TW201944336A - Method and device for processing available resources for service - Google Patents

Abstract

Provided are a method and device for evaluating the credibility of a user applying for available resources of a service and a method and device for processing available resources for the service, the method for evaluating credibility comprising: acquiring application data of a user for available resources; determining first evaluation information according to the application data, the first evaluation information corresponding to an abnormality of the application data; acquiring historical behavior data of the user; determining second evaluation information according to the historical behavior data, the second evaluation information corresponding to attribute features of the user; and combining the first evaluation information and the second evaluation information to evaluate the credibility of the user applying for the available resources of the service.

Description

Method and device for processing available resources of business

The embodiments of the present specification relate to the field of data processing technology, and more specifically, to a method and device for evaluating the credibility of resources available to a user for applying for a service, and a method and device for processing available resources for a service.

With the development of Internet technology, more and more traditional businesses have corresponding online solutions. However, the traditional health and medical insurance business is still basically at the stage of manual processing of paper materials. In the field of health care related insurance, the timeliness and risk control of claims has always been a problem in the industry. Claims fraud includes insurance with illness, false credentials, and false medical information. In particular, the outpatient insurance is a high-frequency scenario, and it is necessary to quickly and accurately judge and control risks in the claims process. Therefore, there is a need for a more effective business risk control scheme and a compensation scheme to meet the above needs.

