product are obtained. Then, the insurance contract clauses are parsed, and the check responsibility points are extracted, wherein the check responsibility points refer to the minimum responsibility units in the insurance contract clauses and can be specific clause contents or responsibility fine items.

In the embodiments of the present application, first, the insurance contract terms need to be parsed, the contract text converted into machine readable form, such as by structuring the text data, or using natural language processing techniques to extract key information. By analyzing the insurance contract terms, key words describing responsibilities are identified, which may relate to insurance types, scope of responsibilities, conditional restrictions, etc., depending on the type of insurance product. Based on parsing and keyword recognition, responsibilities are divided into minimum units, namely nuclear responsibility points, which should be atomic responsibility units that are not subdivided, by acquiring nuclear responsibility points for subsequent logical judgment and calculation.

It should be noted that the core points of responsibility may be of different types, such as fixed core points of responsibility, which are fixed in most cases and do not require responsibility for additional configuration, and configurable core points of responsibility, which may require custom configuration in different situations, such as according to age range or other conditions. And for each core responsibility point, it is necessary to record information about its attributes, such as keywords, descriptions, responsibility types, etc., which facilitates use in subsequent core responsibility tree configuration and merging algorithms.

In the above embodiment, acquiring the point of responsibility involves extracting the minimum unit of responsibility from the insurance contract terms and then organizing it into a library of responsibility for subsequent configuration and calculation, an important step in the automated insurance claim validation process, helping to ensure the accuracy and effectiveness of the overall process.

S202, grouping the responsibility points of the target insurance products based on a preset combination mode to obtain a responsibility grouping.

Constructing a responsibility bag is another key step in the automated insurance claim responsibility settlement process, involving combining multiple responsibility points together to form a responsibility set to better describe the complexity of insurance responsibilities.

In this embodiment of the present application, according to a preset combination manner, the core responsibility points of the target insurance product are combined to form a core responsibility packet, where the core responsibility packet refers to that the related core responsibility points are combined to form an integral core responsibility unit.

In the embodiment of the application, first, the core responsibility points matched with the related insurance contract clauses are identified, for the identified core responsibility points, how to combine the core responsibility points into a core responsibility packet is determined according to practical situations, including considering the factors of logic relation, sequence, importance and the like among the core responsibility points, the core responsibility packet can be simply composed of a plurality of core responsibility points or can be formed by mixing different types of core responsibility points, the identified core responsibility points are organized according to a preset combination mode to form the core responsibility packet, and the core responsibility packet can accurately describe the insurance responsibility related in the insurance contract clauses.

It should be noted that, for each responsibility packet, it is necessary to define its attributes, including name, description, responsibility type, etc., which will be used in subsequent responsibility tree configuration and responsibility result calculation.

In the above embodiments, building the responsibility packets involves selecting related responsibility points from the responsibility library, determining the manner in which the responsibility points are combined, defining the attributes of the responsibility packets, and organizing the responsibility points into a unit that can be used for configuration of the responsibility tree, which helps to better describe complex insurance responsibilities and makes the automated insurance claim settlement process more accurate and comprehensive.

And S203, importing the nuclear responsibility points and/or the nuclear responsibility packets into a preset tree-shaped hierarchical structure to obtain a nuclear responsibility tree.

The combination of the responsibility points and the responsibility packets forms a key step in the responsibility tree forming process of automatic insurance claim settlement, and the responsibility points and the responsibility packets in the responsibility library are organized according to a certain logic structure so as to quickly and accurately judge responsibility in the responsibility process. A core tree is a hierarchical structure similar to a decision tree to describe the relationship of core points and core packages, and is called a core tree.

In the embodiment of the application, the core responsibility points and/or the core responsibility packets are imported according to a preset tree hierarchy structure to form a core responsibility tree, wherein the core responsibility tree is a hierarchy structure used for representing the relationship between the core responsibility points and the core responsibility packets.

In the embodiment of the present application, first, it is necessary to determine the hierarchical structure of the core responsibility tree, that is, how to hierarchically organize the core responsibility points and the core responsibility packets in the core responsibility library. Typically, a tree of responsibilities can be divided into different levels according to product, terms, and responsibilities (or details of responsibilities). The core responsibility points and core responsibility packets in the core responsibility library are placed in the respective levels of the core responsibility tree according to their dependencies, wherein the fixed core responsibility points and the configurable core responsibility points may be placed at different levels according to their nature. In a kernel tree, there may be a logical relationship between nodes, such as an association between a parent node and a child node, and it is necessary to ensure that the logical relationship accurately reflects the structure and requirements of insurance responsibilities when constructing the kernel tree.

In the embodiment, the method and the system form the responsibility tree through the combination of the responsibility points and the responsibility packets, so that an insurance company can describe the relation and requirements among different insurance responsibilities more clearly, provide standards and basis for automatic responsibility calculation, enable the responsibility tree to be established more reliably and accurately, and reduce the influence of subjective judgment.

