CN118071519A - Method and device for processing claim settlement request, readable medium and electronic equipment - Google Patents
Method and device for processing claim settlement request, readable medium and electronic equipment Download PDFInfo
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Abstract
The application discloses a method and a device for processing claim settlement requests, a readable medium and electronic equipment, wherein the method comprises the following steps: responding to the claim settlement request, determining a case to be subjected to claim settlement and a case reporting way, a product type, a policy description and a case-related amount of the case to be subjected to claim settlement; collecting policy data required by processing the case to be clashed according to the case reporting path, the product type, the policy description and the case-related amount, and customizing a target case to be clashed for the case to be clashed; and checking the collected policy data by adopting the target claim settlement process. By executing the technical scheme provided by the application, the efficiency of the claim settlement and auditing can be improved, and the cost of the claim settlement and auditing can be reduced.
Description
Technical Field
The present application relates to the field of financial services, and in particular, to a method and apparatus for processing claims settlement requests, a readable medium, and an electronic device.
Background
In the related technology, in the method for verifying and checking the claims of insurance business data, the claim settlement flow is immobilized, all business verification links in the claim settlement flow need to be manually participated, the market change is difficult to be met rapidly, and the industrial requirement of the product on the underwriting side is met.
The claim settlement side needs to make regularized adjustment and customized treatment for the claim settlement flow aiming at different product types and service sources. The method can be quickly adapted to the online requirement, and has important significance for improving the efficiency of the claim settlement audit and reducing the cost of the claim settlement audit.
Disclosure of Invention
The application provides a method and a device for processing a claim settlement request, a readable medium and electronic equipment, which can achieve the purposes of improving the claim settlement auditing efficiency and reducing the claim settlement auditing cost.
According to a first aspect of the present application, there is provided a method of processing a claim request, the method comprising:
responding to the claim settlement request, determining a case to be subjected to claim settlement and a case reporting way, a product type, a policy description and a case-related amount of the case to be subjected to claim settlement;
Collecting policy data required by processing the case to be clashed according to the case reporting path, the product type, the policy description and the case-related amount, and customizing a target case to be clashed for the case to be clashed;
and checking the collected policy data by adopting the target claim settlement process.
According to a second aspect of the present application, there is provided an apparatus for processing claims, the apparatus comprising:
The system comprises a case to be claiming determining module, a case managing module and a case managing module, wherein the case to be claiming determining module is used for determining a case to be claiming and a case reporting way, a product type, a policy description and a case-related amount of the case to be claiming in response to the acquisition of a claim claiming request;
The claim settlement process customizing module is used for collecting and processing the policy data required by the case to be settled according to the case reporting way, the product type, the policy description and the case-related amount and customizing a target claim settlement process for the case to be settled;
And the policy data verification module is used for verifying the collected policy data by adopting the target claim settlement flow.
According to a third aspect of the present application, an embodiment of the present application provides a computer-readable storage medium having stored thereon a computer program which, when executed by a processor, implements a claim settlement request processing method according to the embodiment of the present application.
According to a fourth aspect of the present application, an embodiment of the present application provides an electronic device, including a memory, a processor, and a computer program stored on the memory and executable by the processor, where the processor executes the computer program to implement a method for processing claims according to the embodiment of the present application.
According to the technical scheme, the case to be claiming and the case reporting way, the product type, the policy description and the case-related amount of the case to be claiming are determined in response to the claim-claiming request; collecting policy data required by processing the case to be clashed according to the case reporting path, the product type, the policy description and the case-related amount, and customizing a target case to be clashed for the case to be clashed; and checking the collected policy data by adopting the target claim settlement process. The embodiment of the application supports the customization processing of the claim settlement flow of the case to be clashed aiming at the case reporting way, the product type, the insurance policy description and the case-related amount, can rapidly adapt to the online requirement, and has important significance for improving the claim settlement auditing efficiency and reducing the claim settlement auditing cost.
It should be understood that the description in this section is not intended to identify key or critical features of the embodiments of the application or to delineate the scope of the application. Other features of the present application will become apparent from the description that follows.
Drawings
In order to more clearly illustrate the technical solutions of the embodiments of the present application, the drawings required for the description of the embodiments will be briefly described below, and it is apparent that the drawings in the following description are only some embodiments of the present application, and other drawings may be obtained according to these drawings without inventive effort for a person skilled in the art.
FIG. 1 is a flow chart of a method of claim request processing provided in accordance with a first embodiment;
FIG. 2 is a flow chart of a method of claim request processing provided in accordance with a second embodiment;
fig. 3 is a schematic structural diagram of an apparatus for processing claims according to a third embodiment of the present application;
fig. 4 is a schematic structural diagram of an electronic device according to a fourth embodiment of the present application.