The embodiments of the present specification are intended to provide a more effective method for processing service available resources to solve the deficiencies in the prior art.
In order to achieve the above purpose, one aspect of the present specification provides a method for evaluating the credibility of a user's application for a service available resource. The method is executed by a system where the service is located, and includes: obtaining the user's application data for the available resource. Determining first evaluation information according to the application data, the first evaluation information corresponding to the abnormality of the application data; obtaining historical behavior data of the user; determining second evaluation information based on the historical behavior data The second evaluation information corresponds to the attribute characteristics of the user; and combining the first evaluation information and the second evaluation information to evaluate the credibility of the resources available for the user to apply for the service.
In one embodiment, in the above method for assessing the credibility of the resources available to a user for applying for a service, the service is a medical insurance service, and the application data includes at least: the name of the visitor, the picture of the identity certificate of the visitor, and the time of the visit , Visiting hospital, visiting department, doctor's name, symptoms, invoice picture and medical record picture.
In one embodiment, in the above method for evaluating the credibility of a user's application for available resources for the service, determining the first evaluation information according to the application data includes determining the first evaluation information by determining at least one of the following:
Whether a picture similar to the voucher picture exists in the corresponding picture library;
Whether the application data is abnormal compared with the historical application data of the user;
Whether the application data is aggregated with the application data of the system friend of the user;
Whether the application data related to the visiting hospital is aggregated;
Whether the application data related to the consultation department is aggregated;
Whether the application data related to the doctor is aggregated; and whether the geographic location information of the user terminal is consistent with the visiting hospital.
In one embodiment, in the above method for evaluating the credibility of the resources available to the user for applying for the service, the application data further includes at least one of the following: the name of the treatment drug, the price of the treatment drug, a picture of the prescription, a picture of the doctor's order, and a picture of the bill , Wherein determining the first evaluation information based on the application data includes determining at least one of the following: based on a health insurance related knowledge map, whether the therapeutic effect of the therapeutic drug corresponds to the symptoms, and whether the therapeutic drug price is in line with the market Price, thereby determining the first evaluation information.
In one embodiment, in the above method for evaluating the credibility of the resources available to a user for applying for a service, the available resources set by the service for its user are associated with offline transactions conducted by the user through the system, where: The historical behavior data is transaction data of the user conducting offline transactions through the system within a predetermined period of time, and the second evaluation information corresponds to that of the user performing through the system during the predetermined period of time. The percentage of false offline transactions compared to the total number of offline transactions conducted by the user through the system during the predetermined period.
In one embodiment, the method for evaluating the credibility of a user's application for available resources further includes: before obtaining the user's application information for the available resources, obtaining account information of the user, and according to the account information To determine the identity evaluation information of the user, and, in combination with the first evaluation information and the second evaluation information, evaluating the credibility of the resources available for the user to apply for the service includes combining the identity evaluation information, The first evaluation information and the second evaluation information evaluate the credibility of the resources available for the user to apply for a service.
In one embodiment, in the above method for evaluating the credibility of the resources available to the user for applying for the service, the account information includes at least one of the following: registration time, registration time, operation frequency, operation time, login device, binding Phone number, funding status, password modification history, and geographic location.
In one embodiment, the method for evaluating the credibility of a user's application for available resources further includes: before obtaining the user's application information for the available resources, obtaining account rating information of the user, and, Combining the first evaluation information and the second evaluation information to evaluate the credibility of the resources available for the user to apply for the service includes combining the account rating information, the first evaluation information, and the second evaluation information, Evaluate the credibility of the resources available to the user for business applications.
In one embodiment, the method for evaluating the credibility of the resources available to the user for applying for the service further includes: after determining the second evaluation information, obtaining historical data related to the user and the offline transaction, and according to the Historical data to determine third evaluation information, the third evaluation information is used to evaluate a user's operating status of the offline transaction, and, in combination with the first evaluation information and the second evaluation information, an office is evaluated The credibility of the user-available service application resources includes evaluating the credibility of the user-available service application resources in combination with the first evaluation information, the second evaluation information, and the third evaluation information.
Another aspect of the present specification provides a method for processing available resources of a service. The method is executed by a system where the service is located, and includes: obtaining a user's application data for available resources of the service; and determining whether the application data meets predetermined basic rules. Obtaining the credibility of the resources available to the user to apply for the service evaluated by the method for assessing credibility in the case that the application data meets the predetermined basic rules; and according to the credibility, the available resources are evaluated For processing.
In one embodiment, in the above method for processing available resources of a business, the business is a medical insurance business, and the predetermined basic rule includes at least one of the following: the medical treatment is required, the medical treatment time is within the guarantee period, and the medical treatment is Non-exempt diseases, the visiting hospital is the agreed hospital, the report invoice is not reused, and the type of visit is the agreed type of insurance business.
In one embodiment, in the above method for processing available resources of a service, processing the available resources according to the credibility includes, if the credibility is greater than a predetermined threshold, sending the request to the user Quickly transfer the available resources.
In one embodiment, in the above-mentioned method for processing available resources of a service, quickly transferring the available resources to the user includes calculating a user's compensation by invoking a rule engine according to a predetermined compensation rule in combination with the user's claim amount. Amount and make a payment.
In one embodiment, in the above method for processing available resources of a service, processing the available resources according to the credibility includes, if the credibility is less than a predetermined threshold, applying the application The data is sent to the business personnel of the business for processing.
Another aspect of this specification provides a device for evaluating the credibility of a resource available to a user for applying for a service. The device is implemented by a system in which the service is located, and includes: an application data obtaining unit configured to obtain the user's access to the available Resource application data; a first determination unit configured to determine first evaluation information according to the application data, the first evaluation information corresponding to the abnormality of the application data; a behavior data acquisition unit configured to acquire Historical behavior data of the user; a second determination unit configured to determine second evaluation information based on the historical behavior data, the second evaluation information corresponding to the attribute characteristics of the user; and an evaluation unit configured to Combining the first evaluation information and the second evaluation information to evaluate the credibility of the resources available for the user to apply for the service.
In one embodiment, in the above-mentioned device for evaluating the credibility of a user's application for a service available resource, the first determining unit is further configured to determine the first evaluation information by determining at least one of the following:
Whether a picture similar to the voucher picture exists in the corresponding picture library;
Whether the application data is abnormal compared with the historical application data of the user;
Whether the application data is aggregated with the application data of the system friend of the user;
Whether the application data related to the visiting hospital is aggregated;
Whether the application data related to the consultation department is aggregated;
Whether the application data related to the doctor is aggregated; and whether the geographic location information of the user terminal is consistent with the visiting hospital.
In one embodiment, the above-mentioned apparatus for evaluating the credibility of a user's application for available resources further includes: an account information acquisition unit configured to obtain the user's application information before acquiring the user's application information for the available resources. Account information; a third determination unit configured to determine the identity evaluation information of the user according to the account information, and wherein the evaluation unit is further configured to combine the identity evaluation information and the first evaluation The information and the second evaluation information to evaluate the credibility of the resources available for the user to apply for the service.
In one embodiment, the above-mentioned apparatus for evaluating the credibility of a user's application for available resources further includes: an account rating information acquisition unit configured to acquire the user before acquiring the user's application information for the available resources. And the evaluation unit is further configured to evaluate the credibility of the resources available for the user to apply for the service in combination with the account rating information, the first evaluation information, and the second evaluation information.
In one embodiment, the above-mentioned device for evaluating the credibility of the resources available to the user for applying for the service further includes: a historical data acquisition unit configured to obtain, after determining the second evaluation information, the user's related to the offline transaction. Historical data, and a fourth determination unit configured to determine a third evaluation information based on the historical data, the third evaluation information being used to evaluate a user's operating status of the offline transaction, and The evaluation unit is further configured to evaluate the credibility of the resources available to the user to apply for a service in combination with the first evaluation information, the second evaluation information, and the third evaluation information.
Another aspect of the present specification provides a device for processing available resources of a service. The device is implemented by a system in which the service is located, and includes: an application data acquisition unit configured to acquire a user's application data for available resources of the service; a judgment unit Is configured to determine whether the application data meets a predetermined basic rule; a credibility acquisition unit is configured to obtain, when the application data meets the predetermined basic rule, an The user applies for the credibility of the available resources of the service; and a processing unit configured to process the available resources according to the credibility.
In one embodiment, in the above-mentioned device for processing available resources of a service, the processing unit is further configured to quickly transfer the available resources to the user if the credibility is greater than a predetermined threshold.
In one embodiment, in the above-mentioned device for processing available resources of a service, the processing unit is further configured to calculate a user's compensation amount by invoking a rule engine according to a predetermined compensation rule in combination with the user's claim amount, and perform Pay.
In an embodiment, in the above-mentioned device for processing available resources of a service, the processing unit is further configured to send the application data to a service of the service when the credibility is less than a predetermined threshold. Personnel for processing.
Another aspect of the present specification provides a computer-readable storage medium having stored therein an instruction code that, when executed in a computer, causes the computer to execute the above method.
The method for processing available resources of a service according to the embodiments of the present specification effectively balances user experience, timeliness of claims settlement, and risk control. On the one hand, it greatly reduces manual investment and improves user experience. On the other hand, effectively control risks and identify possible risks of fraud and fraud from various angles.