S204, identifying tree nodes of the kernel tree, defining four-quadrant configuration in the tree nodes, and mapping the kernel points and/or kernel packets into the four-quadrant configuration.

The four-quadrant configuration is a classification method for describing the responsibility requirement in the automatic insurance claim settlement process, and the classification method helps to ensure more flexibility and accuracy of logic calculation of the responsibility tree by dividing the responsibility requirement under different conditions into four quadrants so as to more clearly define the establishment condition of the responsibility.

Four-quadrant configuration is typically used to check the leaf nodes (product, clause, responsibility/responsibility details) of the responsibility tree to determine if the responsibility holds under different conditions, the four quadrants being:

standard Met (Standard Met): this quadrant describes the conditions under which the requirement of a responsibility is met under standard conditions, the responsibility being met if the conditions specified in the insurance clause are met.

Standard no (Standard Not Met): this quadrant describes the condition of failure of the requirement of the responsibility under standard conditions, the responsibility not being established if the conditions specified in the insurance clause are not met.

Special establishment (Special Circumstances Met): this quadrant describes the conditions under which the requirement of a responsibility is met in a particular situation, even if the conditions under the standard situation are not met, the responsibility can still be met according to the requirements under the particular situation.

Special false (Special Circumstances Not Met): this quadrant describes the condition of failure of the requirement of the responsibility in the special case, even if the condition in the standard case is satisfied, but the requirement in the special case is not satisfied, and the responsibility is not satisfied.

For example, assuming a medical insurance contract, where the terms involved relate to "hospitalization medical cost" responsibilities, on the responsibilities leaf nodes of the responsibility tree, a four-quadrant configuration is defined as follows:

the standard is established: medical diagnosis of hospitalization meets the scope of the disease set by the insurance clause.

The standard is not established: medical diagnosis of hospitalization does not meet the scope of the disease as prescribed by the insurance clause.

The special establishment is as follows: although medical diagnosis does not meet the standard disease category, hospitalization is indeed required according to expert opinion.

The special disagreement is: although medical diagnosis meets the standard disease category, no hospitalization is selected for its own reasons.

When a certain insured person is hospitalized and the medical diagnosis accords with the standard disease range, a check and responsibility conclusion of 'standard establishment' can be obtained according to the four-quadrant configuration, and an insurer can decide whether to pay for hospitalized medical expenses or not according to the conclusion.

In the embodiment of the application, the tree nodes of the kernel tree are identified, and four-quadrant configuration is defined in the tree nodes, wherein the four-quadrant configuration is a classification mode for dividing the kernel points and/or kernel packets into different quadrants so as to perform kernel analysis and management better.

The purpose of defining the four-quadrant configuration in each leaf node of the responsibility tree is to ensure a comprehensive and accurate description of the responsibility requirements under different conditions, so that logic judgment and calculation can be better performed in the automatic responsibility checking process.

In the embodiment of the application, first, tree nodes of a kernel responsibility tree are identified, and a four-quadrant configuration is defined in each tree node, wherein the four-quadrant configuration refers to a configuration of mapping kernel responsibility points and/or kernel responsibility packets into four quadrants, and is used for describing kernel responsibility requirements and conditions. And then acquiring historical responsibility checking data matched with insurance contract clauses, wherein the historical responsibility checking data refers to the prior responsibility checking records or data and can be used for performing responsibility checking judgment and processing.

Executing the corresponding nuclear responsibility conditions of the nuclear responsibility points and/or the nuclear responsibility packets to process the historical nuclear responsibility data to obtain the execution results of the nuclear responsibility points and/or the nuclear responsibility packets, and judging whether the nuclear responsibility requirements are met or not according to the historical nuclear responsibility data by executing the nuclear responsibility conditions to obtain the corresponding execution results. According to the execution result, mapping the conditions of the nuclear responsibility points and/or the nuclear responsibility packets into four quadrants of standard establishment, standard non-establishment, special establishment and special non-establishment so as to clearly judge that the nuclear responsibility requirements are under different conditions.

In the above embodiment, by defining the four-quadrant configuration and mapping the core responsibility points and/or the core responsibility packets into the four-quadrant configuration, the present application ensures that in each leaf node of the core responsibility tree, the well-defined four-quadrant configuration is available, and the execution condition of the core responsibility points and/or the core responsibility packets can be accurately mapped into different quadrants, which provides basis for the automated core responsibility process, and ensures that the core responsibility requirements under different conditions can be comprehensively and accurately described and judged.

In the embodiment of the application, the execution results of the core responsibility points and/or the core responsibility packets are analyzed, whether the execution results are or not is judged, and the execution results are matched with the core responsibility requirements in the four-quadrant configuration to determine core responsibility matching results. Based on the matching result of the last step, mapping the execution result into different quadrants of the four-quadrant configuration, and mapping the execution result into four quadrants of standard establishment, standard non-establishment, special establishment and special non-establishment according to the establishment or non-establishment of the nuclear responsibility requirement.

