WO2019019744A1 - 理赔流程识别方法、装置、服务器和存储介质 - Google Patents

理赔流程识别方法、装置、服务器和存储介质 Download PDF

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Publication number
WO2019019744A1
WO2019019744A1 PCT/CN2018/084971 CN2018084971W WO2019019744A1 WO 2019019744 A1 WO2019019744 A1 WO 2019019744A1 CN 2018084971 W CN2018084971 W CN 2018084971W WO 2019019744 A1 WO2019019744 A1 WO 2019019744A1
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data
case
rule
recorded
field name
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PCT/CN2018/084971
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English (en)
French (fr)
Inventor
刘智丹
吴志祥
杨德草
李意
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平安科技（深圳）有限公司
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Publication of WO2019019744A1 publication Critical patent/WO2019019744A1/zh

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    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance

Definitions

  • the present application relates to a claim process identification method, apparatus, server and storage medium.
  • a claim process identification method, apparatus, server, and storage medium are provided.
  • a method for identifying a claims process comprising:
  • the claim data is used to generate a claim case
  • the corresponding claim process is queried in the flow table, and the claim case is sent to the corresponding claim terminal according to the claim process.
  • a claim process identification device comprising:
  • a receiving module configured to receive a claim request sent by a plurality of client terminals, where the claim request carries claim data, where the claim data includes a customer identifier and a place of participation;
  • the query module is configured to obtain a rule table, where the rule rule corresponding to the plurality of customer identifiers is recorded; and the corresponding claim rule is queried in the rule table according to the customer identifier;
  • a process identification module configured to generate a claim case by using the claim data if the claim data meets the claim rule; the query module is further configured to acquire a flow table, where the plurality of insurance places corresponding to the insurance record are recorded a claim process; querying a corresponding claim process in the process table according to the insured place carried in the claim request; and
  • the sending module is configured to send the claim case to the corresponding claim terminal according to the claim process.
  • a computer device comprising a memory and one or more processors having stored therein computer readable instructions, the computer readable instructions being executable by the processor to cause the one or more processors to execute The following steps:
  • the claim data is used to generate a claim case
  • the corresponding claim process is queried in the flow table, and the claim case is sent to the corresponding claim terminal according to the claim process.
  • One or more non-volatile storage media storing computer readable instructions, when executed by one or more processors, cause one or more processors to perform the following steps:
  • the claim data is used to generate a claim case
  • the corresponding claim process is queried in the flow table, and the claim case is sent to the corresponding claim terminal according to the claim process.
  • FIG. 1 is a diagram of an application environment diagram of a claims process identification method in accordance with one or more embodiments.
  • FIG. 2 is a flow diagram of a claim process identification method in accordance with one or more embodiments.
  • FIG. 3 is a block diagram showing the structure of a claims process identification device in accordance with one or more embodiments.
  • FIG. 4 is a block diagram of a server in accordance with one or more embodiments.
  • first may be referred to as a second client
  • second client may be referred to as a first client, without departing from the scope of the present application.
  • Both the first client and the second client are clients, but they are not the same client.
  • the claim process identification method provided in the embodiment of the present application can be applied to the application environment as shown in FIG. 1.
  • a plurality of client terminals 102 are connected to the server 104 via a network.
  • the claims terminal 106 is connected to the server 104 via a network.
  • the client terminal 102 When the client needs to handle the claims business, the client terminal 102 generates a claim request using the claim data entered by the client, and sends the claim request to the server 104.
  • Claim data includes multiple fields, such as the insured location, customer identification.
  • the server 104 receives the claim request and acquires a rule table according to the claim request.
  • the claim rules corresponding to multiple customer IDs are recorded in the rules table.
  • the server 104 queries the corresponding claim rule in the rule table according to the customer identifier.
  • Claim rules include multiple required fields and claim conditions.
  • the server 104 identifies whether the claim data contains all of the required fields and whether the claim conditions are met. If the claim data contains all of the required fields and the claim conditions are met, the server 104 uses the claim data to generate a claim case.
  • the server 104 obtains a flow table. The settlement process corresponding to multiple insurance locations is recorded in the flow chart.
  • the server 104 queries the corresponding claim process in the flow table according to the insured, and sends the claim case to the corresponding claim terminal 106 according to the claim process.
  • the claims terminal 106 includes an adjustment terminal, an account management terminal, a hosting terminal, and the like.
  • the server 104 For example, if the claim process is the first process, the server 104 generates a claim by using the claim case, and sends the claim to the account management terminal. If the claim process is the second process, the server 104 sends the claim case to the adjustment terminal. The adjustment terminal performs adjustment on the claim data, and returns the adjustment result to the server 104. The server 104 generates a claim by using the adjustment result and the claim case, and transmits the claim to the account management terminal. The account management terminal returns a payment response to the server 104. If the payout response is a confirmation payout, the server 104 generates a payout order to send the payout order to the hosting terminal. The claim data also includes the collection account, and the escrow terminal transfers the account according to the claim. Thus, the server 104 uses the flow table to identify the claims process applicable to the current customer from the diversified claims process, and directly sends the claim case to the claim terminal corresponding to the claim process, which can effectively improve the claim efficiency.
  • a claim process identification method is provided, which is applied to the server as an example, and specifically includes the following steps:
  • Step 202 Receive a claim request sent by multiple client terminals, where the claim request carries the claim data, and the claim data includes the customer identifier and the participating place.
  • Claim data is carried in the claim.
  • Claim data includes multiple fields, such as the name of the insured, the ID number of the insured, the place of insured, the number of the hospital registration, the hospital number, the date of the visit, and the medical diagnosis certificate.
  • the customer identification is used to uniquely identify the customer's identity, which can be the insured's ID number.
  • Step 204 Obtain a rule table, where the claim rules corresponding to the plurality of customer identifiers are recorded in the rule table.
  • Step 206 Query the corresponding claim rule in the rule table according to the customer identifier.
  • Step 208 If the claim data meets the claim rule, the claim data is used to generate a claim case.
  • a database is deployed on the server, and policy data of multiple customers is pre-stored in the database.
  • the server obtains policy data based on the customer ID.
  • Policy data includes contract number, policy status, and more. Among them, the policy status includes valid, first expected to underwrite, suspend and terminate.
  • the server uses the policy data to determine whether the policy status of the customer is valid.
  • the server obtains the rule table according to the claim request.
  • the rules table can be used to claim the terminal pre-upload server.
  • the claim rules corresponding to multiple customer IDs are recorded in the rules table.
  • the server queries the corresponding claim rule in the rule table according to the customer identifier.
  • the claim rule includes multiple required fields and corresponding claim conditions.
  • the required fields are indispensable for the insurance company to handle the major disease claims business, such as the insured's ID number and hospital number.
  • the claim condition is the attribute requirement of each field in the claim data. For example, the corresponding field value in the claim data should be non-empty; the medical diagnosis disease name belongs to the specified major disease range, and the insured person's policy is in the insurance period.
  • the judgment expression corresponding to the claim condition and the target result are also recorded in the rule table.
  • the server determines whether the claim data satisfies the corresponding claim condition by executing the judgment expression.
  • the judgment expression can be used to determine whether the corresponding field value of the required field in the claim data is empty, such as "whether the hospital number is empty".
  • the judgment expression can also be used to determine whether the field in the claim data meets the corresponding claim condition, for example, the name of the medical diagnosis disease belongs to the prescribed major disease range, and the policy of the insured person is within the insurance period.
  • the judgment expression can be represented by a SQL statement.
  • the server executes a plurality of judgment expressions to obtain an execution result.
  • the server compares the execution result with the target result, and uses the required field to query whether the corresponding field in the claim data satisfies the corresponding claim condition. If the execution result of the plurality of judgment expressions is the same as the corresponding target result, it indicates that the claim data satisfies all the claim conditions, and the server generates the claim case by using the claim data; otherwise, the claim case is not generated.
  • Step 210 Obtain a flow table, where the claim process corresponding to the plurality of insurance places is recorded.
  • the server stores the process table in the database.
  • the settlement process corresponding to multiple insurance locations is recorded in the flow chart.
  • the different claims policies of the participating areas make the insurance company adopt different claims processing procedures. For example, some areas directly pay according to the hospital's payment, and the claim process adopted by the insurance company can be the corresponding first process. Some areas pay according to the adjustment results of the insurance company, and the claim process adopted by the insurance company can be the corresponding second process. In some areas, the insurance company's adjustment results and hospital fees are paid for after payment, and the claims process adopted by the insurance company may be the corresponding third process.
  • Step 212 Query the corresponding claim process in the flow table according to the insurance place carried in the claim, and send the claim case to the corresponding claim terminal according to the claim process.
  • the server queries the corresponding claim process in the process table according to the insurance place carried in the claim. According to the claimed claim process, the server sends the claim case directly to the corresponding claim terminal.
  • the claims terminal includes an adjustment terminal, an account management terminal, and a managed terminal. For example, if the claim process is the first process, the server generates a payout task by using the claim case, and sends the claim task to the account management terminal corresponding to the accountant of the insurance company. The account manager returns a payment response to the server through the account management terminal. If the payout response is a confirmation payment, the server generates a claim for payment, and sends the claim to the managed terminal corresponding to the bank staff of the third party. The claim is carried in the claim, and the escrow terminal transfers the account according to the claim.