The embodiments of the present specification will be described below with reference to the drawings.
FIG. 1 shows a schematic diagram of a system 100 for processing available resources of a service according to an embodiment of the present specification. In one example, the service is, for example, the multi-collection and multi-guaranteed outpatient insurance business in Alipay. In this service, small offline merchants (business target users) only need to use Alipay's receipt code to receive payments for free outpatient insurance. Sum Assured, the more you collect, the higher the Sum Assured. In this embodiment, the system 100 is a claims system for the outpatient insurance business. Of course, the services described in the embodiments of the present specification are not limited to the above outpatient insurance services, and may be other services that need to process the resources available to the services. For example, the services may also be loan services.
As shown in FIG. 1, the system 100 includes a pre-judgment unit 11, a credibility evaluation unit 12, and an adjustment unit 13. For example, in the above example, the user submits a report report in the outpatient insurance business, such as an ID picture, an invoice picture, and a medical record picture. The system extracts report information from the pictures through artificial intelligence or a third party, such as the name of the visitor, the time of the visit, and the hospital. It is sent to the predictive unit 11 of the system 100 together. After obtaining the report materials, the pre-judgment unit 11 determines whether the report materials meet basic rules, for example, whether the doctor visits himself, whether the consultation time is within the guarantee period, whether the doctor's disease is a non-exempt disease, etc. In the case where the report materials do not satisfy the basic rules, the system 100 sends a prompt to the user terminal to refuse payment. In a case where the report materials meet the basic rules, the pre-judgment unit 11 sends the report materials to the credibility evaluation unit 12.
The credibility evaluation unit 12 includes a scoring model, which can score the report materials from multiple dimensions to evaluate the credibility of the report materials. For example, by combining the evaluation of the abnormality of the report materials and the attributes of the user (such as the proportion of false offline transactions performed by the user within a predetermined period), the credibility of the report data is evaluated. In addition, the credibility of the report data can be comprehensively evaluated in combination with the user's identity evaluation information, blacklist information, and user's business status information. When the credibility is less than a predetermined threshold, the application data is sent to a service personnel of the service for processing. In the case where the credibility is greater than a predetermined threshold, the credibility evaluation unit 12 sends the report materials to the adjustment unit 13 for quick compensation processing.
The adjustment unit 13 calls the rule engine, calculates the user's compensation amount based on the predetermined compensation rules, and combines the compensation amount described by the user, and performs the payment, thereby realizing fast claims at the hour or even minute level.
FIG. 2 shows a flowchart of a method for evaluating the credibility of a user's application for a service available resource according to an embodiment of the present specification. The method is executed by the system in which the service is located, and includes: in step S21, obtaining application information of the user for the available resources; in step S22, determining first evaluation information based on the application data, the first An evaluation information corresponds to the abnormality of the application data; in step S23, historical user behavior data is obtained; in step S24, second evaluation information is determined based on the historical behavior data, and the second evaluation information corresponds to Based on the attributes of the user; and in step S25, combining the first evaluation information and the second evaluation information to evaluate the credibility of the resources available for the user to apply for services.
First, in step S21, the user's application data for the available resources is obtained. For example, the business is a medical insurance business, such as the outpatient insurance mentioned above. In this case, the application information includes at least: the name of the visitor, the picture of the visitor's identity certificate, the time of the visit, the hospital, the department, the name of the doctor, the symptoms, the picture of the invoice, and the picture of the medical record. The application data is not limited to the above-mentioned data, for example, it may further include drug name information, drug price information, doctor order picture, prescription picture, charge bill picture, and the like. Among them, the voucher pictures such as the invoice picture, medical record picture, prescription picture, etc. are obtained through direct upload by the user. In one embodiment, the voucher picture is obtained by on-site shooting of the voucher by a user. Through artificial intelligence or a third party to perform text recognition processing on the voucher picture, thereby obtaining the name of the visitor, the time of the visit, the visit to the hospital, the visit department, the doctor, the drug information, and the price information of the drug. In one embodiment, the above text information may be obtained from a user's readme text information.
Step S22: Determine first evaluation information according to the application data, and the first evaluation information corresponds to the abnormality of the application data. The first evaluation information may be, for example, a score indicating whether there is abnormality. For example, when there is abnormality, the first evaluation information is set to 1, and when there is no abnormality, the first evaluation information is set to 0. In one embodiment, the first evaluation information may also be a probability indicating that there is abnormality.
In one embodiment, determining the first evaluation information according to the application data includes determining the first evaluation information by determining at least one of the following: whether a picture similar to the voucher picture exists in a corresponding picture library; Whether the application data is abnormal compared with the historical application data of the user; whether the application data is aggregated with the application data of the system friend of the user; whether the application data related to the visiting hospital is aggregated; and Whether the application data related to the consultation department is aggregated; whether the application data related to the doctor is aggregated; whether the geographical location information of the user terminal is consistent with the visiting hospital; whether the curative effect of the therapeutic drug is the same as the Symptoms correspond; and whether the price of the therapeutic drug is in line with the market price. It can be understood that the information used to determine the first evaluation information is not limited to the above information. In practical applications, there are many other abnormal situations, which are not listed here one by one.
For example, for a medical record picture uploaded by a user, if there is a picture in the corresponding medical record picture library with a very high similarity to the medical record picture, the medical record picture uploaded by the user may be a stolen picture, so the report material may be a false report Data so that the first evaluation information can be determined accordingly.
For example, in the case where the report materials of the user and the report materials of Alipay friends are abnormally gathered, for example, if the doctors who treat them are the same doctor, or if their visit time is the same time, there is a doctor-patient combination in the report materials. The possibility of cheating or gang cooperation is high, so that the first evaluation information can be determined accordingly.