And obtaining the nuclear-responsibility mapping results obtained in different quadrants, and then carrying out logic operation on the results according to a preset logic operation rule (such as AND, OR, NOT etc.) to obtain a logic operation result. And mapping the core responsibility points and/or the core responsibility packets into the four-quadrant configuration according to the result of the logic operation, and judging whether the core responsibility requirements under different conditions are met or not according to the result of the logic operation, thereby determining the mapping of the core responsibility points and/or the core responsibility packets in the four-quadrant configuration.

In a specific embodiment of the present application, the logic operation may be implemented using a Merge algorithm, which is an algorithm for merging and processing multiple data or results, typically for merging information from different sources into a whole or to arrive at a comprehensive conclusion. In the above scheme, the Merge algorithm is a part of the process of automatic insurance claim settlement and responsibility, and is used for logically combining the execution results of different responsibility points to finally obtain an overall responsibility conclusion.

In the insurance claim validation process, each of the validation points may generate different decision results (such as whether the responsibility is true or not) according to terms, conditions and different situations, where the Merge algorithm functions to combine the individual validation point execution results according to rules and logic to determine the final validation result.

For example, the execution result of the rule engine is converted into the execution result of each core responsibility point/packet, usually a boolean value (true/false), and mapped into a four-quadrant configuration, and the or logic operation is performed for the core responsibility points of the first and four quadrants, so long as one is satisfied, the whole quadrant is considered to be satisfied, and logic operation is performed for the core responsibility points of the second and three quadrants, so that only all the core responsibility points are satisfied, and the or logic operation is performed for the same core responsibility point, so long as one is satisfied, the whole core responsibility is considered to be satisfied, and finally, the final core responsibility conclusion is obtained according to the merging result of each quadrant.

The design and application of the Merge algorithm enable the execution results of the nuclear responsibility points from different sources to be logically combined to obtain a more comprehensive and consistent nuclear responsibility conclusion, which is helpful for eliminating subjective factors, improving the accuracy of nuclear responsibility and enabling insurance companies to effectively make a decision of nuclear responsibility settlement.

In the above embodiment, assuming a medical insurance contract, there are two points of responsibility as follows: the A core responsibility point is in accordance with the standard disease type range of medical diagnosis, the B core responsibility point is in need of hospitalization of expert opinion, and according to the execution condition, the A core responsibility point is assumed to be false (not true), and the B core responsibility point is true (true).

Mapping the execution cases to four quadrants: the execution result of the A core responsibility point is false, the A core responsibility point is mapped to a quadrant of 'standard is not established', the B core responsibility point is true, the B core responsibility point is mapped to a quadrant of 'special establishment', the results of 'standard is not established' and 'special establishment' are combined based on a Merge algorithm, and a core responsibility conclusion is finally obtained as 'special establishment' according to priority logic.

In this example, the execution conditions of the two core responsibility points are mapped into the four-quadrant configuration, the final core responsibility conclusion is obtained through the merging operation, and the judgment of whether the responsibility is established is obtained by matching the execution conditions of the core responsibility points with the four-quadrant configuration.

In the above embodiment, the execution results of the responsibility points and/or the responsibility packets are mapped to different four-quadrant configurations by using logical operations, so as to determine the judgment of the responsibility requirements under different conditions, ensure that the automated responsibility checking process can perform logical judgment and calculation according to actual conditions, and obtain the conclusion of whether the responsibility is established.

S205, importing the responsibility tree with the four-quadrant configuration into a preset responsibility rule engine.

In the embodiment of the application, the responsibility tree completing the four-quadrant configuration is imported into a preset responsibility rule engine, and the responsibility rule engine is a system for executing the responsibility rules and can perform responsibility judgment and decision according to the responsibility tree and the preset rules.

S206, receiving the claim settlement responsibility instruction, acquiring the to-be-verified responsibility data, and importing the to-be-verified responsibility data into a responsibility rule engine to obtain a claim settlement responsibility result.

In the embodiment of the application, a claim settlement responsibility instruction is received, to-be-verified responsibility data is obtained, the to-be-verified responsibility data is imported into a responsibility verification rule engine, and the responsibility verification calculation and judgment are carried out according to a preset responsibility verification rule to obtain a claim settlement responsibility result, wherein the claim settlement responsibility result can indicate a responsibility verification result and responsibility distribution.

In the embodiment of the application, firstly, the data to be subjected to the responsibility is acquired, and the data to be subjected to the responsibility is imported into a responsibility rule engine, wherein the responsibility rule engine is a system for executing the responsibility rule, and can perform responsibility judgment and processing according to the data to be subjected to the responsibility. And then determining the type of the insurance product matched with the to-be-verified data, and calling a verification tree matched with the type of the insurance product matched with the to-be-verified data in a verification rule engine to obtain a target verification tree, wherein the target verification tree is a verification tree corresponding to the type of the insurance product matched with the to-be-verified data.