  • the server sends the claim case to the adjustment terminal corresponding to the adjuster of the insurance company.
  • the adjustment terminal adjusts the claim data and returns the adjustment result to the server.
  • the server uses the adjustment result and the claim case to generate a payout task, and sends the payout task to the account management terminal.
  • the account manager returns a payment response to the server through the account management terminal. If the payout response is a confirmation payment, the server generates a claim for payment, and sends the claim to the managed terminal.
  • the claim is carried in the claim, and the escrow terminal transfers the account according to the claim.
  • the server sends the claim case to the adjustment terminal.
  • the adjustment terminal adjusts the claim data and returns the adjustment result to the server.
  • the adjustment result includes the adjustment amount.
  • Claim data also includes medical amounts. The server compares whether the medical amount and the adjustment amount are equal. If the medical amount and the adjustment amount are equal, the server pays according to the first process. Otherwise, the server pays according to the second process.
  • the server directly sends the claim case to the corresponding claim terminal, which can realize the rapid distribution of the claim case in the diversified claims process, and reduce the burden on the insurance company to manually allocate the claim case, thereby improving the claim efficiency.
  • a plurality of customer identifiers and corresponding claim rules are recorded through the rule table, and the rule table can be used to query the corresponding claim rules according to the customer identifier, thereby determining whether the claim data conforms to the corresponding claim rules, and the claims data conforming to the claim rules.
  • the claim data includes a plurality of original field names.
  • the method further includes: obtaining a docking configuration table, where the service field name and the corresponding original are recorded in the docking configuration table. Field name; query the corresponding original field name in the claim data according to the business field name; record the corresponding service field name of the claim data to the claim data table according to the original field name of the query.
  • an insurance company When an insurance company handles a major illness claims business for a client, it needs customers to provide data related to claims.
  • the data provided by the customer can be referred to as raw data. If the original data is recorded in a different way than the insurance company requires, the insurance company cannot directly use the original data to process the claims, and the original data needs to be docked to make the docked data easy for the insurance company to handle the claims. .
  • the server stores the entry configuration table and the docking configuration table in the database. Multiple original field names provided by the customer are recorded in the entry configuration table. The business field name and the original field name are recorded in the docking configuration table. Wherein, there is a mapping relationship between the business field name and one or more original field names.
  • the original field name can be extracted from the entry configuration table by the server.
  • the business field name can be extracted by the server from the claim data table.
  • the claim data sheet is a data structure table established by the insurance company according to its own claims case processing specification. Multiple business field names are recorded in the claims data table.
  • the customer When the customer needs to handle the claims business, the customer initiates a claim request to the server through the client terminal.
  • the original data is carried in the claim.
  • the raw data includes multiple original field names.
  • the server queries the original field name corresponding to the service field name in the claim data table in the docking configuration table, and uses the original field name to query the original original field name in the original data. According to the original field name that is queried, the server records the original data corresponding business field name into the claim data table.
  • the data received in the claim data table can be referred to as claim data.
  • the mapping relationship between the service field name and the original field name is recorded in the docking configuration table.
  • the original field name corresponding to the service field name can be queried in the original data, so that the original data corresponding business field name can be recorded into the claim data table according to the original field name that is queried, thereby realizing the original data and
  • the accurate docking between the claims data can make the docked data easy for the insurance company to handle the claims case.
  • the claim data includes a plurality of fields
  • the claim rule includes a plurality of required fields and corresponding claim conditions. If the claim data meets the claim rule, the step of generating the claim case by using the claim data includes: utilizing the required The field queries the corresponding field in the claim data; obtains a corresponding judgment expression according to the claim condition; and executes the judgment expression to determine whether the corresponding field in the claim data satisfies the claim condition; if yes, record the Claim data is in compliance with the claim rules.
  • the claim rule includes multiple required fields and corresponding claim conditions.
  • the required fields are indispensable for the insurance company to handle the major disease claims business, such as the ID number of the insured, the hospital registration serial number, and the hospital number.
  • the claim condition is the attribute requirement of each field in the claim data. For example, the corresponding field value in the claim data should be non-empty; the medical diagnosis disease name belongs to the specified major disease range, and the insured person's policy is in the insurance period.
  • the judgment expression corresponding to the claim condition and the target result are also recorded in the rule table.
  • the server determines whether the claim data satisfies the corresponding claim condition by executing the judgment expression.
  • the judgment expression can be used to determine whether the corresponding field value of the required field in the claim data is empty, such as "whether the hospital number is empty".
  • the judgment expression can also be used to determine whether the field in the claim data meets the corresponding claim condition, for example, the name of the medical diagnosis disease belongs to the prescribed major disease range, and the policy of the insured person is within the insurance period.
  • the judgment expression can be represented by a SQL statement. If the execution result of the judgment expression is the same as the target result, it indicates that the corresponding field in the claim data is non-empty and conforms to the corresponding claim condition.
  • the server executes the judgment expression and obtains the execution result.
  • the server compares the execution result with the target result, and determines, according to the comparison result, whether the corresponding field in the claim data satisfies the corresponding
  • the server may separately execute each of the independent judgment expressions, and compare the execution result of each judgment expression with the corresponding target result to determine whether each field corresponding to the claim data and the required field satisfies the corresponding claim condition.
  • Each judgment expression finally returns an execution result, and as long as one execution result is different from the corresponding target result, it indicates that the claim data does not satisfy the claim condition.
  • the server may also use the operator "or” and/or the operator “and” to splicing all the judgment expressions, execute the spliced judgment expression, and determine whether the claim data is satisfied according to the execution result of the spliced judgment expression as a whole. Claim conditions. If the execution result of the independent judgment expression is the same as the corresponding target result, the server marks the execution result of the judgment expression as the first intermediate result; otherwise, the server marks the execution result of the judgment expression as the second intermediate result. According to the operator used in judging the expression splicing, the server uses the same operator to splicing the plurality of first intermediate results and the second intermediate result, and calculates the execution result of the spliced judgment expression. The target result corresponding to the spliced judgment expression is also recorded in the rule table. The spliced judgment expression finally returns an execution result, and the server compares the execution result with the target result to determine whether the claim data satisfies the claim condition.
  • the judgment expression A is whether the hospital number is empty, and the corresponding target result is no; the judgment expression B is whether the medical diagnosis disease name belongs to the prescribed major disease, and the corresponding target result is yes; the judgment expression C is the reference Whether the policy of the policy is within the insurance period, the corresponding target result is yes; the judgment expression D is whether or not the major disease claim has been applied, and the corresponding target result is no. If the execution result of the judgment expression is the same as the target result, the execution result of the judgment expression is marked as an empty field string, and conversely, the execution result of the judgment expression is marked as a non-empty string.
  • the execution result of the judgment expression A is marked as an empty field string; the execution result of the judgment expression B is marked as an empty field string; the execution result of the judgment expression C is marked as an empty field string; the execution result of the judgment expression D is judged It is marked as a non-empty field string. If the spliced judgment expression is A or B or C or D, the execution result is a non-empty field string. Assuming that the target result corresponding to A or B or C or D is an empty string, it indicates that the claim data does not satisfy the claim condition.
  • the judgment expression for judging whether the required field corresponding to the field value of the claim data is empty may be referred to as a first judgment expression. If the execution result of the one or more first determination expressions is different from the corresponding target result, the server generates data lacking a prompt, and sends a data lacking prompt to the client terminal. The customer can supplement the claim data through the client terminal, and the client terminal regenerates the claim request by using the supplemented claim data, and sends the claim request to the server.
  • the judgment expression for determining whether the field in the claim data conforms to the corresponding claim condition may be referred to as a second judgment expression. If the execution result of the one or more second determination expressions is different from the corresponding target result, the server generates a prompt that does not satisfy the claim condition, and sends the prompt that does not satisfy the claim condition to the client terminal.
  • the server If the execution result of the first judgment expression and the execution result of the second judgment expression are both the same as the corresponding target result, that is, the claim data includes all the necessary fields and all the claim conditions, the server generates the claim by using the claim data. Case; on the contrary, no claims case is generated.
  • a plurality of customer identifiers and corresponding claim rules are recorded in the rule table, and the claim rules include a plurality of required fields and corresponding claim conditions, and the required fields are used to query whether the corresponding fields in the claim data satisfy the corresponding claim conditions;
  • the claim data contains all the necessary fields and satisfies the claim conditions, and then uses the claim data to generate claims cases, thereby reducing the burden on the insurance company to manually identify whether a claim case should be generated, thereby improving the claim efficiency.
  • the step of transmitting the claim case to the corresponding claim terminal according to the claim process includes: obtaining a claim data table, wherein the claim data table records the case identifier corresponding to the plurality of claim cases and the processing status, and the processing status includes Waiting for processing; screening in the claim data table, screening out the case ID of the case to be processed; recording the case ID of the pending case to the case list; extracting one or more case IDs in the case table, according to The extracted case identifier obtains the corresponding claim case from the claim data table; according to the claim process, the obtained claim case is sent to the corresponding claim terminal; the received success information returned by the claim terminal is received, and the claim case is determined in the claim data table.
  • the corresponding processing status is changed to the processing success; in the case table, the processing status is changed to the case ID of the processing success.