For another example, in the case where it is determined that the efficacy of a therapeutic drug does not correspond to the symptoms according to the health insurance related knowledge map, for example, if the symptoms are hypertension, but the therapeutic drug is a medicine for beriberi, the reporting information is false reporting information Is more likely to determine the first evaluation information accordingly.
In one embodiment, multiple pieces of information are combined to determine the first evaluation information. For example, according to the application data, it can be determined at the same time that a picture with a very high similarity to the medical record picture exists in the corresponding medical record picture library, The report materials of Alipay friends are abnormally aggregated, and the curative effect of the treatment drugs does not correspond to the symptoms. In this case, a score corresponding to each piece of information can be obtained, and multiplied by their respective preset weights, and added, to obtain a comprehensive score as the first evaluation information. For example, assuming that each piece of information has a score of 1 and its respective weights are 1/4, 1/3, and 1/3, the first evaluation information obtained is 11/12. In this case, the more information items used to determine the abnormality, the greater the abnormality of the report material.
In step S23, historical behavior data of the user is acquired. In one embodiment, the available resources set by the service for its users are associated with offline transactions conducted by the users through the system, wherein the historical behavior data is that the users pass through the system within a predetermined period of time. The system conducts transaction data for offline transactions. For example, the business is the above-mentioned multi-collection and multi-insurance outpatient insurance business. In this business, small offline merchants only need to use Alipay to receive money to receive outpatient insurance coverage for free. The more the collection, the higher the insurance coverage. . In this example, the historical behavior data of the user is offline transaction data of the user receiving money through the money collection code within a predetermined period of time. The predetermined period is, for example, within three months, within six months, and the like. The transaction data includes, for example, at least one of the following data: the respective network environments of the parties to the transaction, the respective devices of the parties to the transaction, the relationship between the parties to the transaction, the geographical location of the transaction, the transaction amount, and the frequency of the transaction. For example, data related to the transaction may be obtained from a database in which the system stores historical transaction data.
In step S24, second evaluation information is determined according to the historical behavior data, and the second evaluation information corresponds to the attribute characteristics of the user. For example, in the above outpatient insurance example, the second evaluation information is determined according to the offline transaction data in the predetermined period, and the second evaluation information corresponds to the user performed through the system in the predetermined period. The percentage of false offline transactions compared to the total number of offline transactions conducted by the user through the system during the predetermined period. For each offline transaction, the above transaction data can be comprehensively judged through a judgment model to determine whether the offline transaction is a false offline transaction. For example, when the network environments of the two parties to the transaction are the same for a long period of time, for example, the wifi environment is the same for a long period of time, it is considered that the transaction is a false transaction. When the respective devices of the two parties to the transaction are the same device, it is considered that the transaction is likely to be a false transaction. When the relationship between the two parties of the transaction is determined to be a close relationship (such as a family member) or a friend or relative through an analysis of big data, it is considered that the transaction is likely to be a false transaction. When the geographic location of the transaction is significantly different from other transactions of the user, it is considered that the transaction is likely to be a false transaction. When the frequency of the transaction is large, for example, it is brushed many times in ten minutes, and the transaction amount is low, it is considered that the transaction is likely to be a false transaction.
In step S25, the credibility of the resources available for the user to apply for the service is evaluated in combination with the first evaluation information and the second evaluation information. For example, in the above example of outpatient insurance, the first evaluation information corresponds to the abnormality of the report data, and the second evaluation information corresponds to the proportion of users performing false offline transactions within a predetermined period. Corresponding weights may be set for the first evaluation information and the second evaluation information. For example, in one embodiment, it is determined that the first evaluation information is more important than the credibility. Therefore, the weight of the first evaluation information is set. Is a weight greater than the second evaluation information. Then, by multiplying the first evaluation information and the second evaluation information by their respective weights and adding them, comprehensive evaluation information can be obtained. The correspondence between the first evaluation information and the second evaluation information and the credibility can be used to The comprehensive evaluation information is converted into a score of credibility.
In one embodiment, the above-mentioned method for evaluating credibility further includes: before obtaining the user's application information for the available resources, obtaining account information of the user, and determining the user's account information based on the account information. Identity evaluation information, and in combination with the first evaluation information and the second evaluation information, evaluating the credibility of the resources available for the user to apply for a service includes combining the identity evaluation information and the first evaluation information And the second evaluation information to evaluate the credibility of the resources available for the user to apply for the service. The account information includes at least one of the following: registration time, registration time, operating frequency, operating time, login device, phone binding, funding situation, password modification record, and geographic location. By combining this information, it is possible to determine whether the account of the first user is used by himself or by someone else. For example, if it is determined that the registration time of multiple accounts is the same time and the login devices are the same, it may be considered that there is a greater possibility that these accounts have identity fraud. In one embodiment, user account information may be entered into a classification model to determine whether the account is used by others or impersonated by others. Therefore, the identity evaluation information can be used as a factor for comprehensively evaluating the credibility.
In one embodiment, the method for evaluating credibility further includes: before obtaining the user's application information for the available resources, obtaining account rating information of the user, and combining the account rating information, the The first evaluation information and the second evaluation information are used to evaluate the credibility of the resources available for the user to apply for the service. Here, obtaining the account rating information of the user includes, for example, determining whether the user account is in an insurance blacklist, an offline transaction blacklist, an identity fraud blacklist, a fleece user blacklist, and the like. Thereby, the account rating information can be used as a factor for comprehensively evaluating the credibility.