The data to be verified is imported into corresponding nodes of the kernel tree according to different data types, initial kernel results of the nodes are automatically generated by executing kernel points and/or kernel conditions corresponding to kernel packets in the tree nodes, initial kernel results output by the tree nodes are integrated to obtain claim settlement kernel results, and a comprehensive kernel conclusion can be obtained by integrating the kernel results of the tree nodes and used for claim settlement kernel decision.

By logically combining the execution results of the kernel responsibility points corresponding to different types of data, a more comprehensive and consistent kernel responsibility conclusion is obtained, subjective factors are eliminated, the accuracy of kernel responsibility is improved, and an insurance company can effectively make a decision of claiming kernel responsibility. By means of an automatic responsibility checking rule engine and a merging algorithm, the efficiency and accuracy of responsibility checking can be improved, and therefore the claim settlement service level of an insurance company is improved.

In the above embodiments, the present application discloses an insurance claim settlement method, which belongs to the technical field of artificial intelligence and the technical field of finance. According to the method, the insurance contract clause of the target insurance product is acquired, the insurance contract clause is analyzed to obtain the core responsibility point of the target insurance product, wherein the core responsibility point is the minimum responsibility unit in the insurance contract clause, the core responsibility point of the target insurance product is packed based on a preset combination mode to obtain the core responsibility packet, the core responsibility point and/or the core responsibility packet are imported into a preset tree hierarchy structure to obtain a core responsibility tree, the tree node of the core responsibility tree is identified, four-quadrant configuration is defined in the tree node, the core responsibility point and/or the core responsibility packet is mapped into the four-quadrant configuration, the core responsibility tree completing the four-quadrant configuration is imported into a preset core responsibility rule engine, a claim settlement core responsibility instruction is received, to-be-core responsibility data is acquired, and the to-be-core responsibility data is imported into the core responsibility rule engine to obtain a claim settlement core responsibility result. According to the method and the system, the insurance contract clauses are analyzed, the check points and the check packets in the insurance contract clauses are combined and mapped, the check judgment and decision are carried out by using the check tree and the check rule engine, automatic insurance claim settlement check is realized, artificial subjective factors are reduced, and consistency and accuracy of check are improved.

In this embodiment, the electronic device (e.g., the server shown in fig. 1) on which the insurance claim liability check method operates may receive the instruction or acquire the data through a wired connection or a wireless connection. It should be noted that the wireless connection may include, but is not limited to, 3G/4G connections, wiFi connections, bluetooth connections, wiMAX connections, zigbee connections, UWB (ultra wideband) connections, and other now known or later developed wireless connection means.

It should be emphasized that, to further ensure the privacy and security of the above-mentioned data to be verified, the above-mentioned data to be verified may also be stored in a node of a blockchain.

The blockchain referred to in the application is a novel application mode of computer technologies such as distributed data storage, point-to-point transmission, consensus mechanism, encryption algorithm and the like. The Blockchain (Blockchain), which is essentially a decentralised database, is a string of data blocks that are generated by cryptographic means in association, each data block containing a batch of information of network transactions for verifying the validity of the information (anti-counterfeiting) and generating the next block. The blockchain may include a blockchain underlying platform, a platform product services layer, an application services layer, and the like.

Those skilled in the art will appreciate that implementing all or part of the processes of the methods of the embodiments described above may be accomplished by way of computer readable instructions, stored on a computer readable storage medium, which when executed may comprise processes of embodiments of the methods described above. The storage medium may be a nonvolatile storage medium such as a magnetic disk, an optical disk, a Read-Only Memory (ROM), or a random access Memory (Random Access Memory, RAM).

It should be understood that, although the steps in the flowcharts of the figures are shown in order as indicated by the arrows, these steps are not necessarily performed in order as indicated by the arrows. The steps are not strictly limited in order and may be performed in other orders, unless explicitly stated herein. Moreover, at least some of the steps in the flowcharts of the figures may include a plurality of sub-steps or stages that are not necessarily performed at the same time, but may be performed at different times, the order of their execution not necessarily being sequential, but may be performed in turn or alternately with other steps or at least a portion of the other steps or stages.

With further reference to fig. 3, as an implementation of the method shown in fig. 2, the present application provides an embodiment of an insurance claim verification and responsibility verification apparatus, where the embodiment of the apparatus corresponds to the embodiment of the method shown in fig. 2, and the apparatus may be specifically applied in various electronic devices.

As shown in fig. 3, the insurance claim verification and responsibility verification device 300 according to the present embodiment includes:

the term analysis module 301 is configured to obtain an insurance contract term of the target insurance product, analyze the insurance contract term, and obtain a verification point of the target insurance product, where the verification point is a minimum responsibility unit in the insurance contract term;

the responsibility point grouping module 302 is configured to group responsibility points of the target insurance product based on a preset combination manner to obtain a responsibility point group;

the responsibility tree construction module 303 is configured to import responsibility points and/or responsibility packets into a preset tree hierarchy structure to obtain a responsibility tree;

a four-quadrant configuration module 304, configured to identify tree nodes of the kernel tree, define a four-quadrant configuration in the tree nodes, and map the kernel points and/or kernel packets into the four-quadrant configuration;

a rule engine module 305, configured to import the responsibility tree with the four-quadrant configuration into a preset responsibility rule engine;

And the claim settlement module 306 is configured to receive the claim settlement instruction, acquire the to-be-clawed data, and import the to-be-clawed data into the clawed rule engine to obtain a claim settlement result.