Detailed Description
In order that those skilled in the art will better understand the present application, a technical solution in the embodiments of the present application will be clearly and completely described below with reference to the accompanying drawings in which it is apparent that the described embodiments are only some embodiments of the present application, not all embodiments. All other embodiments, which can be made by those skilled in the art based on the embodiments of the present application without making any inventive effort, shall fall within the scope of the present application.
It should be noted that the terms "first," "second," "target," and "candidate" in the description and claims of the present application and the above figures are used for distinguishing between similar objects and not necessarily for describing a particular sequential or chronological order. It is to be understood that the data so used may be interchanged where appropriate such that the embodiments of the application described herein may be implemented in sequences other than those illustrated or otherwise described herein. Furthermore, the terms "comprises," "comprising," and "having," and any variations thereof, are intended to cover a non-exclusive inclusion, such that a process, method, system, article, or apparatus that comprises a list of steps or elements is not necessarily limited to those steps or elements expressly listed but may include other steps or elements not expressly listed or inherent to such process, method, article, or apparatus.
Example 1
Fig. 1 is a flowchart of a method for processing an claim settlement request according to a first embodiment, which is applicable to a case for settlement of a case to be clawed, and the method may be executed by an claim settlement request processing device, and the claim settlement request processing device may be implemented in the form of hardware and/or software and may be integrated in an electronic device running the system.
As shown in fig. 1, the method includes:
s110, responding to the claim settlement request, and determining the case to be claiming and the case reporting way, the product type, the insurance policy description and the case-related amount of the case to be claiming.
S120, collecting and processing the policy data required by the case to be clashed according to the case reporting path, the product type, the policy description and the case-related amount, and customizing a target claim claiming process for the case to be clashed.
S130, checking the collected policy data by adopting the target claim settlement process.
The claim settlement request is used for requesting the claim settlement auditing system to perform claim settlement auditing on the case to be subjected to claim settlement. The case to be subjected to claim settlement refers to a case needing claim settlement and auditing.
The case to be claiming is associated with a case reporting way, a product type, a policy description and a case related amount. Wherein the entry way is used to determine the identity of the user initiating the claim settlement request for the case to be clawed. Optionally, the case reporting way includes: internet reporting and partner reporting. The case reporting path is used for determining the information integrity of the case to be claiming.
The product type is used to determine the product type to which the case to be claiming belongs. The claims settling flows applicable to different products are different. Exemplary product types include health risks, accident risks, financial risks, life risks, and the like. Accident risks may require a telephone survey or an in-field survey. The product types of the case to be claiming can be obtained by inquiring different underwriting systems by using the policy description of the case to be claiming.
The policy description is used for describing the policy content of the case to be claiming, and optionally, the policy description includes: protected object information, order-identified good-application object information, etc. The amount of the case refers to the amount of the case to be clashed.
The information integrity, product type, policy description and amount of the case will all affect the complexity of the claim settlement process.
The target claim settlement process is a claim settlement process suitable for carrying out claim settlement processing on the case to be claiming. The target claim settlement flow is determined according to the report path, the product type, the policy description and the case-related amount of the case to be claiming.
The claim settlement process of the case to be claiming can be configured by creating a process configuration table. The flow configuration table has flow configuration data recorded therein. The process configuration data is data for configuring the claim settlement process of the claim case to be settled.
Optionally, the flow configuration data of the case to be claiming is called according to the case reporting way, the product type, the policy description and the case-related amount of the case to be claiming. And customizing a target claim settlement process for the case to be clawed according to the process configuration data of the case to be clawed.
Optionally, the target claim settlement process flow includes at least two flow nodes, and the target claim settlement process flow is obtained by combining the flow nodes.
The method comprises the steps of providing a document to be claiming, wherein the required policy data are different when claiming the case to be claiming of different case reporting paths, different product types, different policy descriptions and different case-related amounts. Different policy data need different flow nodes to check. The flow node is configured with policy audit logic, and the policy audit logic applicable to different policy data is different.
And under the condition that the target claim settlement flow of the case to be clashed is determined, checking the collected policy data of the case to be clashed by adopting the target claim settlement flow.
According to the technical scheme, the case to be claiming and the case reporting way, the product type, the policy description and the case-related amount of the case to be claiming are determined in response to the claim-claiming request; collecting policy data required by processing the case to be clashed according to the case reporting path, the product type, the policy description and the case-related amount, and customizing a target case to be clashed for the case to be clashed; and checking the collected policy data by adopting the target claim settlement process. The embodiment of the application supports the customization processing of the claim settlement flow of the case to be clashed aiming at the case reporting way, the product type, the insurance policy description and the case-related amount, can rapidly adapt to the online requirement, and has important significance for improving the claim settlement auditing efficiency and reducing the claim settlement auditing cost.