  • the server stores the claims data table in the database.
  • a plurality of claims data and corresponding case identifiers are recorded in the claim data table.
  • Claim data can be pre-uploaded to the server by the client terminal.
  • the server docks the claim data carried in the claim request to the claim data table.
  • the server generates a corresponding claim case according to the claim request.
  • Claims cases include case identification.
  • the case identification is used to uniquely identify a claim case, which can be a case number or the like.
  • the server records the claim case and the case identification corresponding claim data into the claim data table.
  • the processing status of each claim case is also recorded in the claim data sheet. Processing status includes pending, processing, processing success, and processing failure. For claim cases that have not yet been processed, the server marks its corresponding processing status as pending.
  • the server stores the case table in the database.
  • the case table records multiple case identifiers.
  • the case identification can be obtained by the server from the claim data table.
  • the server filters the claim data table, selects the claim case whose processing status is to be processed, obtains the case identifier corresponding to the claim case to be processed, and records the case ID corresponding to the claim case to be processed to the case. In the table.
  • the server Before sending the claim case to the claim terminal, the server may obtain the pre-set condition of the case identifier, and capture one or more case identifiers in the case table according to the crawl condition. Crawl conditions include the crawl order and the number of crawls. According to the captured case identifier, the server obtains the corresponding claim case in the claim data table. According to the claim process, the server sends the obtained claim case to the corresponding claim terminal. If the claim case is processed and the processing is successful, the claim terminal returns the processing success information to the server. After receiving the processing success information returned by the claim terminal, the server updates the processing status corresponding to the corresponding case identifier in the claim data table, and deletes the successfully processed case identifier in the case table. Therefore, each time the server performs the claim case extraction, it only needs to extract from the claim case that is to be processed, which can reduce the time for claim case extraction, thereby improving the processing efficiency of the claim case.
  • the method further includes: crawling the claims process in the plurality of web pages; comparing the claimed claims process with the claims process recorded in the process table, and if the crawled process changes, utilizing The process table is updated according to the claims rules that are crawled.
  • the claims policy of each participating place has changed, and the insurance company needs to adjust the corresponding claims process in time according to the claims policy.
  • the management personnel of the insurance company need to manually identify whether the claims process corresponding to each participating place changes.
  • the management personnel manually modify the claim process, which makes the claims process update not timely. Poor timeliness, it is also easy to produce modification errors, increasing the workload of managers.
  • the server crawls the claims process in the plurality of claims corresponding to the claim page according to the preset frequency.
  • the server compares the claims process that is crawled to the corresponding claims process in the process table according to the insured state to determine whether the claim process corresponding to the participating place changes. If one or more of the claims processing corresponding to the change occurs, the server updates the process table using the climbed claims process.
  • the server automatically crawls the related claims process from the preset plurality of claims pages, and if it finds that one or more of the claims corresponding to the claims process changes by comparing with the existing claims process, according to the climbed claims
  • the process updates the process schedule in a timely manner, which can improve the efficiency of the claims process update and reduce the workload of managers.
  • steps in the flowchart of FIG. 2 are sequentially displayed as indicated by the arrows, these steps are not necessarily performed in the order indicated by the arrows. Except as explicitly stated herein, the execution of these steps is not strictly limited, and the steps may be performed in other orders. Moreover, at least some of the steps in FIG. 2 may include a plurality of sub-steps or stages, which are not necessarily performed at the same time, but may be executed at different times, the execution of these sub-steps or stages The order is also not necessarily sequential, but may be performed alternately or alternately with other steps or at least a portion of the sub-steps or stages of the other steps.
  • a service processing apparatus including: a receiving module 302, a querying module 304, a process identifying module 306, and a sending module 308, where:
  • the receiving module 302 is configured to receive a claim request sent by multiple client terminals, where the claim request carries the claim data, and the claim data includes the customer identifier and the insurance place;
  • the query module 304 is configured to obtain a rule table, where the rule rule corresponding to the plurality of customer identifiers is recorded; and the corresponding claim rule is queried in the rule table according to the customer identifier;
  • the process identification module 306 is configured to generate a claim case by using the claim data if the claim data conforms to the claim rule; the query module is further configured to acquire a process table, and the process table records a plurality of claims corresponding to the claim process; Carrying the insured place, querying the corresponding claim process in the flow chart;
  • the sending module 308 is configured to send the claim case to the corresponding claim terminal according to the claim process.
  • the claim data includes a plurality of fields
  • the claim rule includes a plurality of required fields and corresponding claim conditions
  • the process identification module 306 is further configured to query the corresponding field in the claim data by using the required field;
  • the claim condition acquires a corresponding judgment expression; and the judgment expression is executed to determine whether the corresponding field in the claim data satisfies the claim condition; if yes, the claim data is recorded according to the claim rule.
  • the apparatus further includes an update module 310, configured to crawl the claims process in the plurality of web pages;
  • a server is provided, as shown in FIG. 4, which includes a processor, memory, and network interface connected by a system bus.
  • the processor of the server is used to provide computing and control capabilities.
  • the memory of the server includes a non-volatile storage medium and an internal memory.
  • the server's non-volatile storage medium stores an operating system and computer readable instructions and a database that is executed by the processor to implement a claims process identification method.
  • the internal memory of the server provides an environment for the operation of operating systems and computer readable instructions in a non-volatile storage medium.
  • the network interface of the server is used for communicating with an external terminal through a network connection, for example, receiving claims data sent by the terminal.
  • FIG. 4 is only a block diagram of a part of the structure related to the solution of the present application, and does not constitute a limitation on the server to which the solution of the present application is applied.
  • the specific server may include a ratio. More or fewer components are shown in the figures, or some components are combined, or have different component arrangements.
  • a computer device comprising a memory and one or more processors, the memory storing computer readable instructions, the computer readable instructions being executed by the processor, causing the one or more processors to perform the steps of: receiving a plurality of client terminals
  • the claim claim is sent, and the claim data carries the claim data.
  • the claim data includes the customer ID and the insurance place; the rule table is obtained, and the claim rule corresponding to the plurality of customer identifiers is recorded in the rule table; and the corresponding check is performed in the rule table according to the customer identifier.
  • the claim rule if the claim data meets the claim rule, the claims data is used to generate the claim case; the process table is obtained, and the process table records the claim process corresponding to the plurality of insured places; according to the claim place carried in the claim, in the process
  • the table queries the corresponding claim process, and sends the claim case to the corresponding claim terminal according to the claim process.
  • the method when the processor executes the computer readable instructions, the method further includes: obtaining a docking configuration table, the service field name and the corresponding original field name are recorded in the docking configuration table; and querying the corresponding data in the claim data according to the service field name The original field name; the service field name corresponding to the claim data is recorded in the claim data table according to the original field name that is queried.
  • the claim data includes a plurality of fields
  • the claim rule includes a plurality of required fields and corresponding claim conditions
  • the processor executes the computer readable instructions to perform the following steps: querying the claim data by using the required fields Corresponding field; obtaining a corresponding judgment expression according to the claim condition; executing the judgment expression to determine whether the corresponding field in the claim data satisfies the claim condition; if yes, recording the claim data according to the claim rule.
  • the method when the processor executes the computer readable instructions, the method further includes: acquiring a claim data table, wherein the claim data table records a case identifier corresponding to the plurality of claim cases and a processing status, and the processing status includes to be processed; Screening in the claim data table, screening out the case ID of the case to be processed; recording the case ID of the pending case to the case list; extracting one or more case IDs in the case table, according to the extracted case The identifier obtains the corresponding claim case from the claim data table; according to the claim process, the obtained claim case is sent to the corresponding claim terminal; the processing success information returned by the claim terminal is received, and the processing status corresponding to the claim case is determined in the claim data table. Change to the processing success; delete the case ID in the case table to change the processing status to the successful processing.
  • the processor when executing the computer readable instructions, further performs the steps of: crawling the claims process in the plurality of web pages; comparing the claimed claims process with the claims process recorded in the process table; If the acquired process changes, the process table is updated with the crawled claims rules.
  • One or more non-volatile storage media storing computer readable instructions, when executed by one or more processors, cause one or more processors to perform the steps of: receiving a plurality of client terminals
  • the claims request carries the claim data
  • the claim data includes the customer identification and the insurance place
  • the acquisition rule table the rule table records the claim rules corresponding to the plurality of customer identifiers
  • the corresponding claims are checked in the rule table according to the customer identification Rule
  • if the claim data conforms to the claim rule the claims data is used to generate a claim case
  • the process flow table is obtained, and the process flow table records the claim process corresponding to the plurality of insurance places; according to the insurance place carried in the claim, in the process table
  • the corresponding claim process is queried, and the claim case is sent to the corresponding claim terminal according to the claim process.
  • the computer readable instructions are further executed by the processor to: obtain a docking configuration table, record the business field name and the corresponding original field name in the docking configuration table; query the claim data according to the business field name Corresponding original field name; record the corresponding service field name of the claim data to the claim data table according to the original field name that is queried.
  • the claim data includes a plurality of fields
  • the claim rule includes a plurality of required fields and corresponding claim conditions
  • the computer readable instructions are executed by the processor to perform the following steps: querying the claims with the required fields Corresponding field in the data; obtaining a corresponding judgment expression according to the claim condition; executing the judgment expression to determine whether the corresponding field in the claim data satisfies the claim condition; if yes, recording the claim data according to the claim rule .