In one embodiment, the method for evaluating credibility further includes: after determining the second evaluation information, obtaining historical data related to the user and the offline transaction, and determining a third data based on the historical data. Evaluation information, the third evaluation information is used to evaluate a user's operating status of the offline transaction, and the evaluation is combined with the first evaluation information, the second evaluation information, and the third evaluation information The user applies for the credibility of the resources available to the business. For example, through the system's punishment record for the user on the offline transaction, the user's operating credit can be evaluated; through the transaction amount of each offline transaction, the frequency and number of offline transactions, It can evaluate the user's business situation, business scale, stability, etc .; through the user's access to the collection page, the user's investment time for offline transactions can be evaluated. By comprehensively considering the above data, a user's operating status score of the offline transaction can be obtained as the third evaluation information. Therefore, the third evaluation information can be used as a factor for comprehensively evaluating the reliability.
FIG. 3 shows a flowchart of a method for processing available resources of a service according to an embodiment of the present specification. The method is executed by the system where the service is located, and includes: in step S31, obtaining application information of a user for available resources of the service; in step S32, determining whether the application data meets a predetermined basic rule; in step S33, When the application data meets the predetermined basic rule, obtain the credibility of the resources available for the user to apply for the service, which is evaluated by the method for assessing credibility; and, in step S34, according to the credibility, Available resources for processing.
In step S31, the application materials for the available resources of the service by the user are obtained. For example, the business is a medical insurance business, such as the outpatient insurance mentioned above. In this case, the application information includes at least: the name of the visitor, the picture of the visitor's identity certificate, the time of the visit, the hospital, the department, the name of the doctor, the symptoms, the picture of the invoice, and the picture of the medical record. The application materials are not limited to the above materials, and may further include drug name information, drug price information, doctor order pictures, prescription pictures, charge bill pictures, and the like. Among them, the voucher pictures such as the invoice picture, medical record picture, prescription picture, etc. are obtained through direct upload by the user. In one embodiment, the voucher picture is obtained by directly shooting the voucher by a user. Through artificial intelligence or a third party to perform text recognition processing on the voucher picture, thereby obtaining the name of the visitor, the time of the visit, the visit to the hospital, the visit department, the doctor, the drug information, and the price information of the drug. In one embodiment, the above information is obtained by being filled in by the user.
In step S32, it is determined whether the application data meets a predetermined basic rule. For example, in the above outpatient insurance example, the predetermined basic rules include at least one of the following: I need to see a doctor, the time of the consultation is within the guarantee period, the disease being treated is a non-exempt disease, the hospital is an agreed hospital, the report invoice is not reused, And the type of consultation is the agreed type of insurance business.
For example, by comparing the name of the visitor in the report materials with the name obtained from the picture of the user's ID card, it is determined whether he or she sees the doctor. By establishing the disease database, department database, etc., and by matching the information of the visiting department and symptoms in the report database with the keywords in the disease database and department database, it is determined whether the treated disease is an exempt disease. . For example, department diseases such as cosmetic, dental, and fertility are exempt diseases. For example, the claiming hospital for outpatient insurance can be set as a public second-level or higher hospital. Therefore, a hospital database can be established to obtain the grade and nature of the visiting hospital through matching, so as to determine whether the visiting hospital is the scheduled outpatient insurance. Claims Hospital. For example, you can set up an invoice library, and search for invoices with duplicate numbers in the invoice library in real time to determine whether report invoices are reused. In addition, you can also use the keywords in your medical records and invoices to determine the type of treatment, such as emergency outpatient and hospitalization.
In step S33, if the application data satisfies the predetermined basic rule, obtain the credibility of the resources available for the user to apply for the service, which is evaluated by the method for evaluating credibility described above. For example, in the above-mentioned outpatient insurance case, in a case where the application data meets the predetermined basic rules, the credibility of the user's claim for compensation that is evaluated through the above method is obtained, that is, the risk of claiming for the user. In the case that the application data does not meet the predetermined basic rules, since the predetermined basic rules are all strong conditions that must be satisfied for claims settlement, in this case, the system can immediately send a prompt to the user to refuse claims, and Show reasons for rejection.
In step S34, the available resources are processed according to the credibility. In one embodiment, the credibility is greater than a predetermined threshold, that is, the risk of claiming from a user is small, so that the available resources can be quickly transferred to the user. That is, by calling the rule engine, according to a predetermined compensation rule, the user's compensation amount is calculated, and the compensation is performed. For example, the scheduled compensation rules may include calculating a single visit claim limit based on the amount of the invoice, the pooled amount, the amount paid by a third party, and the user's current cumulative sum insured in the business.
In one embodiment, the credibility is less than a predetermined threshold, that is, the claim risk is greater. In this case, the application data is sent to a business staff of the service for processing. Business personnel can appropriately increase the threshold for claims according to the level of credibility, such as requiring users to supplement other vouchers, requesting the sending of original information, etc., so as to further control the risk of fraud.
FIG. 4 shows a device 400 for evaluating the credibility of a resource available to a user for applying for a service according to an embodiment of the present specification. The device is implemented by a system where the service is located, and includes: an application data obtaining unit 401 configured to obtain The user's application data for the available resources; a first determining unit 402 configured to determine first evaluation information according to the application data, the first evaluation information corresponding to the abnormality of the application data; behavior data The obtaining unit 403 is configured to obtain historical behavior data of the user; the second determination unit 404 is configured to determine second evaluation information according to the historical behavior data, and the second evaluation information corresponds to the user's Attribute characteristics; and an evaluation unit 405 configured to evaluate the credibility of the resources available to the user to apply for services in combination with the first evaluation information and the second evaluation information.