In an alternative embodiment, customizing a target claim settlement process for the case to be settled according to the case reporting path, the product type, the policy description and the case-related amount, including: determining the information integrity of the case to be claiming according to the case reporting way of the case to be claiming; if the information integrity meets the integrity requirement, determining whether the case to be clashed can execute a self-checking flow according to the product type, the policy description and the case-related amount; and if the case to be claiming can execute the self-checking flow, taking the self-checking flow as a target claiming flow customized for the case to be claiming.
The information integrity is used for measuring the integrity of information required by processing the case to be claiming. The information integrity of the case to be claiming is related to the reporting path of the case to be claiming. Optionally, the case reporting way of the case to be claiming includes: internet approach and partner approach. Taking the approach of the partner as an example, for a case to be claiming, the report source is the approach of the partner. A target partner corresponding to the partner path may be further determined, and a determination may be made as to whether the degree of cooperation with the target partner is deep cooperation. If the information is in the deep cooperation, the information integrity of the case to be claiming can be determined to meet the integrity requirement, because the information of the case to be claiming from the cooperation of the deep cooperation is more complete, and the cooperation of the deep cooperation can also perform online checking periodically.
Under the condition that the information integrity meets the integrity requirement, determining whether the case to be clashed can execute the self-checking flow according to the product type, the policy description and the case-related amount. For example, a self-checking procedure may be performed for some conventional products, general cases of general amounts. The self-checking procedure cannot be performed for some special products or special cases with excessive amounts.
Wherein, self-checking means automatic auditing. The case to be claiming executes the self-checking flow, namely, the case to be claiming is automatically checked through the claiming checking system, and manual checking is not needed.
According to the technical scheme, under the condition that the information integrity of the case to be claiming meets the integrity requirement. And determining whether the case to be clashed can execute the self-checking flow according to the product type, the policy description and the case-related amount, and taking the self-checking flow as a target claiming flow customized for the case to be clashed under the condition that the case to be claiming can execute the self-checking flow. By the aid of the method, the efficiency of claim settlement and auditing is improved, and the process of claim settlement processing is quickened.
In an alternative embodiment, before customizing the target claim settlement process for the case to be claiming according to the claim way, the product type, the policy description, and the amount of the case involved, the method further comprises: determining whether the case to be claiming belongs to repeated claiming according to the policy description and the case claiming record of the case to be claiming; if the case to be claiming belongs to the repeated report, the claim request of the case to be claiming is not submitted and terminated, and the claim request of the case to be claiming is processed.
The case claim records are used for recording cases in the accepted state. Optionally, matching the policy description of the case to be claiming with the case claiming record, and determining whether the case to be claiming belongs to the repeated report according to the matching result. Specifically, if the matching result is that the matching is successful, determining that the case to be claiming belongs to the repeated report; if the matching result is that the matching fails, determining that the case to be clashed is not a repeated report, and reporting the claim claiming request of the case to be clashed to continuously process the claim claiming request of the case to be clashed.
If the case to be claiming belongs to the repeated report, the claim request of the case to be claiming is not submitted and terminated, and the claim request of the case to be claiming is processed. By doing so, repeated cases can be prevented from flowing into the case claim settlement system, so that the business workload is increased, and the situation of mistaking for payment occurs.
Example two
Fig. 2 is a flowchart of a claim settlement request processing method provided according to the second embodiment. The present embodiment is further optimized on the basis of the above embodiment.
As shown in fig. 2, the method includes:
s210, determining a case to be claiming and a case reporting way, a product type, a policy description and a case-related amount of the case to be claiming in response to the claim settlement request.
S220, collecting and processing the policy data required by the case to be clashed according to the case reporting path, the product type, the policy description and the case-related amount.
The policy data of the case to be claiming is the basis for claiming and auditing the case to be claiming. The policy data for the case to be claiming includes a document for the case to be claiming.
According to the case report path, determining which insurance policy is required for processing case report by the path; determining basic information of the product according to the type of the product, and adding documents with special requirements; determining which documents need to be uploaded for the case to be clawed according to the policy description; it is possible to determine which documents such a credit needs to be uploaded according to the amount involved.
S230, determining the information integrity of the case to be claiming according to the case reporting way of the case to be claiming.
S240, if the information integrity is lower than the integrity requirement, the flow configuration data of the case to be clashed is called according to the case reporting path, the product type, the insurance policy description and the case-related amount.