  • the following steps are further performed: acquiring a claim data table, wherein the claim data table records a case identifier corresponding to the plurality of claim cases and a processing status, and the processing status includes to be processed; Screening in the claim data table, screening out the case ID of the case to be processed; recording the case ID of the pending case to the case list; extracting one or more case IDs in the case table, according to the extracted
  • the case identification obtains the corresponding claim case from the claim data table; according to the claim process, the obtained claim case is sent to the corresponding claim terminal; the processing success information returned by the claim terminal is received, and the claim case corresponding processing is processed in the claim data table.
  • the status is changed to the processing success; in the case table, the processing status is changed to the case ID of the processing success.
  • the computer readable instructions are further executed by the processor to: crawl the claims process in the plurality of web pages; compare the crawled claims process with the claims process recorded in the process table; When the process of crawling changes, the process table is updated with the rule of claim that is crawled.
  • Non-volatile memory can include read only memory (ROM), programmable ROM (PROM), electrically programmable ROM (EPROM), electrically erasable programmable ROM (EEPROM), or flash memory.
  • Volatile memory can include random access memory (RAM) or external cache memory.
  • RAM is available in a variety of formats, such as static RAM (SRAM), dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), synchronization chain.
  • SRAM static RAM
  • DRAM dynamic RAM
  • SDRAM synchronous DRAM
  • DDRSDRAM double data rate SDRAM
  • ESDRAM enhanced SDRAM
  • Synchlink DRAM SLDRAM
  • Memory Bus Radbus
  • RDRAM Direct RAM
  • DRAM Direct Memory Bus Dynamic RAM
  • RDRAM Memory Bus Dynamic RAM

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Abstract

一种理赔流程识别方法，包括：接收多个客户终端发送的理赔请求，理赔请求中携带了理赔数据，理赔数据包括客户标识和参保地；获取规则表，规则表中记录了多个客户标识对应的理赔规则；根据客户标识在规则表中查询对应的理赔规则；若理赔数据符合理赔规则，则利用理赔数据生成理赔案件；获取流程表，流程表中记录了多个参保地对应的理赔流程；根据理赔请求中携带的参保地，在流程表中查询对应的理赔流程，根据理赔流程将理赔案件发送至对应的理赔终端。

Description

理赔流程识别方法、装置、服务器和存储介质
本申请要求于2017年7月25日提交中国专利局，申请号为2017106138061，申请名称为“理赔流程识别方法、装置、服务器和存储介质”的中国专利申请的优先权，其全部内容通过引用结合在本申请中。
技术领域
本申请涉及一种理赔流程识别方法、装置、服务器和存储介质。
背景技术
当客户委托保险公司处理理赔案件时，保险公司根据指定的理赔流程处理理赔案件。不同险种的理赔案件有不同的理赔流程，同一险种的理赔案件也可能有不同的理赔流程，比如重大疾病理赔案件。由于各地政府关于重大疾病的理赔政策不同，导致针对不同客户，保险公司对重大疾病理赔案件的理赔流程也不同。保险公司在处理重大疾病保险理赔案件之前，需要根据各地不同的理赔政策，从多样化的理赔流程中人工识别出适用于当前客户的理赔流程，再根据识别出的理赔流程，人工将理赔案件分配至对应的流程岗位，增加了保险公司的理赔负担，降低理赔效率。
发明内容
根据本申请公开的各种实施例，提供一种理赔流程识别方法、装置、服务器和存储介质。
一种理赔流程识别方法，包括：
接收多个客户终端发送的理赔请求，所述理赔请求中携带了理赔数据，所述理赔数据包括客户标识和参保地；
获取规则表，所述规则表中记录了多个客户标识对应的理赔规则；
根据客户标识在规则表中查询对应的理赔规则；
若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件；
获取流程表，所述流程表中记录了多个参保地对应的理赔流程；及
根据所述理赔请求中携带的参保地，在所述流程表中查询对应的理赔流程，根据理赔流程将所述理赔案件发送至对应的理赔终端。
一种理赔流程识别装置，所述装置包括：
接收模块，用于接收多个客户终端发送的理赔请求，所述理赔请求中携带了理赔数据，所述理赔数据包括客户标识和参保地；
查询模块，用于获取规则表，所述规则表中记录了多个客户标识对应的理赔规则；根据客户标识在规则表中查询对应的理赔规则；
流程识别模块，用于若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件；所述查询模块还用于获取流程表，所述流程表中记录了多个参保地对应的理赔流程；根据所述理赔请求中携带的参保地，在所述流程表中查询对应的理赔流程；及
发送模块，用于根据理赔流程将所述理赔案件发送至对应的理赔终端。
一种计算机设备，包括存储器和一个或多个处理器，所述存储器中储存有计算机可读指令，所述计算机可读指令被所述处理器执行时，使得所述一个或多个处理器执行以下步骤：
接收多个客户终端发送的理赔请求，所述理赔请求中携带了理赔数据，所述理赔数据包括客户标识和参保地；
获取规则表，所述规则表中记录了多个客户标识对应的理赔规则；
根据客户标识在规则表中查询对应的理赔规则；
若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件；
获取流程表，所述流程表中记录了多个参保地对应的理赔流程；及
根据所述理赔请求中携带的参保地，在所述流程表中查询对应的理赔流程，根据理赔流程将所述理赔案件发送至对应的理赔终端。
一个或多个存储有计算机可读指令的非易失性存储介质，计算机可读指令被一个或多个处理器执行时，使得一个或多个处理器执行以下步骤：
接收多个客户终端发送的理赔请求，所述理赔请求中携带了理赔数据，所述理赔数据包括客户标识和参保地；
获取规则表，所述规则表中记录了多个客户标识对应的理赔规则；
根据客户标识在规则表中查询对应的理赔规则；
若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件；
获取流程表，所述流程表中记录了多个参保地对应的理赔流程；及
根据所述理赔请求中携带的参保地，在所述流程表中查询对应的理赔流程，根据理赔流程将所述理赔案件发送至对应的理赔终端。
本申请的一个或多个实施例的细节在下面的附图和描述中提出。本申请的其它特征和优点将从说明书、附图以及权利要求书变得明显。