In one embodiment, in the above-mentioned device for evaluating the credibility of a user's application for a service available resource, the first determining unit is further configured to determine the first evaluation information by determining at least one of the following:
Whether a picture similar to the voucher picture exists in the corresponding picture library;
Whether the application data is abnormal compared with the historical application data of the user;
Whether the application data is aggregated with the application data of the system friend of the user;
Whether the application data related to the visiting hospital is aggregated;
Whether the application data related to the consultation department is aggregated;
Whether the application data related to the doctor is aggregated; and whether the geographic location information of the user terminal is consistent with the visiting hospital.
In one embodiment, the above-mentioned apparatus 400 for evaluating the credibility of a user's application for a service available resource further includes: an account information acquisition unit 406 configured to acquire the user's application information for the available resource before acquiring the user User account information; a third determining unit 407 configured to determine the identity evaluation information of the user according to the account information, and wherein the evaluation unit is further configured to combine the identity evaluation information, the The first evaluation information and the second evaluation information evaluate the credibility of the resources available for the user to apply for the service.
In one embodiment, the above-mentioned device for evaluating the credibility of a user's application for a service available resource further includes: an account rating information acquisition unit 408 configured to acquire the user's application information for the available resource before acquiring the user The user's account rating information, and the evaluation unit is further configured to combine the account rating information, the first evaluation information, and the second evaluation information to evaluate the credibility of the resources available to the user for business applications.
In one embodiment, the above-mentioned device for evaluating the credibility of the resources available to the user for the service application further includes: a historical data acquisition unit 409 configured to, after determining the second evaluation information, acquire the user's relevance to the offline transaction Historical data, and a fourth determining unit 410 configured to determine third evaluation information based on the historical data, the third evaluation information is used to evaluate a user's operating status of the offline transaction, and, wherein, The evaluation unit is further configured to evaluate the credibility of the resources available for the user to apply for the service in combination with the first evaluation information, the second evaluation information, and the third evaluation information.
FIG. 5 illustrates an apparatus 500 for processing available resources of a service according to an embodiment of the present specification. The apparatus is implemented by a system where the service is located, and includes: an application data obtaining unit 51 configured to obtain a user's available resources for the service. Application data; a determination unit 52 configured to determine whether the application data satisfies a predetermined basic rule; a credibility acquisition unit 53 configured to obtain, through a case where the application data meets the predetermined basic rule, The method for evaluating credibility evaluates the credibility of the resources available to the user applying for the service; and the processing unit 54 is configured to process the available resources according to the credibility.
In one embodiment, in the above-mentioned device for processing available resources of a service, the processing unit is further configured to quickly transfer the available resources to the user if the credibility is greater than a predetermined threshold.
In one embodiment, in the above-mentioned device for processing available resources of a service, the processing unit is further configured to calculate a user's compensation amount by invoking a rule engine according to a predetermined compensation rule in combination with the user's claim amount. .
In an embodiment, in the above-mentioned device for processing available resources of a service, the processing unit is further configured to send the application data to a service of the service when the credibility is less than a predetermined threshold. Personnel for processing.
Another aspect of the present specification provides a computer-readable storage medium having stored therein an instruction code that, when executed in a computer, causes the computer to execute the above method.
Through the method for processing the resources available to the business according to the embodiments of this specification, the user experience, the timeliness of claims settlement, and risk control are effectively balanced. On the one hand, labor input is greatly reduced, thereby improving the user experience. Hourly or even minute-level fast claims services are provided for cases with high credibility that comply with business claims rules, and subvert the concept of a long period of claims for health care. Cases that do not meet the compensation rules and have high credibility will promptly refuse compensation, and give specific reasons for rejection, conduct product guidance and user education, which can improve the success rate of the next report. On the other hand, it can effectively control risks and identify possible risks of fraud and fraud from various angles. For suspected cases, it can implement automatic system triggers to raise the threshold for claims, such as sending original information, or flowing into auditors with professional background experience to focus Review.
Those of ordinary skill in the art should be further aware that the units and algorithm steps of each example described in connection with the embodiments disclosed herein can be implemented by electronic hardware, computer software, or a combination of the two, in order to clearly illustrate The interchangeability of hardware and software. In the above description, the composition and steps of each example have been described generally in terms of functions. Whether these functions are implemented in hardware or software depends on the specific application and design constraints of the technical solution. Those skilled in the art may use different methods to implement the described functions for each specific application, but such implementation should not be considered to be beyond the scope of the present application.
The steps of the method or algorithm described in connection with the embodiments disclosed herein may be implemented by hardware, a software module that executes a processor, or a combination of the two. Software modules can be placed in random access memory (RAM), internal memory, read-only memory (ROM), electrically programmable ROM, electrically erasable programmable ROM, scratchpad, hard disk, removable disk, CD-ROM, or any other form of storage medium known in the art.
The specific embodiments described above further describe the objectives, technical solutions, and beneficial effects of the present invention in detail. It should be understood that the above are only specific embodiments of the present invention and are not intended to limit the present invention. The scope of protection, any modification, equivalent replacement, and improvement made within the spirit and principle of the present invention shall be included in the scope of protection of the present invention.