If the information integrity of the case to be claiming is lower than the integrity requirement, the case to be claiming cannot execute the self-checking flow. Or simply executing the self-checking process does not complete the claims of the case to be claimed, that is, the case to be claimed also needs to be subjected to additional audits. The additional audits correspond to the flow nodes.
The flow stage of processing the case to be claiming is determined according to the flow configuration data of the case to be claiming. The flow configuration data is recorded in a flow configuration table. The target claim settlement process customized for the case to be settled can be determined based on the process configuration data, wherein the target claim settlement process is obtained through the combined process nodes. The modification flow configuration data can modify the claim settlement flow of the case to be claiming.
S250, selecting a target process node from the candidate process nodes according to the process configuration data of the case to be claiming, and combining the target process nodes to obtain a target claiming process customized for the case to be claiming.
Wherein the candidate flow nodes may be full-scale flow nodes. The candidate process nodes may constitute a general claim process. The general claim settlement flow can be used for processing any case to be claiming.
The target flow nodes are selected from the candidate flow nodes, and the number of the target flow nodes is smaller than that of the candidate flow nodes. The target process nodes are used for forming a target claim settlement process. The target claim settlement process is customized for the case to be settled, unlike the general claim settlement process, which is simplified.
In an optional embodiment, according to the process configuration data of the case to be claiming, selecting a target process node from candidate process nodes and combining the target process nodes to obtain a target claiming process customized for the case to be claiming, including: extracting a process node identifier and a node dependency relationship from the process configuration data of the case to be claiming; selecting a target process node from the candidate process nodes according to the process node identification; and combining the target flow nodes according to the node dependency relationship to obtain a target claim settlement flow customized for the case to be subjected to claim settlement.
Optionally, the flow configuration data includes a flow node identifier and a node dependency relationship. Wherein the flow node identification is used to select a target flow node from the candidate flow nodes. And the target flow node is provided with a policy audit logic. The target process node is used for auditing the policy data of the case to be claiming, and different policy data of the case to be claiming are audited by different process nodes.
Wherein the node dependencies may be used to determine a combined order of the target flow nodes. The process node with the dependency relationship in the target process node can be determined based on the node dependency relationship. The flow nodes with the dependency relationship have clear front-back logic relationship. There is no explicit logical relationship between flow nodes of which there is no dependency. And adopting a serial combination mode for the flow nodes with the dependency relationships, and adopting a parallel combination mode for the flow nodes without the dependency relationships.
And combining the target flow nodes based on the node dependency relationship to obtain a target claim settlement flow customized for the case to be claim settled.
The technical scheme provides a practical and feasible flow customizing method which can be used for customizing the flow of the case to be claiming, and provides data support for improving the claiming auditing efficiency and reducing the claiming auditing cost.
S260, checking the collected policy data by adopting the target claim settlement process.
According to the embodiment of the application, under the condition that the information integrity of the case to be claiming is lower than the integrity requirement. According to the report path, the product type, the policy description and the case-related amount, the flow configuration data of the case to be claiming is called, and according to the flow configuration data of the case to be claiming, a target flow node is selected from the candidate flow nodes and combined to obtain a target claiming flow customized for the case to be claiming; and checking the collected policy data by adopting a target claim settlement process. According to the embodiment of the application, the process configuration data are set, the target claim settlement process is customized for the case to be clawed, so that the method is favorable for rapidly meeting market change, meets the industrial requirements of products on the underwriting side, can regularly adjust and customize the claim settlement process according to the case to be clawed with different product types and service sources, and is favorable for improving the efficiency of claim settlement audit and accelerating the process of claim settlement.
In an optional implementation, the verifying the collected policy data using the target claim settlement procedure includes: extracting node calling time and node policy correspondence from flow configuration data required by the case to be clawed; determining a target claim settlement stage applicable to the target claim settlement flow according to the node calling time; controlling the case to be clashed to jump to the target claiming stage; and according to the node policy correspondence, verifying policy data corresponding to the target claim settlement process by adopting the target claim settlement process in the target claim settlement stage.
Optionally, the flow configuration data further includes node calling time and node policy correspondence. The node calling time is used for determining a target claim settlement stage applicable to the target claim settlement flow. This is because the case to be claiming may execute a self-checking procedure at some claiming stage in the whole claiming period. After the self-checking process is performed on the case to be claiming, the target claiming process is also required to be performed. The claim settlement stage to which the target claim settlement process is applied is a target claim settlement stage. Optionally, the method includes recording an identification of an claim settlement stage corresponding to the end of execution of the self-checking process in the process configuration data, and determining a target claim settlement process applicable to the target claim settlement process according to the identification of the claim settlement stage corresponding to the end of execution of the self-checking process. Wherein the target claims stage includes at least two flow nodes. That is, at least two kinds of policy data of the case to be claiming are verified at the target claiming stage.