Further, the term parsing module 301 specifically includes:

the clause analysis unit is used for acquiring insurance contract clauses of the target insurance product, analyzing the insurance contract clauses and identifying responsibility keywords in the insurance contract clauses;

the unit is used for dividing responsibility of insurance contract clauses according to the responsibility keywords, constructing a minimum responsibility unit and obtaining a responsibility point of a target insurance responsibility division insurance product;

and the nuclear responsibility point type identification unit is used for identifying the type of the nuclear responsibility point, wherein the type of the nuclear responsibility point comprises a fixed nuclear responsibility point and a configurable nuclear responsibility point.

Further, the core responsibility point group package module 302 specifically includes:

the association relation identification unit is used for identifying association relation among the nuclear responsibility points, wherein the association relation comprises a logic relation, a sequence relation and an importance degree;

the combination mode determining unit is used for determining the combination mode of the nuclear responsibility points based on the association relation;

the core responsibility point grouping unit is used for grouping the core responsibility points of the target insurance product based on the combination mode of the core responsibility points to obtain a core responsibility packet;

And the responsibility packet attribute definition unit is used for defining the attribute of the responsibility packet, wherein the attribute of the responsibility packet comprises a name, a description and a responsibility type.

Further, the tree hierarchy structure includes a product hierarchy, a clause hierarchy, and a responsibility hierarchy, and the core responsibility tree construction module 303 specifically includes:

the attribute information acquisition unit is used for acquiring attribute information of the nuclear responsibility points and/or the nuclear responsibility packets, wherein the attribute information of the nuclear responsibility points and/or the nuclear responsibility packets comprises names, descriptions and responsibility types;

the hierarchy dividing unit is used for carrying out hierarchy division on the core responsibility points and/or the core responsibility packets according to the attribute information;

and the kernel responsibility tree construction unit is used for importing the kernel responsibility points and/or the kernel responsibility packets which complete the hierarchical division into the matching hierarchy of the tree-shaped hierarchical structure to obtain the kernel responsibility tree.

Further, the four-quadrant configuration module 304 specifically includes:

a four-quadrant defining unit for identifying tree nodes of the kernel tree and defining four-quadrant configuration in each tree node;

a history responsibility checking data unit for acquiring history responsibility checking data matched with insurance contract clauses;

the history responsibility processing unit is used for executing the responsibility conditions corresponding to the responsibility points and/or the responsibility packets so as to process the history responsibility data and obtain the execution results of the responsibility points and/or the responsibility packets;

And the kernel responsibility mapping unit is used for mapping the kernel responsibility points and/or the kernel responsibility packets into the four-quadrant configuration based on the execution result.

Further, the four-quadrant configuration is used for representing different nuclear responsibility requirements, the four-quadrant configuration comprises a first quadrant, a second quadrant, a third quadrant and a fourth quadrant, and the nuclear responsibility mapping unit specifically comprises:

the execution result analysis subunit is used for analyzing the execution result, and matching the execution result with the responsibility requirement in the four-quadrant configuration to obtain a responsibility matching result;

the execution result mapping subunit is used for mapping the execution result into different quadrants of the four-quadrant configuration according to the kernel responsibility matching result to obtain a kernel responsibility mapping result;

the logic operation subunit is used for acquiring the kernel mapping results in different quadrants, and carrying out logic operation on the kernel mapping results in different quadrants based on a preset logic operation rule to obtain a logic operation result;

and the core responsibility point and/or core responsibility packet mapping subunit is used for mapping the core responsibility point and/or core responsibility packet into the four-quadrant configuration according to the logic operation result.

Further, the claim validation module 306 specifically includes:

the responsibility data importing unit is used for acquiring the responsibility data to be verified and importing the responsibility data to be verified into the responsibility rule engine;

The responsibility tree matching unit is used for determining the type of the insurance product matched with the responsibility data to be checked, and calling a responsibility tree matched with the type of the insurance product matched with the responsibility data to be checked in the responsibility rule engine to obtain a target responsibility tree;

the responsibility processing unit is used for classifying the responsibility data to be checked, respectively importing the responsibility data to be checked into tree nodes of the target responsibility trees according to the data types, and acquiring initial responsibility results output by the tree nodes of each target responsibility tree;

and the responsibility result integrating unit is used for integrating the initial responsibility result output by each tree node to obtain the claim settlement responsibility result.