附图说明
为了更清楚地说明本申请实施例中的技术方案，下面将对实施例中所需要使用的附图作简单地介绍，显而易见地，下面描述中的附图仅仅是本申请的一些实施例，对于本领域普通技术人员来讲，在不付出创造性劳动的前提下，还可以根据这些附图获得其它的附图。
图1为根据一个或多个实施例中的理赔流程识别方法应用环境图。
图2为根据一个或多个实施例中理赔流程识别方法的流程图。
图3为根据一个或多个实施例中理赔流程识别装置的结构示意图。
图4为根据一个或多个实施例中服务器的框图。
具体实施方式
为了使本申请的技术方案及优点更加清楚明白，以下结合附图及实施例，对本申请进行进一步详细说明。应当理解，此处描述的具体实施例仅仅用以解释本申请，并不用于限定本申请。
可以理解，本申请所使用的术语“第一”、“第二”等可在本文中用于描述各种元件，但这些元件不受这些术语限制。这些术语仅用于将第一个元件与另一个元件区分。举例来说，在不脱离本申请的范围的情况下，可以将第一客户端称为第二客户端，且类似地，可将第二客户端称为第一客户端。第一客户端和第二客户端两者都是客户端，但其不是同一客户端。
本申请实施例中所提供的理赔流程识别方法可以应用于如图1所示的应用环境中。多个客户终端102通过网络与服务器104连接。理赔终端106通过网络与服务器104连接。当客户需要办理理赔业务时，客户终端102利用客户录入的理赔数据生成理赔请求，将理赔请求发送至服务器104。理赔数据包括多个字段，如参保地，客户标识。服务器104接收理赔请求，根据理赔请求获取规则表。规则表中记录了多个客户标识对应的理赔规则。服务器104根据客户标识在规则表中查询对应的理赔规则。理赔规则包括多个必需字段和理赔条件。服务器104识别理赔数据是否包含了所有的必需字段以及是否满足理赔条件。若理赔数据包含了所有的必需字段且满足理赔条件，则服务器104利用理赔数据生成理赔案件。服务器104获取流程表。流程表中记录了多个参保地对应的理赔流程。服务器104根据参保地在流程表中查询对应的理赔流程，根据理赔流程将理赔案件发送至对应的理赔终端106。理赔终端106包括理算终端、账管终端和托管终端等。例如，若理赔流程为第一流程，则服务器104利用理赔案件生成赔付请求，将赔付请求发送至账管终端。若理赔流程为第二流程，服务器104将理赔案件发送至理算终端。理算终端对理赔数据进行理算，将理算结果返回至服务器104。服务器104利用理算结果和理赔案件生成赔付请求，将赔付请求发送至账管终端。账管终端向服务器104返回赔付应答。若赔付应答为确认赔付，则服务器104生成赔付指令，将赔付指令发送至托管终端。理赔数据还包括领取账户，托管终端根据赔付指令向领取账户转账。由此，服务器104利用流程表从多样化的理赔流程中识别出适用于当前客户的理赔流程，并将理赔案件直接发送到理赔流程对应的理赔终端，可以有效提高理赔效率。
在其中一个实施例中，如图2所示，提供了一种理赔流程识别方法，以该方法应用于服务器为例进行说明，具体包括以下步骤：
步骤202，接收多个客户终端发送的理赔请求，理赔请求中携带了理赔数据，理赔数据包括客户标识和参保地。
当客户需要办理重大疾病理赔业务时，客户可以通过客户终端向服务器发起理赔请 求。理赔请求中携带了理赔数据。理赔数据包括多个字段，如参保人姓名、参保人证件号、参保地、住院登记流水号、医院编号、就诊日期、医疗诊断证明等。客户标识用于唯一识别客户身份，可以是参保人证件号等。
步骤204，获取规则表，规则表中记录了多个客户标识对应的理赔规则。
步骤206，根据客户标识在规则表中查询对应的理赔规则。
步骤208，若理赔数据符合理赔规则，则利用理赔数据生成理赔案件。
服务器上部署了数据库，在数据库中预先存储了多位客户的保单数据。服务器根据客户标识获取保单数据。保单数据包括合同编号、保单状态等。其中，保单状态包括有效、首期待承保、中止和终止。服务器利用保单数据，判断该客户对应的保单状态是否为有效。
若该客户对应的保单状态为有效，则服务器根据理赔请求获取规则表。规则表可以理赔终端预先上传服务器的。规则表中记录了多个客户标识对应的理赔规则。服务器根据客户标识在规则表中查询对应的理赔规则。理赔规则包括多个必需字段和对应的理赔条件，必需字段是保险公司办理重大疾病理赔业务所不可缺少的字段，如参保人证件号、医院编号等。理赔条件是对理赔数据中各字段的属性要求，例如，必需字段在理赔数据中对应的字段值应当非空；医疗诊断疾病名称属于规定的重大疾病范围，参保人保单在保险期间内等。
规则表中还记录了理赔条件对应的判断表达式以及目标结果。服务器通过执行判断表达式判断理赔数据是否满足对应的理赔条件。判断表达式可以用于判断必需字段在理赔数据中对应的字段值是否为空，如“医院编号是否为空”。判断表达式还可以用于判断理赔数据中字段是否符合对应的理赔条件，如医疗诊断疾病名称属于规定的重大疾病范围，参保人保单在保险期间内等。判断表达式可以采用SQL语句表示。
服务器执行多个判断表达式，获取执行结果。服务器比较执行结果和目标结果，利用必需字段查询理赔数据中对应字段是否满足对应的理赔条件。若多个判断表达式的执行结果均与对应的目标结果相同，则表示理赔数据满足所有的理赔条件，服务器利用理赔数据生成理赔案件；反之，不生成理赔案件。
步骤210，获取流程表，流程表中记录了多个参保地对应的理赔流程。
服务器在数据库中存储了流程表。流程表中记录了多个参保地对应的理赔流程。各参保地的理赔政策不同，使得保险公司采用的理赔流程也不同。例如，有些地区直接根据医院的垫付费用进行赔付，保险公司采用的理赔流程可以是对应的第一流程。有些地区根据保险公司的理算结果进行赔付，保险公司采用的理赔流程可以是对应的第二流程。还有些地区比较保险公司理算结果和医院垫付费用后再进行赔付，保险公司采用的理赔流程可以是对应的第三流程。
步骤212，根据理赔请求中携带的参保地，在流程表中查询对应的理赔流程，根据理赔流程将理赔案件发送至对应的理赔终端。
服务器根据理赔请求中携带的参保地，在流程表中查询对应的理赔流程。根据查询到 的理赔流程，服务器将理赔案件直接发送到对应的理赔终端。理赔终端包括理算终端、账管终端和托管终端等。例如，若理赔流程为第一流程，则服务器利用理赔案件生成赔付任务，将赔付任务发送至保险公司的账管人员对应的账管终端。账管人员通过账管终端向服务器返回赔付应答。若赔付应答为确认赔付，则服务器生成赔付请求，将赔付请求发送至第三方的银行工作人员对应的托管终端。赔付请求中携带了领取账户，托管终端根据赔付请求向领取账户转账。
若理赔流程为第二流程，服务器将理赔案件发送至保险公司的理算人员对应的理算终端。理算终端对理赔数据进行理算，将理算结果返回至服务器。服务器利用理算结果和理赔案件生成赔付任务，将赔付任务发送至账管终端。账管人员通过账管终端向服务器返回赔付应答。若赔付应答为确认赔付，则服务器生成赔付请求，将赔付请求发送至托管终端。赔付请求中携带了领取账户，托管终端根据赔付请求向领取账户转账。
若理赔流程为第三流程，服务器将理赔案件发送至理算终端。理算终端对理赔数据进行理算，将理算结果返回至服务器。理算结果包括理算金额。理赔数据还包括医用金额。服务器比较医用金额和理算金额是否相等。若医用金额和理算金额相等，则服务器按照第一流程进行赔付。否则，服务器按照第二流程进行赔付。
根据查询到的理赔流程，服务器将理赔案件直接发送到对应的理赔终端，能够在多样化的理赔流程中实现理赔案件快速分配，减少保险公司需要人工分配理赔案件的负担，进而可以提高理赔效率。
本实施例中，通过规则表记录多个客户标识和对应的理赔规则，利用规则表可以根据客户标识查询对应的理赔规则，进而可以判断理赔数据是否符合对应的理赔规则，符合理赔规则的理赔数据可以用于生成理赔案件。通过流程表记录多个参保地和对应的理赔流程，利用该对应关系，从而能够从多样化的理赔流程中准确识别出适用于当前客户的理赔流程，有效减少保险公司需要人工识别理赔流程的负担，进而可以提高理赔效率。
在其中一个实施例中，理赔数据包括多个原始字段名，在接收多个客户终端发送的理赔请求的步骤之后，还包括：获取对接配置表，对接配置表中记录了业务字段名和对应的原始字段名；根据业务字段名在理赔数据中查询对应的原始字段名；根据查询到的原始字段名将理赔数据对应业务字段名记录至理赔数据表中。
保险公司为客户办理重大疾病理赔业务时，需要客户提供与理赔相关的数据。客户提供的数据可以称为原始数据。原始数据的记录方式如果与保险公司所需的记录方式不同，保险公司无法直接使用原始数据进行理赔案件处理，还需要对原始数据进行对接处理，以使得对接后的数据便于保险公司进行理赔案件处理。
服务器在数据库中存储了录入配置表和对接配置表。录入配置表中记录了客户提供的多个原始字段名。对接配置表中记录了业务字段名和原始字段名。其中，业务字段名和一个或多个原始字段名之间具有映射关系。原始字段名可以是服务器从录入配置表中提取得到的。业务字段名可以是服务器从理赔数据表中提取得到的。理赔数据表是保险公司根据 自身的理赔案件处理规范建立的数据结构表。理赔数据表中记录了多个业务字段名。
当客户需要办理理赔业务时，客户通过客户终端向服务器发起理赔请求。理赔请求中携带了原始数据。原始数据包括多个原始字段名。服务器在对接配置表中查询与理赔数据表中的业务字段名对应的原始字段名，利用该原始字段名在原始数据中查询相同的原始字段名。根据查询到的原始字段名，服务器将原始数据对应业务字段名记录至理赔数据表中。对接到理赔数据表中的数据可以称为理赔数据。