The process node belonging to the target claim settlement stage is a target process node, and policy check logic is configured in the target process node. The policy check logic configured by the different flow nodes is different.
The node policy correspondence is used for determining correspondence between the flow nodes and policy data. Based on the corresponding relation of the node policy, the policy data of the to-be-claiming cases which are respectively used for processing by all flow nodes in the target claiming flow can be determined.
And controlling the case to be subjected to claim settlement to jump to a target claim settlement stage, and checking the policy data corresponding to the target claim settlement process by adopting the target claim settlement process in the target claim settlement stage. The technical scheme provides a practical and feasible policy data verification method which is suitable for verifying the collected policy data by adopting a target claim settlement process. Technical support is provided for improving the efficiency of the claim settlement and auditing and accelerating the process of the claim settlement processing.
In an alternative embodiment, the method further comprises: extracting data pushing time from the flow configuration data of the case to be claiming; according to the data pushing opportunity, selecting a key flow node needing data pushing from the target flow nodes; and controlling the key flow node, and pushing the verification result of the policy data according to the case report path.
The data pushing occasion is used for determining when to push data to a party submitting the case to be claiming. The data pushing time is recorded in the flow configuration data of the case to be claiming. And selecting key flow nodes needing data pushing from the target flow nodes according to the data pushing time. The target process node needing data pushing is a key process node.
After the key flow node finishes checking the policy of the case to be clashed, the key flow node is controlled to push the checking effect of the policy data according to the case reporting way. The case reporting way is used for determining a party submitting the case to be claiming.
According to the technical scheme, in the process of carrying out the claim settlement on the case to be subjected to the claim settlement, the verification result of the policy data of the case to be subjected to the claim settlement is pushed according to the requirement. The method is beneficial to improving the auditing efficiency of the claims and providing user experience in the claims settling process.
In an alternative embodiment, the method further comprises: responding to the acquired inquiry request, determining a case to be inquired, and a case reporting way, a product type, a policy description and a case-related amount of the case to be inquired; according to the report path, the product type, the policy description and the case-related amount of the case to be queried, the flow configuration data of the case to be queried is called; and extracting a query key field from the flow configuration data, and carrying out data query according to the query key field to take a data query result as feedback of a query request.
The query request is used for carrying out data query on the claim auditing system. The case to be queried refers to a case needing to be queried for data.
Under the condition that the case to be queried is determined, obtaining the case reporting way, the product type, the policy description and the case related amount of the case to be queried. And calling the flow configuration data of the case to be queried according to the case reporting path, the product type, the policy description and the case related amount of the case to be queried.
The flow configuration data comprises a query key field. The query key field is used for determining which data of the case to be queried is supported by the claim auditing system.
And extracting the query key field from the flow configuration data of the case to be queried. And carrying out data query according to the query key field, and taking the data query result as feedback of the query request.
According to the technical scheme, the query key field is configured in the flow configuration data, so that the data generated in the process of the claim settlement processing is supported to be queried as required, the efficiency of the claim settlement audit is improved, and the data security in the process of the claim settlement audit is ensured. When the data to be queried of the case to be queried changes, only the query key fields in the stream configuration data are adjusted. Dynamic switching can be realized, and the data access pressure of the claim auditing system can be reduced.
Example III
Fig. 3 is a schematic structural diagram of an apparatus for processing claim settlement requests according to a third embodiment of the present application, where the present embodiment is applicable to a case to be claiming, and the apparatus may be implemented by software and/or hardware and may be integrated in an electronic device such as an intelligent terminal.
As shown in fig. 3, the apparatus may include:
A case to be claiming determining module 310, configured to determine a case to be claiming and a case reporting path, a product type, a policy description and a case-related amount of the case to be claiming in response to acquiring the claim claiming request;
The claim settlement process customizing module 320 is configured to collect policy data required for processing the case to be settled according to the case reporting path, the product type, the policy description and the case-related amount, and customize a target claim settlement process for the case to be settled;
and the policy data verification module 330 is configured to verify the collected policy data by using the target claim settlement procedure.