In the above-mentioned embodiment, this application discloses an insurance claim settlement device of checking responsibility belongs to artificial intelligence technical field and finance science and technology field. According to the method, the insurance contract clause of the target insurance product is acquired, the insurance contract clause is analyzed to obtain the core responsibility point of the target insurance product, wherein the core responsibility point is the minimum responsibility unit in the insurance contract clause, the core responsibility point of the target insurance product is packed based on a preset combination mode to obtain the core responsibility packet, the core responsibility point and/or the core responsibility packet are imported into a preset tree hierarchy structure to obtain a core responsibility tree, the tree node of the core responsibility tree is identified, four-quadrant configuration is defined in the tree node, the core responsibility point and/or the core responsibility packet is mapped into the four-quadrant configuration, the core responsibility tree completing the four-quadrant configuration is imported into a preset core responsibility rule engine, a claim settlement core responsibility instruction is received, to-be-core responsibility data is acquired, and the to-be-core responsibility data is imported into the core responsibility rule engine to obtain a claim settlement core responsibility result. According to the method and the system, the insurance contract clauses are analyzed, the check points and the check packets in the insurance contract clauses are combined and mapped, the check judgment and decision are carried out by using the check tree and the check rule engine, automatic insurance claim settlement check is realized, artificial subjective factors are reduced, and consistency and accuracy of check are improved.

In order to solve the technical problems, the embodiment of the application also provides computer equipment. Referring specifically to fig. 4, fig. 4 is a basic structural block diagram of a computer device according to the present embodiment.

The computer device 4 comprises a memory 41, a processor 42, a network interface 43 communicatively connected to each other via a system bus. It should be noted that only computer device 4 having components 41-43 is shown in the figures, but it should be understood that not all of the illustrated components are required to be implemented and that more or fewer components may be implemented instead. It will be appreciated by those skilled in the art that the computer device herein is a device capable of automatically performing numerical calculations and/or information processing in accordance with predetermined or stored instructions, the hardware of which includes, but is not limited to, microprocessors, application specific integrated circuits (Application Specific Integrated Circuit, ASICs), programmable gate arrays (fields-Programmable Gate Array, FPGAs), digital processors (Digital Signal Processor, DSPs), embedded devices, etc.

The computer equipment can be a desktop computer, a notebook computer, a palm computer, a cloud server and other computing equipment. The computer equipment can perform man-machine interaction with a user through a keyboard, a mouse, a remote controller, a touch pad or voice control equipment and the like.

The memory 41 includes at least one type of readable storage medium including flash memory, hard disk, multimedia card, card memory (e.g., SD or DX memory, etc.), random Access Memory (RAM), static Random Access Memory (SRAM), read Only Memory (ROM), electrically Erasable Programmable Read Only Memory (EEPROM), programmable Read Only Memory (PROM), magnetic memory, magnetic disk, optical disk, etc. In some embodiments, the storage 41 may be an internal storage unit of the computer device 4, such as a hard disk or a memory of the computer device 4. In other embodiments, the memory 41 may also be an external storage device of the computer device 4, such as a plug-in hard disk, a Smart Media Card (SMC), a Secure Digital (SD) Card, a Flash Card (Flash Card) or the like, which are provided on the computer device 4. Of course, the memory 41 may also comprise both an internal memory unit of the computer device 4 and an external memory device. In this embodiment, the memory 41 is typically used to store an operating system and various application software installed on the computer device 4, such as computer readable instructions for insurance claim verification methods. Further, the memory 41 may be used to temporarily store various types of data that have been output or are to be output.

The processor 42 may be a central processing unit (Central Processing Unit, CPU), controller, microcontroller, microprocessor, or other data processing chip in some embodiments. The processor 42 is typically used to control the overall operation of the computer device 4. In this embodiment, the processor 42 is configured to execute computer readable instructions stored in the memory 41 or process data, such as computer readable instructions for executing the insurance claim settlement method.

The network interface 43 may comprise a wireless network interface or a wired network interface, which network interface 43 is typically used for establishing a communication connection between the computer device 4 and other electronic devices.

In the above embodiment, the application discloses a computer device, which belongs to the technical field of artificial intelligence and the technical field of finance. According to the method, the insurance contract clause of the target insurance product is acquired, the insurance contract clause is analyzed to obtain the core responsibility point of the target insurance product, wherein the core responsibility point is the minimum responsibility unit in the insurance contract clause, the core responsibility point of the target insurance product is packed based on a preset combination mode to obtain the core responsibility packet, the core responsibility point and/or the core responsibility packet are imported into a preset tree hierarchy structure to obtain a core responsibility tree, the tree node of the core responsibility tree is identified, four-quadrant configuration is defined in the tree node, the core responsibility point and/or the core responsibility packet is mapped into the four-quadrant configuration, the core responsibility tree completing the four-quadrant configuration is imported into a preset core responsibility rule engine, a claim settlement core responsibility instruction is received, to-be-core responsibility data is acquired, and the to-be-core responsibility data is imported into the core responsibility rule engine to obtain a claim settlement core responsibility result. According to the method and the system, the insurance contract clauses are analyzed, the check points and the check packets in the insurance contract clauses are combined and mapped, the check judgment and decision are carried out by using the check tree and the check rule engine, automatic insurance claim settlement check is realized, artificial subjective factors are reduced, and consistency and accuracy of check are improved.