本实施例中，由于对接配置表中记录了业务字段名与原始字段名之间的映射关系。利用该映射关系，可以在原始数据中查询与业务字段名对应的原始字段名，由此可以根据查询到的原始字段名将原始数据对应业务字段名记录至理赔数据表中，从而实现了原始数据与理赔数据之间的准确对接，能够使得对接后的数据便于保险公司进行理赔案件处理。
在其中一个实施例中，理赔数据包括多个字段，理赔规则包括多个必需字段和对应的理赔条件，若理赔数据符合理赔规则，则利用理赔数据生成理赔案件的步骤，包括：利用所述必需字段查询所述理赔数据中的对应字段；根据所述理赔条件获取对应的判断表达式；执行所述判断表达式，判断所述理赔数据中的对应字段是否满足理赔条件；若是，则记录所述理赔数据符合理赔规则。
理赔规则包括多个必需字段和对应的理赔条件。必需字段是保险公司办理重大疾病理赔业务所不可缺少的字段，如参保人证件号、住院登记流水号、医院编号等。理赔条件是对理赔数据中各字段的属性要求，例如，必需字段在理赔数据中对应的字段值应当非空；医疗诊断疾病名称属于规定的重大疾病范围，参保人保单在保险期间内等。
规则表中还记录了理赔条件对应的判断表达式以及目标结果。服务器通过执行判断表达式判断理赔数据是否满足对应的理赔条件。判断表达式可以用于判断必需字段在理赔数据中对应的字段值是否为空，如“医院编号是否为空”。判断表达式还可以用于判断理赔数据中字段是否符合对应的理赔条件，如医疗诊断疾病名称属于规定的重大疾病范围，参保人保单在保险期间内等。判断表达式可以采用SQL语句表示。若判断表达式的执行结果与目标结果相同，则表示理赔数据中相应字段为非空且符合对应的理赔条件。服务器执行判断表达式，获取执行结果。服务器比较执行结果和目标结果，根据比较结果判断必须字段在理赔数据中对应字段是否满足对应的理赔条件。
服务器可以分别执行每个独立的判断表达式，通过比较每个判断表达式的执行结果和对应的目标结果，判断理赔数据与必需字段对应的各字段是否满足对应的理赔条件。每个判断表达式最终返回一项执行结果，只要有一项执行结果与对应的目标结果不同，则表示理赔数据不满足理赔条件。
服务器也可以采用运算符“或”和/或运算符“和”将所有判断表达式进行拼接，执行拼接后的判断表达式，根据拼接后的判断表达式的执行结果整体上判断理赔数据是否满足理赔条件。若独立的判断表达式的执行结果和对应的目标结果相同，服务器将该判断表达式的执行结果标记为第一中间结果；反之，服务器将该判断表达式的执行结果标记为第 二中间结果。根据判断表达式拼接时采用的运算符，服务器采用相同的运算符将多个第一中间结果和第二中间结果进行拼接，计算得到拼接后的判断表达式的执行结果。规则表中还记录了拼接后的判断表达式对应的目标结果。拼接后的判断表达式最终返回一项执行结果，服务器对该执行结果和目标结果进行比较，进而判断理赔数据是否满足理赔条件。
例如，假设判断表达式A为医院编号是否为空，对应的目标结果为否；判断表达式B为医疗诊断疾病名称是否属于规定的重大疾病，对应的目标结果为是；判断表达式C为参保人保单是否在保险期间内，对应的目标结果为是；判断表达式D为是否已经申请重大疾病理赔，对应的目标结果为否。如果判断表达式的执行结果与目标结果相同，将该判断表达式的执行结果标记为空字段串，反之，将该判断表达式的执行结果标记为非空字符串。假设判断表达式A的执行结果被标记为空字段串；判断表达式B的执行结果被标记为空字段串；判断表达式C的执行结果被标记为空字段串；判断表达式D的执行结果被标记为非空字段串，拼接后的判断表达式为A或B或C或D，则其执行结果为非空字段串。假设A或B或C或D对应的目标结果为空字符串，则表示理赔数据不满足理赔条件。
用于判断必需字段在理赔数据对应字段值是否为空的判断表达式可以称为第一判断表达式。若一个或多个第一判断表达式的执行结果与对应的目标结果不同，则服务器生成数据缺少提示，将数据缺少提示发送至客户终端。客户可以通过客户终端对理赔数据进行补充，客户终端利用补充后的理赔数据重新生成理赔请求，将理赔请求发送至服务器。用于判断理赔数据中字段是否符合对应理赔条件的判断表达式可以称为第二判断表达式。若一个或多个第二判断表达式的执行结果与对应的目标结果不同，则服务器生成不满足理赔条件提示，将不满足理赔条件提示发送至客户终端。
若第一判断表达式的执行结果和第二判断表达式的执行结果均与对应的目标结果相同，即理赔数据既包含所有的必需字段，也满足所有的理赔条件，则服务器利用理赔数据生成理赔案件；反之，不生成理赔案件。
本实施例中，规则表中记录了多个客户标识和对应的理赔规则，理赔规则包括多个必须字段和对应的理赔条件，利用必需字段查询理赔数据中对应字段是否满足对应的理赔条件；只有理赔数据包含所有必需字段且满足理赔条件，才利用理赔数据生成理赔案件，由此可以减少保险公司需要人工识别是否应该生成理赔案件的负担，进而可以提高理赔效率。
在其中一个实施例中，根据理赔流程将理赔案件发送至对应的理赔终端的步骤，包括：获取理赔数据表，理赔数据表中记录了多个理赔案件对应的案件标识以及处理状态，处理状态包括待处理；在理赔数据表中进行筛选，筛选出处理状态为待处理的案件标识；将处理状态为待处理的案件标识记录至案件表中；在案件表中提取一个或多个案件标识，根据提取到的案件标识从理赔数据表中获取对应的理赔案件；根据理赔流程，将获取到的理赔案件发送至对应的理赔终端；接收理赔终端返回的处理成功信息，在理赔数据表中将理赔案件对应的处理状态变更为处理成功；在案件表中将处理状态变更为处理成功的案件标识 进行删除。
服务器在数据库中存储了理赔数据表。理赔数据表中记录了多项理赔数据和对应的案件标识。理赔数据可以是客户终端预先上传至服务器的。当客户需要办理理赔业务时，客户可以通过客户终端向服务器发送理赔请求。服务器将理赔请求中携带的理赔数据对接至理赔数据表中。服务器根据理赔请求生成对应的理赔案件。理赔案件包括案件标识。案件标识用于唯一识别一个理赔案件，可以是案件编号等。服务器将理赔案件和案件标识对应理赔数据记录至理赔数据表中。理赔数据表中还记录了每件理赔案件的处理状态。处理状态包括待处理、处理中、处理成功和处理失败。对于尚未进行处理的理赔案件，服务器将其对应的处理状态标记为待处理。
服务器在数据库中存储了案件表。案件表记录了多个案件标识。案件标识可以是服务器从理赔数据表中提取得到的。服务器在理赔数据表中进行筛选，筛选出处理状态为待处理的理赔案件，获取处理状态为待处理的理赔案件对应的案件标识，将处理状态为待处理的理赔案件对应的案件标识记录至案件表中。
服务器在将理赔案件发送至理赔终端之前，可以获取预先设置的案件标识的抓取条件，根据抓取条件在案件表中抓取一个或多个案件标识。抓取条件包括抓取顺序和抓取数量。根据抓取到的案件标识，服务器在理赔数据表中获取对应的理赔案件。根据理赔流程，服务器将获取到的理赔案件发送至对应的理赔终端。若理赔案件处理完毕且处理成功，理赔终端向服务器返回处理成功信息。服务器在接收到理赔终端返回的处理成功信息之后，在理赔数据表中更新相应案件标识对应的处理状态，在案件表中将处理成功的案件标识进行删除。由此，服务器每次进行理赔案件提取时，只需从处理状态为待处理的理赔案件中进行提取，可以减少理赔案件提取时间，进而能够提高理赔案件处理效率。
在其中一个实施例中，方法还包括：在多个网页中爬取理赔流程；将爬取到的理赔流程与流程表中记录的理赔流程进行比较，若爬取到的流程发生变化，则利用根据爬取到的理赔规则对流程表进行更新。
各参保地的理赔政策时有变化，保险公司需要根据理赔政策及时调整对应的理赔流程。传统的方式中，保险公司的管理人员需要人工识别各参保地对应的理赔流程是否发生变化，当理赔流程发生变化时，管理人员通过人工的方式修改理赔流程，这使得理赔流程更新不及时，时效性差，也易产生修改错误，增加管理人员的工作负担。
为了解决上述问题，服务器按照预设频率在多个参保地对应的理赔网页爬取理赔流程。服务器根据参保地将爬取到的理赔流程与流程表中对应的理赔流程进行比较，以判断该参保地对应的理赔流程是否发生变化。若一个或多个参保地对应的理赔流程发生变化，则服务器利用爬取到的理赔流程对流程表进行更新。
由此，服务器从预设的多个理赔网页自动爬取相关的理赔流程，若通过与已有的理赔流程比较发现一个或多个参保地对应的理赔流程发生变化，根据爬取到的理赔流程对流程表及时进行更新，可以提高理赔流程更新效率，也可以减少管理人员的工作负担。
应该理解的是，虽然图2的流程图中的各个步骤按照箭头的指示依次显示，但是这些步骤并不是必然按照箭头指示的顺序依次执行。除非本文中有明确的说明，这些步骤的执行并没有严格的顺序限制，这些步骤可以以其它的顺序执行。而且，图2中的至少一部分步骤可以包括多个子步骤或者多个阶段，这些子步骤或者阶段并不必然是在同一时刻执行完成，而是可以在不同的时刻执行，这些子步骤或者阶段的执行顺序也不必然是依次进行，而是可以与其它步骤或者其它步骤的子步骤或者阶段的至少一部分轮流或者交替地执行。
在其中一个实施例中，如图3所示，提供了一种业务处理装置，包括：接收模块302、查询模块304、流程识别模块306和发送模块308，其中：
接收模块302，用于接收多个客户终端发送的理赔请求，理赔请求中携带了理赔数据，理赔数据包括客户标识和参保地；
查询模块304，用于获取规则表，规则表中记录了多个客户标识对应的理赔规则；根据客户标识在规则表中查询对应的理赔规则；