According to the technical scheme, the case to be claiming and the case reporting way, the product type, the policy description and the case-related amount of the case to be claiming are determined in response to the claim-claiming request; collecting policy data required by processing the case to be clashed according to the case reporting path, the product type, the policy description and the case-related amount, and customizing a target case to be clashed for the case to be clashed; and checking the collected policy data by adopting the target claim settlement process. The embodiment of the application supports the customization processing of the claim settlement flow of the case to be clashed aiming at the case reporting way, the product type, the insurance policy description and the case-related amount, can rapidly adapt to the online requirement, and has important significance for improving the claim settlement auditing efficiency and reducing the claim settlement auditing cost. Optionally, the claim process customization module 320 includes: the information integrity determining submodule is used for determining the information integrity of the case to be claiming according to the case reporting way of the case to be claiming; the flow configuration data calling sub-module is used for calling the flow configuration data of the case to be clashed according to the case reporting path, the product type, the insurance policy description and the case-related amount if the information integrity is lower than the integrity requirement; and the claim settlement flow defining sub-module is used for selecting a target flow node from the candidate flow nodes according to the flow configuration data of the case to be clashed and combining the target flow nodes to obtain a target claim settlement flow customized for the case to be clashed.
Optionally, the claim settlement process determination submodule includes: the first configuration information extraction unit is used for extracting a process node identifier and a node dependency relationship from the process configuration data of the case to be claiming; a process node selection unit, configured to select a target process node from the candidate process nodes according to the process node identifier; and the claim settlement flow customizing unit is used for combining the target flow nodes according to the node dependency relationship to obtain the target claim settlement flow customized for the case to be clashed.
Optionally, the policy data checking module 330 includes: the second configuration information extraction unit is used for extracting node calling time and node policy corresponding relation from the flow configuration data required by the case to be clawed; the claim settlement stage determining unit is used for determining a target claim settlement stage applicable to the target claim settlement process according to the node calling time; the claim settlement stage jumping unit is used for controlling the case to be subjected to claim settlement to jump to the target claim settlement stage; and the policy data verification unit is used for verifying the policy data corresponding to the target claim settlement process by adopting the target claim settlement process in the target claim settlement stage according to the node policy corresponding relation.
Optionally, the claim process customizing module 320 further includes: the self-checking flow judging sub-module is used for determining whether the self-checking flow can be executed by the case to be claiming according to the product type, the policy description and the case-related amount if the information integrity meets the integrity requirement; and the claim settlement process determining sub-module is used for taking the self-checking process as a target claim settlement process customized for the case to be clashed if the case to be clashed can execute the self-checking process.
Optionally, the apparatus further includes: the pushing opportunity extraction module is used for extracting data pushing opportunity from the flow configuration data of the case to be claiming; the key flow node selection module is used for selecting key flow nodes needing data pushing from the target flow nodes according to the data pushing opportunity; and the verification result pushing module is used for controlling the key flow nodes and pushing the verification result of the policy data according to the case report way.
Optionally, the apparatus further includes: the system comprises a case to be queried determining module, a case query module and a case query module, wherein the case to be queried determining module is used for determining a case to be queried and a case reporting way, a product type, a policy description and a case-related amount of the case to be queried in response to acquiring a query request; the flow configuration data calling module is used for calling the flow configuration data of the case to be inquired according to the case reporting path, the product type, the policy description and the case-related amount of the case to be inquired; and the query request feedback module is used for extracting a query key field from the flow configuration data, carrying out data query according to the query key field and taking a data query result as feedback of a query request.
The claim settlement request processing device provided by the embodiment of the application can execute the claim settlement request processing method provided by any embodiment of the application, and has the corresponding performance module and beneficial effects of executing the claim settlement request processing method.
In the technical scheme of the disclosure, the related user data are collected, stored, used, processed, transmitted, provided, disclosed and the like, all conform to the regulations of related laws and regulations and do not violate the popular regulations of the public order.
Example IV
Fig. 4 illustrates a schematic diagram of an electronic device 410 that may be used to implement an embodiment. The electronic device 410 comprises at least one processor 411, and a memory communicatively coupled to the at least one processor 411, such as a Read Only Memory (ROM) 412, a Random Access Memory (RAM) 413, etc., wherein the memory stores computer programs executable by the at least one processor, and the processor 411 may perform various suitable actions and processes in accordance with the computer programs stored in the Read Only Memory (ROM) 412 or the computer programs loaded from the storage unit 418 into the Random Access Memory (RAM) 413. In the RAM 413, various programs and data required for the operation of the electronic device 410 may also be stored. The processor 411, the ROM 412, and the RAM 413 are connected to each other through a bus 414. An input/output (I/O) interface 415 is also connected to bus 414.