The present application also provides another embodiment, namely, a computer-readable storage medium storing computer-readable instructions executable by at least one processor to cause the at least one processor to perform the steps of an insurance claim validation method as described above.

In the above embodiments, the application discloses a computer readable storage medium, which belongs to the technical field of artificial intelligence and the technical field of finance. According to the method, the insurance contract clause of the target insurance product is acquired, the insurance contract clause is analyzed to obtain the core responsibility point of the target insurance product, wherein the core responsibility point is the minimum responsibility unit in the insurance contract clause, the core responsibility point of the target insurance product is packed based on a preset combination mode to obtain the core responsibility packet, the core responsibility point and/or the core responsibility packet are imported into a preset tree hierarchy structure to obtain a core responsibility tree, the tree node of the core responsibility tree is identified, four-quadrant configuration is defined in the tree node, the core responsibility point and/or the core responsibility packet is mapped into the four-quadrant configuration, the core responsibility tree completing the four-quadrant configuration is imported into a preset core responsibility rule engine, a claim settlement core responsibility instruction is received, to-be-core responsibility data is acquired, and the to-be-core responsibility data is imported into the core responsibility rule engine to obtain a claim settlement core responsibility result. According to the method and the system, the insurance contract clauses are analyzed, the check points and the check packets in the insurance contract clauses are combined and mapped, the check judgment and decision are carried out by using the check tree and the check rule engine, automatic insurance claim settlement check is realized, artificial subjective factors are reduced, and consistency and accuracy of check are improved.

From the above description of the embodiments, it will be clear to those skilled in the art that the above-described embodiment method may be implemented by means of software plus a necessary general hardware platform, but of course may also be implemented by means of hardware, but in many cases the former is a preferred embodiment. Based on such understanding, the technical solution of the present application may be embodied essentially or in a part contributing to the prior art in the form of a software product stored in a storage medium (such as ROM/RAM, magnetic disk, optical disk), comprising several instructions for causing a terminal device (which may be a mobile phone, a computer, a server, an air conditioner, or a network device, etc.) to perform the method described in the embodiments of the present application.

The subject application is operational with numerous general purpose or special purpose computer system environments or configurations. For example: personal computers, server computers, hand-held or portable devices, tablet devices, multiprocessor systems, microprocessor-based systems, set top boxes, programmable consumer electronics, network PCs, minicomputers, mainframe computers, distributed computing environments that include any of the above systems or devices, and the like. The application may be described in the general context of computer-executable instructions, such as program modules, being executed by a computer. Generally, program modules include routines, programs, objects, components, data structures, etc. that perform particular tasks or implement particular abstract data types. The application may also be practiced in distributed computing environments where tasks are performed by remote processing devices that are linked through a communications network. In a distributed computing environment, program modules may be located in both local and remote computer storage media including memory storage devices.

It is apparent that the embodiments described above are only some embodiments of the present application, but not all embodiments, the preferred embodiments of the present application are given in the drawings, but not limiting the patent scope of the present application. This application may be embodied in many different forms, but rather, embodiments are provided in order to provide a more thorough understanding of the present disclosure. Although the present application has been described in detail with reference to the foregoing embodiments, it will be apparent to those skilled in the art that modifications may be made to the embodiments described in the foregoing, or equivalents may be substituted for elements thereof. All equivalent structures made by the specification and the drawings of the application are directly or indirectly applied to other related technical fields, and are also within the protection scope of the application.

Claims

1. A method of claiming responsibility for an insurance claim, comprising:

acquiring insurance contract terms of a target insurance product, and analyzing the insurance contract terms to obtain a check point of the target insurance product, wherein the check point is the minimum responsibility unit in the insurance contract terms;

importing the nuclear responsibility points and/or the nuclear responsibility packets into a preset tree-shaped hierarchical structure to obtain a nuclear responsibility tree;

identifying tree nodes of the kernel tree, defining a four-quadrant configuration in the tree nodes, and mapping the kernel points and/or the kernel packets into the four-quadrant configuration;

importing the responsibility tree which completes the four-quadrant configuration into a preset responsibility rule engine;

and receiving a claim settlement responsibility instruction, acquiring to-be-verified responsibility data, and importing the to-be-verified responsibility data into the responsibility verification rule engine to obtain a claim settlement responsibility result.

2. The method of claim 1, wherein the steps of obtaining insurance contract terms of the target insurance product, analyzing the insurance contract terms, and obtaining the point of responsibility of the target insurance product comprise:

dividing responsibility of the insurance contract clauses according to the responsibility keywords, and constructing a minimum responsibility unit to obtain a responsibility point of the target insurance product;

After the step of dividing responsibility of the insurance contract terms according to the responsibility keywords and constructing the minimum responsibility unit to obtain the responsibility point of the target insurance product, the method further comprises the steps of:

the type of the core responsibility point is identified, wherein the type of the core responsibility point includes a fixed core responsibility point and a configurable core responsibility point.