流程识别模块306，用于若理赔数据符合理赔规则，则利用理赔数据生成理赔案件；查询模块还用于获取流程表，流程表中记录了多个参保地对应的理赔流程；根据理赔请求中携带的参保地，在流程表中查询对应的理赔流程；
发送模块308，用于根据理赔流程将理赔案件发送至对应的理赔终端。
在其中一个实施例中，理赔数据包括多个字段，理赔规则包括多个必需字段和对应的理赔条件，流程识别模块306还用于利用所述必需字段查询所述理赔数据中的对应字段；根据所述理赔条件获取对应的判断表达式；执行所述判断表达式，判断所述理赔数据中的对应字段是否满足理赔条件；若是，则记录所述理赔数据符合理赔规则。
在其中一个实施例中，装置还包括更新模块310，用于在多个网页中爬取理赔流程；
将爬取到的理赔流程与流程表中记录的理赔流程进行比较；若爬取到的流程发生变化，
则利用爬取到的理赔规则对流程表进行更新。
在其中一个实施例中，提供了一种服务器，如图4所示，该服务器包括通过系统总线连接的处理器、存储器和网络接口。其中，该服务器的处理器用于提供计算和控制能力。该服务器的存储器包括非易失性存储介质、内存储器。该服务器的非易失性存储介质存储有操作系统和和计算机可读指令和数据库，该计算机可读指令被处理器执行时以实现一种理赔流程识别方法。该服务器的内存储器为非易失性存储介质中的操作系统和计算机可读指令的运行提供环境。该服务器的网络接口用于与外部的终端通过网络连接通信，比如，接收终端发送的理赔数据等。
本领域技术人员可以理解，图4中示出的结构，仅仅是与本申请方案相关的部分结构的框图，并不构成对本申请方案所应用于其上的服务器的限定，具体的服务器可以包括比图中所示更多或更少的部件，或者组合某些部件，或者具有不同的部件布置。
一种计算机设备，包括存储器和一个或多个处理器，存储器中储存有计算机可读指令，计算机可读指令被处理器执行时，使得一个或多个处理器执行以下步骤：接收多个客户终 端发送的理赔请求，理赔请求中携带了理赔数据，理赔数据包括客户标识和参保地；获取规则表，规则表中记录了多个客户标识对应的理赔规则；根据客户标识在规则表中查询对应的理赔规则；若理赔数据符合理赔规则，则利用理赔数据生成理赔案件；获取流程表，流程表中记录了多个参保地对应的理赔流程；根据理赔请求中携带的参保地，在流程表中查询对应的理赔流程，根据理赔流程将理赔案件发送至对应的理赔终端。
在其中一个实施例中，处理器执行计算机可读指令时还执行以下步骤：获取对接配置表，对接配置表中记录了业务字段名和对应的原始字段名；根据业务字段名在理赔数据中查询对应的原始字段名；根据查询到的原始字段名将理赔数据对应业务字段名记录至理赔数据表中。
在其中一个实施例中，理赔数据包括多个字段，理赔规则包括多个必需字段和对应的理赔条件，处理器执行计算机可读指令时还执行以下步骤：利用所述必需字段查询所述理赔数据中的对应字段；根据所述理赔条件获取对应的判断表达式；执行所述判断表达式，判断所述理赔数据中的对应字段是否满足理赔条件；若是，则记录所述理赔数据符合理赔规则。
在其中一个实施例中，处理器执行计算机可读指令时还执行以下步骤：获取理赔数据表，理赔数据表中记录了多个理赔案件对应的案件标识以及处理状态，处理状态包括待处理；在理赔数据表中进行筛选，筛选出处理状态为待处理的案件标识；将处理状态为待处理的案件标识记录至案件表中；在案件表中提取一个或多个案件标识，根据提取到的案件标识从理赔数据表中获取对应的理赔案件；根据理赔流程，将获取到的理赔案件发送至对应的理赔终端；接收理赔终端返回的处理成功信息，在理赔数据表中将理赔案件对应的处理状态变更为处理成功；在案件表中将处理状态变更为处理成功的案件标识进行删除。
在其中一个实施例中，处理器执行计算机可读指令时还执行以下步骤：在多个网页中爬取理赔流程；将爬取到的理赔流程与流程表中记录的理赔流程进行比较；若爬取到的流程发生变化，则利用爬取到的理赔规则对流程表进行更新。
一个或多个存储有计算机可读指令的非易失性存储介质，计算机可读指令被一个或多个处理器执行时，使得一个或多个处理器执行以下步骤：接收多个客户终端发送的理赔请求，理赔请求中携带了理赔数据，理赔数据包括客户标识和参保地；获取规则表，规则表中记录了多个客户标识对应的理赔规则；根据客户标识在规则表中查询对应的理赔规则；若理赔数据符合理赔规则，则利用理赔数据生成理赔案件；获取流程表，流程表中记录了多个参保地对应的理赔流程；根据理赔请求中携带的参保地，在流程表中查询对应的理赔流程，根据理赔流程将理赔案件发送至对应的理赔终端。
在其中一个实施例中，计算机可读指令被处理器执行时还执行以下步骤：获取对接配置表，对接配置表中记录了业务字段名和对应的原始字段名；根据业务字段名在理赔数据中查询对应的原始字段名；根据查询到的原始字段名将理赔数据对应业务字段名记录至理 赔数据表中。
在其中一个实施例中，理赔数据包括多个字段，理赔规则包括多个必需字段和对应的理赔条件，计算机可读指令被处理器执行时还执行以下步骤：利用所述必需字段查询所述理赔数据中的对应字段；根据所述理赔条件获取对应的判断表达式；执行所述判断表达式，判断所述理赔数据中的对应字段是否满足理赔条件；若是，则记录所述理赔数据符合理赔规则。
在其中一个实施例中，计算机可读指令被处理器执行时还执行以下步骤：获取理赔数据表，理赔数据表中记录了多个理赔案件对应的案件标识以及处理状态，处理状态包括待处理；在理赔数据表中进行筛选，筛选出处理状态为待处理的案件标识；将处理状态为待处理的案件标识记录至案件表中；在案件表中提取一个或多个案件标识，根据提取到的案件标识从理赔数据表中获取对应的理赔案件；根据理赔流程，将获取到的理赔案件发送至对应的理赔终端；接收理赔终端返回的处理成功信息，在理赔数据表中将理赔案件对应的处理状态变更为处理成功；在案件表中将处理状态变更为处理成功的案件标识进行删除。
在其中一个实施例中，计算机可读指令被处理器执行时还执行以下步骤：在多个网页中爬取理赔流程；将爬取到的理赔流程与流程表中记录的理赔流程进行比较；若爬取到的流程发生变化，则利用爬取到的理赔规则对流程表进行更新。
本领域普通技术人员可以理解实现上述实施例方法中的全部或部分流程，是可以通过计算机可读指令来指令相关的硬件来完成，所述的计算机可读指令可存储于一非易失性计算机可读取存储介质中，该计算机可读指令在执行时，可包括如上述各方法的实施例的流程。其中，本申请所提供的各实施例中所使用的对存储器、存储、数据库或其它介质的任何引用，均可包括非易失性和/或易失性存储器。非易失性存储器可包括只读存储器(ROM)、可编程ROM(PROM)、电可编程ROM(EPROM)、电可擦除可编程ROM(EEPROM)或闪存。易失性存储器可包括随机存取存储器(RAM)或者外部高速缓冲存储器。作为说明而非局限，RAM以多种形式可得，诸如静态RAM(SRAM)、动态RAM(DRAM)、同步DRAM(SDRAM)、双数据率SDRAM(DDRSDRAM)、增强型SDRAM(ESDRAM)、同步链路(Synchlink)DRAM(SLDRAM)、存储器总线(Rambus)直接RAM(RDRAM)、直接存储器总线动态RAM(DRDRAM)、以及存储器总线动态RAM(RDRAM)等。
以上实施例的各技术特征可以进行任意的组合，为使描述简洁，未对上述实施例中的各个技术特征所有可能的组合都进行描述，然而，只要这些技术特征的组合不存在矛盾，都应当认为是本说明书记载的范围。
以上实施例仅表达了本申请的几种实施方式，其描述较为具体和详细，但并不能因此而理解为对发明专利范围的限制。应当指出的是，对于本领域的普通技术人员来说，在不脱离本申请构思的前提下，还可以做出若干变形和改进，这些都属于本申请的保护范围。因此，本申请专利的保护范围应以所附权利要求为准。

Claims (20)

  1. 一种理赔流程识别方法，包括：
    接收多个客户终端发送的理赔请求，所述理赔请求中携带了理赔数据，所述理赔数据包括客户标识和参保地；
    获取规则表，所述规则表中记录了多个客户标识对应的理赔规则；
    根据客户标识在规则表中查询对应的理赔规则；
    若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件；
    获取流程表，所述流程表中记录了多个参保地对应的理赔流程；及
    根据所述理赔请求中携带的参保地，在所述流程表中查询对应的理赔流程，根据理赔流程将所述理赔案件发送至对应的理赔终端。
  2. 根据权利要求1所述的方法，其特征在于，所述理赔数据包括多个原始字段名，在所述接收多个客户终端发送的理赔请求之后，还包括：
    获取对接配置表，所述对接配置表中记录了业务字段名和对应的原始字段名；
    根据业务字段名在理赔数据中查询对应的原始字段名；及
    根据查询到的原始字段名将所述理赔数据对应业务字段名记录至理赔数据表中。
  3. 根据权利要求1所述的方法，其特征在于，所述理赔数据包括多个字段，所述理赔规则包括多个必需字段和对应的理赔条件，所述若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件之前，还包括：
    利用所述必需字段查询所述理赔数据中的对应字段；
    根据所述理赔条件获取对应的判断表达式；
    执行所述判断表达式，判断所述理赔数据中的对应字段是否满足理赔条件；及
    若是，则记录所述理赔数据符合理赔规则。