Various components in the electronic device 410 are connected to the I/O interface 415, including: an input unit 416 such as a keyboard, a mouse, etc.; an output unit 417 such as various types of displays, speakers, and the like; a storage unit 418, such as a magnetic disk, optical disk, or the like; and a communication unit 419 such as a network card, modem, wireless communication transceiver, etc. The communication unit 419 allows the electronic device 410 to exchange information/data with other devices through a computer network such as the internet and/or various telecommunication networks.
The processor 411 may be a variety of general and/or special purpose processing components having processing and computing capabilities. Some examples of processor 411 include, but are not limited to, a Central Processing Unit (CPU), a Graphics Processing Unit (GPU), various specialized Artificial Intelligence (AI) computing chips, various processors running machine learning model algorithms, digital Signal Processors (DSPs), and any suitable processor, controller, microcontroller, etc. The processor 411 performs the various methods and processes described above, such as the claims request processing method.
In some embodiments, the claims request processing method may be implemented as a computer program tangibly embodied on a computer-readable storage medium, such as the storage unit 418. In some embodiments, some or all of the computer program may be loaded and/or installed onto the electronic device 410 via the ROM 412 and/or the communication unit 419. When the computer program is loaded into RAM 413 and executed by processor 411, one or more steps of the claims request processing method described above may be performed. Alternatively, in other embodiments, the processor 411 may be configured to perform the claims request processing method in any other suitable manner (e.g., by means of firmware).
Various implementations of the systems and techniques described here above can be implemented in digital electronic circuitry, integrated circuit systems, field Programmable Gate Arrays (FPGAs), application Specific Integrated Circuits (ASICs), application Specific Standard Products (ASSPs), systems On Chip (SOCs), complex Programmable Logic Devices (CPLDs), computer hardware, firmware, software, and/or combinations thereof. These various embodiments may include: implemented in one or more computer programs, the one or more computer programs may be executed and/or interpreted on a programmable system including at least one programmable processor, which may be a special purpose or general-purpose programmable processor, that may receive data and instructions from, and transmit data and instructions to, a storage system, at least one input device, and at least one output device.
A computer program for carrying out methods of the present application may be written in any combination of one or more programming languages. These computer programs may be provided to a processor of a general purpose computer, special purpose computer, or other programmable claim request processing apparatus, such that the computer programs, when executed by the processor, cause the functions/acts specified in the flowchart and/or block diagram block or blocks to be implemented. The computer program may execute entirely on the machine, partly on the machine, as a stand-alone software package, partly on the machine and partly on a remote machine or entirely on the remote machine or server.
In the context of the present application, a computer-readable storage medium may be a tangible medium that can contain, or store a computer program for use by or in connection with an instruction execution system, apparatus, or device. The computer readable storage medium may include, but is not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, or device, or any suitable combination of the foregoing. Alternatively, the computer readable storage medium may be a machine readable signal medium. More specific examples of a machine-readable storage medium would include an electrical connection based on one or more wires, a portable computer diskette, a hard disk, a Random Access Memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or flash memory), an optical fiber, a portable compact disc read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing.
To provide for interaction with a user, the systems and techniques described here can be implemented on an electronic device having: a display device (e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor) for displaying information to a user; and a keyboard and a pointing device (e.g., a mouse or a trackball) through which a user can provide input to the electronic device. Other kinds of devices may also be used to provide for interaction with a user; for example, feedback provided to the user may be any form of sensory feedback (e.g., visual feedback, auditory feedback, or tactile feedback); and input from the user may be received in any form, including acoustic input, speech input, or tactile input.
The systems and techniques described here can be implemented in a computing system that includes a background component (e.g., as a claim processing server), or that includes a middleware component (e.g., an application server), or that includes a front-end component through which a user can interact with an implementation of the systems and techniques described here, or any combination of such background, middleware, or front-end components. The components of the system can be interconnected by any form or medium of digital data communication (e.g., a communication network). Examples of communication networks include: local Area Networks (LANs), wide Area Networks (WANs), blockchain networks, and the internet.
The computing system may include clients and servers. The client and server are typically remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other. The server can be a cloud server, also called a cloud computing server or a cloud host, and is a host product in a cloud computing service system, so that the defects of high management difficulty and weak service expansibility in the traditional physical hosts and VPS service are overcome.
It should be appreciated that various forms of the flows shown above may be used to reorder, add, or delete steps. For example, the steps described in the present application may be performed in parallel, sequentially, or in a different order, so long as the desired results of the technical solution of the present application are achieved, and the present application is not limited herein.
The above embodiments do not limit the scope of the present application. It will be apparent to those skilled in the art that various modifications, combinations, sub-combinations and alternatives are possible, depending on design requirements and other factors. Any modifications, equivalent substitutions and improvements made within the spirit and principles of the present application should be included in the scope of the present application.