3. The method for claiming and claiming the responsibilities of claim 1, wherein the step of grouping the claiming points of the target insurance product based on a preset combination mode to obtain a claiming package specifically comprises:

grouping the nuclear responsibility points of the target insurance product based on the combination mode of the nuclear responsibility points to obtain the nuclear responsibility package;

after the step of grouping the core responsibility points of the target insurance product based on the combination mode of the core responsibility points to obtain the core responsibility package, the method further comprises the following steps:

defining attributes of the responsibility packet, wherein the attributes of the responsibility packet include names, descriptions, and responsibility types.

4. A method of claim 3, wherein the tree hierarchy includes a product hierarchy, a clause hierarchy, and a responsibility hierarchy, and the step of importing the responsibility points and/or the responsibility packets into a predetermined tree hierarchy to obtain a responsibility tree specifically includes:

acquiring attribute information of the core responsibility point and/or the core responsibility packet, wherein the attribute information of the core responsibility point and/or the core responsibility packet comprises a name, a description and a responsibility type;

hierarchical division is carried out on the nuclear responsibility points and/or the nuclear responsibility packets according to the attribute information;

and importing the core responsibility points and/or core responsibility packages which finish the hierarchical division into the matching hierarchy of the tree hierarchy to obtain the core responsibility tree.

5. The method of claim 4, wherein the steps of identifying tree nodes of the responsibility tree, defining a four-quadrant configuration in the tree nodes, and mapping the responsibility points and/or the responsibility packets into the four-quadrant configuration comprise:

identifying tree nodes of the kernel tree and defining the four-quadrant configuration in each of the tree nodes;

acquiring historical responsibility checking data matched with the insurance contract clauses;

Executing the nuclear responsibility point and/or the nuclear responsibility condition corresponding to the nuclear responsibility packet to process the history nuclear responsibility data so as to obtain an execution result of the nuclear responsibility point and/or the nuclear responsibility packet;

and mapping the nuclear responsibility point and/or the nuclear responsibility packet into the four-quadrant configuration based on the execution result.

6. The method of claim 5, wherein the four-quadrant configuration is used to characterize different requirements of the responsibilities, the four-quadrant configuration includes a first quadrant, a second quadrant, a third quadrant, and a fourth quadrant, and the mapping the responsibilities points and/or the packets of the responsibilities into the four-quadrant configuration based on the execution results specifically includes:

And mapping the core responsibility point and/or the core responsibility packet into the four-quadrant configuration according to the logical operation result.

7. The method of claim 6, wherein the steps of receiving an instruction for claiming a liability, obtaining data to be claiming, importing the data to be claiming into the liability rules engine, and obtaining a claiming result comprise:

acquiring to-be-checked responsibility data, and importing the to-be-checked responsibility data into the responsibility checking rule engine;

determining the type of the insurance product matched with the to-be-verified data, and calling a verification tree matched with the type of the insurance product matched with the to-be-verified data in the verification rule engine to obtain a target verification tree;

classifying the to-be-checked responsibility data, respectively importing the to-be-checked responsibility data into tree nodes of the target kernel responsibility trees according to data types, and acquiring initial kernel responsibility results output by the tree nodes of each target kernel responsibility tree;

and integrating initial responsibility verification results output by the tree nodes to obtain the result of the claim settlement.

8. An insurance claim liability check device, comprising:

the clause analysis module is used for acquiring insurance contract clauses of a target insurance product, analyzing the insurance contract clauses and obtaining a check responsibility point of the target insurance product, wherein the check responsibility point is the minimum responsibility unit in the insurance contract clauses;

The responsibility point grouping module is used for grouping the responsibility points of the target insurance product based on a preset combination mode to obtain a responsibility point grouping module;

the kernel responsibility tree construction module is used for importing the kernel responsibility points and/or the kernel responsibility packets into a preset tree-shaped hierarchical structure to obtain kernel responsibility trees;

the four-quadrant configuration module is used for identifying tree nodes of the nuclear responsibility tree, defining four-quadrant configuration in the tree nodes and mapping the nuclear responsibility points and/or the nuclear responsibility packets into the four-quadrant configuration;

and the claim settlement and responsibility checking module is used for receiving the claim settlement and responsibility checking instruction, acquiring the to-be-checked responsibility data, and importing the to-be-checked responsibility data into the responsibility checking rule engine to obtain a claim settlement and responsibility checking result.

9. A computer device comprising a memory having stored therein computer readable instructions which when executed by the processor implement the steps of the insurance claim verification method of any of claims 1 to 7.

10. A computer readable storage medium having stored thereon computer readable instructions which when executed by a processor perform the steps of the insurance claim verification method of any of claims 1 to 7.