By describing the embodiments of this specification with reference to the drawings, the embodiments of this specification can be made clearer:

FIG. 1 shows a schematic diagram of a system 100 for processing available resources of a service according to an embodiment of the present specification;

FIG. 2 shows a flowchart of a method for evaluating the credibility of a user's application for a service available resource according to an embodiment of the present specification;

FIG. 3 shows a flowchart of a method for processing available resources of a service according to an embodiment of the present specification;

FIG. 4 illustrates an apparatus 400 for evaluating the credibility of a user's application for available resources according to an embodiment of the present specification; and

FIG. 5 illustrates an apparatus 500 for processing available resources of a service according to an embodiment of the present specification.

Claims (29)

A method for evaluating the credibility of the resources available to a user for applying for a service. The method is executed by the system where the service is located, and includes: Obtain the user's application information for the available resources; Determining the first evaluation information according to the application data, the first evaluation information corresponding to the abnormality of the application data; Obtain historical behavior data of the user; Determining second evaluation information based on the historical behavior data, the second evaluation information corresponding to the attribute characteristics of the user; and Combine the first evaluation information and the second evaluation information to evaluate the credibility of the resources available for the user to apply for the service. According to the method for assessing the credibility of the resources available to the user for applying for the business according to item 1 of the scope of patent application, wherein the business is a medical insurance business, the application information includes at least: the name of the visitor, the picture of the identity certificate of the visitor, and the appointment Time, visiting hospital, visiting department, doctor's name, symptoms, invoice picture and medical record picture. According to the method for assessing the credibility of the resources available to a user for a business application according to item 2 of the scope of the patent application, wherein determining the first evaluation information according to the application data includes determining the first evaluation information by determining at least one of the following: Whether a picture similar to the voucher picture exists in the corresponding picture library; Whether the application data is abnormal compared to the user's historical application data; Whether the application data is aggregated with the application data of the user's system friend; Whether the application data related to the visiting hospital is aggregated; Whether the application data related to the consultation department is aggregated; Whether the application data related to the doctor is aggregated; and Whether the geographical location information of the user terminal matches the visiting hospital. According to the method for evaluating the credibility of the resources available to the user for the application according to item 2 of the scope of the patent application, the application data also includes at least one of the following: the name of the treatment drug, the price of the treatment drug, a picture of the prescription, a picture of the doctor's order, and a bill for payment Pictures, where the first assessment information is determined based on the application data, including determining at least one of the following: based on the health insurance-related knowledge map: whether the therapeutic drug's efficacy corresponds to the symptoms, and whether the therapeutic drug's price matches the market price, thereby Determine the first evaluation information. According to the method for assessing the credibility of the resources available to a user for applying for a service according to item 1 of the scope of patent application, the available resources set by the service for its user are associated with offline transactions conducted by the user through the system, where, The historical behavior data is transaction data of the user performing offline transactions through the system in a predetermined period, and the second evaluation information corresponds to the number of false offline transactions performed by the user through the system in the predetermined period. The percentage of the total number of offline transactions conducted by the user through the system during the predetermined period. The method for evaluating the credibility of a user's application for available resources according to item 1 of the scope of patent application, further comprising: before obtaining the user's application information for the available resources, obtaining the user's account information, and according to the account information To determine the identity evaluation information of the user, and, in combination with the first evaluation information and the second evaluation information, evaluating the credibility of the resources available for the user to apply for business includes combining the identity evaluation information and the first evaluation information And the second evaluation information to evaluate the credibility of the resources available for the user to apply for the service. According to the method for assessing the credibility of the resources available to a user for a business application according to item 6 of the scope of patent application, the account information includes at least one of the following: registration time, registration time, operating frequency, operating time, login device, Binding phone, funding, password modification records, and geographic location. The method for evaluating the credibility of a user's application for available resources according to item 1 of the scope of patent application, further comprising: before obtaining the user's application information for the available resources, obtaining the user's account rating information, and, where Combining the first evaluation information and the second evaluation information, and evaluating the credibility of the resources available for the user to apply for the service includes evaluating the user's application for the business by combining the account rating information, the first evaluation information, and the second evaluation information. Credibility of available resources. According to the method for assessing the credibility of the resources available to the user for the application according to item 5 of the scope of the patent application, the method further includes: after determining the second evaluation information, obtaining historical data related to the user and the offline transaction, and The historical data determines the third evaluation information, which corresponds to the user's operating status of the offline transaction, And, in combination with the first evaluation information and the second evaluation information, evaluating the credibility of the resources available for the user to apply for the service includes, in combination with the first evaluation information, the second evaluation information, and the third evaluation information, evaluating The user applies for the credibility of the resources available to the service. A method for processing available resources of a service, the method being executed by a system where the service is located, including: Obtain user application materials for available resources of the service; Determine whether the application materials meet the predetermined basic rules; In the case where the application data meets the predetermined basic rules, obtain the credibility of the resources available to the user for applying for the business, which is evaluated by the method described in any one of items 1-9 of the scope of patent application; and Based on the credibility, the available resources are processed. According to the method for processing the available resources of a business as described in item 10 of the scope of patent application, wherein the business is a medical insurance business, the predetermined basic rules include at least one of the following: the need for medical treatment, the medical treatment time is within the guarantee period, and the medical treatment is Non-exempt diseases, the visiting hospital is the agreed hospital, the report invoice is not reused, and the type of visit is the agreed type of insurance business. The method for processing available resources of a service according to item 10 of the scope of patent application, wherein processing the available resources according to the credibility includes, if the credibility is greater than a predetermined threshold, quickly requesting the user Transfer this available resource. The method for processing available resources of a service according to item 12 of the scope of the patent application, wherein the rapid transfer of the available resources to the user includes calculating the user's compensation amount by invoking a rule engine and combining the user's claim amount with a predetermined payment rule. And make a payment. The