Claims (9)
1. A method of claim request processing, the method comprising:
responding to the claim settlement request, determining a case to be subjected to claim settlement and a case reporting way, a product type, a policy description and a case-related amount of the case to be subjected to claim settlement;
Collecting policy data required by processing the case to be clashed according to the case reporting path, the product type, the policy description and the case-related amount, and customizing a target case to be clashed for the case to be clashed;
Checking the collected policy data by adopting the target claim settlement process;
the method comprises the steps of customizing a target claim settlement process for the case to be clashed according to the claim way, the product type, the policy description and the case-related amount, and comprises the following steps:
Determining the information integrity of the case to be claiming according to the case reporting way of the case to be claiming;
If the information integrity is lower than the integrity requirement, the flow configuration data of the case to be claiming is called according to the case reporting path, the product type, the policy description and the case-related amount;
and selecting a target process node from the candidate process nodes according to the process configuration data of the case to be claiming, and combining the target process nodes to obtain a target claiming process customized for the case to be claiming.
2. The method of claim 1, selecting a target process node from candidate process nodes according to the process configuration data of the case to be claiming, and combining the target process nodes to obtain a target claiming process customized for the case to be claiming, comprising:
Extracting a process node identifier and a node dependency relationship from the process configuration data of the case to be claiming;
selecting a target process node from the candidate process nodes according to the process node identification;
And combining the target flow nodes according to the node dependency relationship to obtain a target claim settlement flow customized for the case to be subjected to claim settlement.
3. The method of claim 1, wherein verifying the collected policy data using the target claim process comprises:
Extracting node calling time and node policy correspondence from flow configuration data required by the case to be clawed;
Determining a target claim settlement stage applicable to the target claim settlement flow according to the node calling time;
controlling the case to be clashed to jump to the target claiming stage;
and according to the node policy correspondence, verifying policy data corresponding to the target claim settlement process by adopting the target claim settlement process in the target claim settlement stage.
4. The method of claim 1, wherein customizing the target claim settlement process for the claim to be settled case based on the claim approach, the product type, the policy description, and the claim amount further comprises:
if the information integrity meets the integrity requirement, determining whether the case to be clashed can execute a self-checking flow according to the product type, the policy description and the case-related amount;
And if the case to be claiming can execute the self-checking flow, taking the self-checking flow as a target claiming flow customized for the case to be claiming.
5. The method according to claim 1, wherein the method further comprises:
Extracting data pushing time from the flow configuration data of the case to be claiming;
according to the data pushing opportunity, selecting a key flow node needing data pushing from the target flow nodes;
And controlling the key flow node, and pushing the verification result of the policy data according to the case report path.
6. The method according to claim 1, wherein the method further comprises:
Responding to the acquired inquiry request, determining a case to be inquired, and a case reporting way, a product type, a policy description and a case-related amount of the case to be inquired;
According to the report path, the product type, the policy description and the case-related amount of the case to be queried, the flow configuration data of the case to be queried is called;
And extracting a query key field from the flow configuration data, and carrying out data query according to the query key field to take a data query result as feedback of a query request.
7. An apparatus for processing claims, the apparatus comprising:
The system comprises a case to be claiming determining module, a case managing module and a case managing module, wherein the case to be claiming determining module is used for determining a case to be claiming and a case reporting way, a product type, a policy description and a case-related amount of the case to be claiming in response to the acquisition of a claim claiming request;
The claim settlement process customizing module is used for collecting and processing the policy data required by the case to be settled according to the case reporting way, the product type, the policy description and the case-related amount and customizing a target claim settlement process for the case to be settled;
the policy data verification module is used for verifying the collected policy data by adopting the target claim settlement flow;
Wherein, the settlement flow customization module includes: the information integrity determining submodule is used for determining the information integrity of the case to be claiming according to the case reporting way of the case to be claiming; the flow configuration data calling sub-module is used for calling the flow configuration data of the case to be clashed according to the case reporting path, the product type, the insurance policy description and the case-related amount if the information integrity is lower than the integrity requirement; and the claim settlement flow defining sub-module is used for selecting a target flow node from the candidate flow nodes according to the flow configuration data of the case to be clashed and combining the target flow nodes to obtain a target claim settlement flow customized for the case to be clashed.
8. A computer-readable storage medium, on which a computer program is stored, characterized in that the program, when being executed by a processor, implements the claim 1-6 claim request processing method.
9. An electronic device comprising a memory, a processor and a computer program stored on the memory and running on the processor, wherein the processor implements the claim request processing method of any one of claims 1-6 when the computer program is executed by the processor.
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