  4. 根据权利要求1所述的方法，其特征在于，所述根据理赔流程将所述理赔案件发送至对应的理赔终端，包括：
    获取理赔数据表，所述理赔数据表中记录了多个理赔案件对应的案件标识以及处理状态，所述处理状态包括待处理；
    在所述理赔数据表中进行筛选，筛选出处理状态为待处理的案件标识；
    将处理状态为待处理的案件标识记录至案件表中；
    在所述案件表中提取一个或多个案件标识，根据提取到的案件标识从理赔数据表中获取对应的理赔案件；
    根据理赔流程，将获取到的理赔案件发送至对应的理赔终端；
    接收所述理赔终端返回的处理成功信息，在理赔数据表中将所述理赔案件对应的处理状态变更为处理成功；及
    在案件表中将处理状态变更为处理成功的案件标识进行删除。
  5. 根据权利要求1所述的方法，其特征在于，还包括：
    在多个网页中爬取理赔流程；
    将爬取到的理赔流程与流程表中记录的理赔流程进行比较；及
    若爬取到的流程发生变化，则利用爬取到的理赔规则对流程表进行更新。
  6. 一种理赔流程识别装置，包括：
    接收模块，用于接收多个客户终端发送的理赔请求，所述理赔请求中携带了理赔数据，所述理赔数据包括客户标识和参保地；
    查询模块，用于获取规则表，所述规则表中记录了多个客户标识对应的理赔规则；根据客户标识在规则表中查询对应的理赔规则；
    流程识别模块，用于若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件；所述查询模块还用于获取流程表，所述流程表中记录了多个参保地对应的理赔流程；根据所述理赔请求中携带的参保地，在所述流程表中查询对应的理赔流程；及
    发送模块，用于根据理赔流程将所述理赔案件发送至对应的理赔终端。
  7. 根据权利要求6所述的装置，其特征在于，所述理赔数据包括多个原始字段名；所述接收模块还用于获取对接配置表，所述对接配置表中记录了业务字段名和对应的原始字段名；根据业务字段名在理赔数据中查询对应的原始字段名；及根据查询到的原始字段名将所述理赔数据对应业务字段名记录至理赔数据表中。
  8. 根据权利要求6所述的装置，其特征在于，所述理赔数据包括多个字段，所述理赔规则包括多个必需字段和对应的理赔条件，所述流程识别模块还用于利用所述必需字段查询所述理赔数据中的对应字段；根据所述理赔条件获取对应的判断表达式；执行所述判断表达式，判断所述理赔数据中的对应字段是否满足理赔条件；若是，则记录所述理赔数据符合理赔规则。
  9. 根据权利要求6所述的装置，其特征在于，所述发送模块还用于：获取理赔数据表，所述理赔数据表中记录了多个理赔案件对应的案件标识以及处理状态，所述处理状态包括待处理；在所述理赔数据表中进行筛选，筛选出处理状态为待处理的案件标识；将处理状态为待处理的案件标识记录至案件表中；在所述案件表中提取一个或多个案件标识，根据提取到的案件标识从理赔数据表中获取对应的理赔案件；根据理赔流程，将获取到的理赔案件发送至对应的理赔终端；接收所述理赔终端返回的处理成功信息，在理赔数据表中将所述理赔案件对应的处理状态变更为处理成功；及在案件表中将处理状态变更为处理成功的案件标识进行删除。
  10. 根据权利要求6所述的装置，其特征在于，所述装置还包括更新模块，用于在多个网页中爬取理赔流程；将爬取到的理赔流程与流程表中记录的理赔流程进行比较；若爬取到的流程发生变化，则利用爬取到的理赔规则对流程表进行更新。
  11. 一种服务器，包括存储器及一个或多个处理器，所述存储器中储存有计算机可读指令，所述计算机可读指令被所述一个或多个处理器执行时，使得所述一个或多个处理器执行以下步骤：
    接收多个客户终端发送的理赔请求，所述理赔请求中携带了理赔数据，所述理赔数据包括客户标识和参保地；
    获取规则表，所述规则表中记录了多个客户标识对应的理赔规则；
    根据客户标识在规则表中查询对应的理赔规则；
    若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件；
    获取流程表，所述流程表中记录了多个参保地对应的理赔流程；及
    根据所述理赔请求中携带的参保地，在所述流程表中查询对应的理赔流程，根据理赔流程将所述理赔案件发送至对应的理赔终端。
  12. 根据权利要求11所述的服务器，其特征在于，所述理赔数据包括多个原始字段名，所述处理器执行所述计算机可读指令时还执行以下步骤：
    获取对接配置表，所述对接配置表中记录了业务字段名和对应的原始字段名；
    根据业务字段名在理赔数据中查询对应的原始字段名；及
    根据查询到的原始字段名将所述理赔数据对应业务字段名记录至理赔数据表中。
  13. 根据权利要求11所述的服务器，其特征在于，所述理赔数据包括多个字段，所述理赔规则包括多个必需字段和对应的理赔条件，所述处理器执行所述计算机可读指令时还执行以下步骤：
    利用所述必需字段查询所述理赔数据中的对应字段；
    根据所述理赔条件获取对应的判断表达式；
    执行所述判断表达式，判断所述理赔数据中的对应字段是否满足理赔条件；及
    若是，则记录所述理赔数据符合理赔规则。
  14. 根据权利要求11所述的服务器，其特征在于，所述处理器执行所述计算机可读指令时还执行以下步骤：
    获取理赔数据表，所述理赔数据表中记录了多个理赔案件对应的案件标识以及处理状态，所述处理状态包括待处理；
    在所述理赔数据表中进行筛选，筛选出处理状态为待处理的案件标识；
    将处理状态为待处理的案件标识记录至案件表中；
    在所述案件表中提取一个或多个案件标识，根据提取到的案件标识从理赔数据表中获取对应的理赔案件；
    根据理赔流程，将获取到的理赔案件发送至对应的理赔终端；
    接收所述理赔终端返回的处理成功信息，在理赔数据表中将所述理赔案件对应的处理状态变更为处理成功；及
    在案件表中将处理状态变更为处理成功的案件标识进行删除。
  15. 根据权利要求11所述的服务器，其特征在于，所述处理器执行所述计算机可读指令时还执行以下步骤：
    在多个网页中爬取理赔流程；
    将爬取到的理赔流程与流程表中记录的理赔流程进行比较；及
    若爬取到的流程发生变化，则利用爬取到的理赔规则对流程表进行更新。
  16. 一个或多个存储有计算机可读指令的非易失性计算机可读存储介质，所述计算机可读指令被一个或多个处理器执行时，使得所述一个或多个处理器执行以下步骤：
    接收多个客户终端发送的理赔请求，所述理赔请求中携带了理赔数据，所述理赔数据包括客户标识和参保地；
    获取规则表，所述规则表中记录了多个客户标识对应的理赔规则；
    根据客户标识在规则表中查询对应的理赔规则；
    若所述理赔数据符合理赔规则，则利用所述理赔数据生成理赔案件；
    获取流程表，所述流程表中记录了多个参保地对应的理赔流程；及
    根据所述理赔请求中携带的参保地，在所述流程表中查询对应的理赔流程，根据理赔流程将所述理赔案件发送至对应的理赔终端。
  17. 根据权利要求16所述的存储介质，其特征在于，所述理赔数据包括多个原始字段名，所述计算机可读指令被所述处理器执行时还执行以下步骤：
    获取对接配置表，所述对接配置表中记录了业务字段名和对应的原始字段名；
    根据业务字段名在理赔数据中查询对应的原始字段名；及
    根据查询到的原始字段名将所述理赔数据对应业务字段名记录至理赔数据表中。
  18. 根据权利要求16所述的存储介质，其特征在于，所述理赔数据包括多个字段，所述理赔规则包括多个必需字段和对应的理赔条件，所述计算机可读指令被所述处理器执行时还执行以下步骤：
    利用所述必需字段查询所述理赔数据中的对应字段；
    根据所述理赔条件获取对应的判断表达式；
    执行所述判断表达式，判断所述理赔数据中的对应字段是否满足理赔条件；及
    若是，则记录所述理赔数据符合理赔规则。
  19. 根据权利要求16所述的存储介质，其特征在于，所述计算机可读指令被所述处理器执行时还执行以下步骤：
    获取理赔数据表，所述理赔数据表中记录了多个理赔案件对应的案件标识以及处理状态，所述处理状态包括待处理；
    在所述理赔数据表中进行筛选，筛选出处理状态为待处理的案件标识；
    将处理状态为待处理的案件标识记录至案件表中；
    在所述案件表中提取一个或多个案件标识，根据提取到的案件标识从理赔数据表中获取对应的理赔案件；
    根据理赔流程，将获取到的理赔案件发送至对应的理赔终端；
    接收所述理赔终端返回的处理成功信息，在理赔数据表中将所述理赔案件对应的处理状态变更为处理成功；及
    在案件表中将处理状态变更为处理成功的案件标识进行删除。
  20. 根据权利要求16所述的存储介质，其特征在于，所述计算机可读指令被所述处理器执行时还执行以下步骤：
    在多个网页中爬取理赔流程；
    将爬取到的理赔流程与流程表中记录的理赔流程进行比较；及
    若爬取到的流程发生变化，则利用爬取到的理赔规则对流程表进行更新。
PCT/CN2018/084971 2017-07-25 2018-04-28 理赔流程识别方法、装置、服务器和存储介质 WO2019019744A1 (zh)

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