method for processing available resources of a service according to item 10 of the scope of patent application, wherein processing the available resources according to the credibility includes, if the credibility is less than a predetermined threshold, applying the application data Send to the business staff of the business for processing. A device for evaluating the credibility of resources available to a user for applying for a service. The device is implemented by a system in which the service is located, and includes: An application data obtaining unit configured to obtain the user's application data for the available resources; A first determining unit configured to determine first evaluation information according to the application data, where the first evaluation information corresponds to an abnormality of the application data; A behavior data acquisition unit configured to acquire historical behavior data of the user; A second determining unit configured to determine second evaluation information according to the historical behavior data, the second evaluation information corresponding to the attribute characteristic of the user; and The evaluation unit is configured to, in combination with the first evaluation information and the second evaluation information, evaluate the credibility of the resource available for the user to apply for the service. The device for evaluating the credibility of the resources available to the user for applying for the business according to item 15 of the scope of the patent application, wherein the business is a medical insurance business, and the application data includes at least: the name of the visitor, the picture of the identity certificate of the visitor, and the appointment Time, visiting hospital, visiting department, doctor's name, symptoms, invoice picture and medical record picture. According to the device for evaluating the credibility of the resources available to the user for business application according to item 16 of the scope of the patent application, the first determination unit is further configured to determine the first evaluation information by determining at least one of the following: Whether a picture similar to the voucher picture exists in the corresponding picture library; Whether the application data is abnormal compared to the user's historical application data; Whether the application data is aggregated with the application data of the user's system friend; Whether the application data related to the visiting hospital is aggregated; Whether the application data related to the consultation department is aggregated; Whether the application data related to the doctor is aggregated; and Whether the geographical location information of the user terminal matches the visiting hospital. According to the device for assessing the credibility of the resources available to the user for the application according to item 16 of the scope of the patent application, the application data also includes at least one of the following: the name of the treatment drug, the price of the treatment drug, a picture of the prescription, a picture of the doctor's order and a bill Picture, wherein the first determining unit is further configured to determine at least one of the following based on the health insurance related knowledge map: whether the curative effect of the therapeutic drug corresponds to the symptom, and whether the therapeutic drug price conforms to the market price, thereby determining the first Evaluation information. According to the device for assessing the credibility of the resources available for a user's application according to item 15 of the scope of patent application, the available resources set by the service for its user are associated with offline transactions conducted by the user through the system, where, The historical behavior data is transaction data of the user performing offline transactions through the system in a predetermined period, and the second evaluation information corresponds to the number of false offline transactions performed by the user through the system in the predetermined period. The percentage of the total number of offline transactions conducted by the user through the system during the predetermined period. The apparatus for evaluating the credibility of a user's available resources for business applications according to item 15 of the scope of patent applications, further comprising: an account information acquisition unit configured to obtain the user's application information for the available resources before obtaining the user's application information for the available resources A third determination unit configured to determine the identity evaluation information of the user based on the account information, and wherein the evaluation unit is further configured to combine the identity evaluation information, the first evaluation information, and the first Second, evaluate the information to evaluate the credibility of the resources available for the user to apply for business. According to the device for assessing the credibility of the resources available to a user for a business application according to item 20 of the scope of patent application, the account information includes at least one of the following: registration time, registration time, operating frequency, operating time, login device, Binding phone, funding, password modification records, and geographic location. The device for evaluating the credibility of a user's application for available resources according to item 15 of the scope of patent application, further comprising: an account rating information acquisition unit configured to obtain the user's application information for the available resources before acquiring the application The user's account rating information, and the evaluation unit is further configured to combine the account rating information, the first evaluation information, and the second evaluation information to evaluate the credibility of the resources available for the user to apply for the business. The device for evaluating the credibility of a user's available resources for business application according to item 19 of the scope of patent application, further comprising: a historical data acquisition unit configured to acquire the user and the offline transaction after determining the second evaluation information Relevant historical data, and a fourth determination unit configured to determine third evaluation information based on the historical data, the third evaluation information corresponding to a user's operating status of the offline transaction, And, the evaluation unit is further configured to evaluate the credibility of the resources available for the user to apply for the service in combination with the first evaluation information, the second evaluation information, and the third evaluation information. A device for processing available resources of a service. The device is implemented by a system where the service is located and includes: An application data acquisition unit configured to acquire application data of a user's available resources for the service; A judging unit configured to judge whether the application data meets a predetermined basic rule; The credibility obtaining unit is configured to obtain, from a case where the application data satisfies the predetermined basic rule, a user's ability to apply for available resources for the business, which is evaluated through the method described in any one of items 1-9 of the scope of patent application. Reliability; and The processing unit is configured to process the available resource according to the credibility. The device for processing available resources of a business according to Item 24 of the scope of the patent application, wherein the business is a medical insurance business, and the predetermined basic rule includes at least one of the following: the need for medical treatment, the time of the medical treatment within the coverage period, Non-exempt diseases, the visiting hospital is the agreed hospital, the report invoice is not reused, and the type of visit is the agreed type of insurance business. According to the device for processing available resources of a service according to item 24 of the scope of patent application, wherein the processing unit is further configured to quickly transfer the available resources to the user if the credibility is greater than a predetermined threshold. The device for processing available resources of a service according to item 26 of the scope of patent application, wherein the processing unit is further configured to calculate a user's compensation amount by invoking a rule engine according to a predetermined compensation rule in combination with the user's claim amount, and Make a payment. According to the device for processing available resources of a service according to item 24 of the scope of patent application, wherein the processing unit is further configured to send the application data to the business personnel of the service if the credibility is less than a predetermined threshold. For processing. A computer-readable storage medium stores an instruction code thereon. When the instruction code is executed in a computer, the computer is caused to execute the method described in any one of claims 1-14 of the scope of patent application.