WO2019100601A1

WO2019100601A1 - Claim risk evaluation method and device

Info

Publication number: WO2019100601A1
Application number: PCT/CN2018/075677
Authority: WO
Inventors: 蔡宁; 和婷
Original assignee: 平安科技（深圳）有限公司
Priority date: 2017-11-22
Filing date: 2018-02-07
Publication date: 2019-05-31
Also published as: CN107871284A

Abstract

A claim risk evaluation method and device, relating to the technical field of data processing, mainly aiming to solve the problem that high risk cases missed by manual review during review of claims incur economic losses to an insurance company. The claim risk evaluation method comprises: obtaining claim information and historical insurance policy information of an insured in a claim case (101); analyzing logical parameters to be evaluated in the claim information and the historical insurance policy information (102), wherein the logical parameters reflect a situation wherein the insured is involved in a medical treatment program during a claim case; and matching the logical parameters with preconfigured evaluation logic, and collecting statistics on an evaluation result of the claim case corresponding to the logical parameters (103), wherein the preconfigured evaluation logic reflects a relationship between different logical parameters and different evaluation scores. The method of the invention is used for evaluating high risk claims.

Description

Method and device for evaluating risk claims

The present application claims priority from the Chinese Patent Application filed on Nov. 22, 2017, filed on Jan. 22, 2011, filed Jan. in.

Technical field

The present application relates to the field of data processing technologies, and in particular, to a method and an apparatus for evaluating risk claims.

Background technique

After the insurance claims case occurs, the insurance industry's underwriting personnel need to approve the proofreading case in order to accurately make claims and reduce the risk of claims. Among them, the insured personnel in the process of evaluating claims cases include the loss and the nuclear damage. After the damage is determined, the nuclear damage personnel will review the results of their work. If there is no doubt, they will agree to the result. If there is any objection, Will be returned to prevent fraud.

At present, the existing nuclear damage personnel conduct manual review of the insured person's insurance information and the fixed loss information when conducting the review of the claim case, but for the manual proofreading, each of the nuclear damage personnel The cognitive criteria are different from the judgment principles, and the efficiency is different, which will lead to different results. For the claims scope of some claims in insurance claims, some strict nuclear damage personnel will reject some cases that should be settled, some loose nuclear losses. The staff will agree to some cases that should not be settled. This makes it easy to miss some high-risk cases and bring some economic losses to the insurance company. If many people proofread the same claim case, they will waste a lot of human resources. Manual review reduces the efficiency of the evaluation of claims.

Summary of the invention

In view of this, the present application provides a method and an apparatus for evaluating risk claims, and the main purpose thereof is to solve the problem that an existing nuclear damage personnel can easily miss some high-risk cases through manual review when conducting a review of a claim case. Bring some economic losses.

According to an aspect of the present application, a method for evaluating risk claims is provided, including:

Obtaining claim information and historical policy information of the insured in the claim case; parsing the claim information and the logical parameter to be evaluated in the historical policy information, wherein the logic parameter is used to reflect the insured participates in the medical item in the claim case a situation; matching the logical parameter with the preset evaluation logic, and counting the evaluation result of the claim case corresponding to the logical parameter, wherein the preset evaluation logic is used to reflect the relationship between different logical parameters and different evaluation scores .

Further, the parsing the logic information to be evaluated in the claim information and the historical policy information includes: extracting the claim information and the historical policy information, respectively, the number of times, the number of types, the type of the fee, and the type of the attribute Corresponding logical parameter; determining whether the value of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively greater than a preset upper limit value, and/or less than a preset a lower limit value; if less than the preset upper limit value, and/or greater than the preset lower limit value, the logic corresponding to the number of times, the number of types, the type of the fee, and the attribute type The parameter configures the number of intervals, and the number of intervals is used to distinguish parameters corresponding to the preset preset evaluation logic formula.

Further, the matching according to the logic parameter and the preset evaluation logic, and counting the evaluation result of the claim case corresponding to the logic parameter includes: calculating the logic of the number of times according to the preset evaluation logic formula by using different interval numbers The evaluation score corresponding to the parameter, and the preset evaluation logic formula is

Where i is the number of intervals, x is the value of the logical parameter of the order type; and the evaluation score corresponding to the logical parameter of the number type is calculated according to the preset evaluation logic formula by different interval numbers, and the preset evaluation logic formula is

Where i is the interval number, y is the value of the logical parameter of the number type; and the evaluation score corresponding to the logical parameter of the fee type is calculated according to the preset evaluation logic formula with different interval numbers, and the preset evaluation logic formula is

Where i is the interval number, z is the value of the logical parameter of the expense type; and the evaluation score corresponding to the logical parameter of the attribute type is calculated according to the preset evaluation logic formula by different interval numbers, and the preset evaluation logic formula is

Where i is the number of intervals, and l is the value of the logical parameter of the attribute type; according to the preset interval weight vector, the evaluation of the number of times, the type of the number, the type of the fee, and the corresponding type of the attribute are obtained by statistics. The result of the evaluation of the score.

Further, the method further includes: generating an interval weight vector corresponding to the claim case according to the different claim product information, wherein the weight value corresponding to the fee type in the interval weight vector is respectively greater than the number of times, the number type, and the attribute type. Corresponding weights.

Further, after the matching, according to the logic parameter, the preset evaluation logic, and the evaluation result of the claim case corresponding to the logic parameter, the method further includes: performing the evaluation result and the preset claim amount Comparing; if the comparison result is that the evaluation result is greater than two-thirds of the preset claim amount, the claim case is determined as a risk claim case, and the warning information is sent.

According to an aspect of the present application, an apparatus for evaluating risk claims includes: an obtaining unit for acquiring claim information and historical policy information of an insured in a claim case; and an analyzing unit for parsing the claim information and the a logical parameter to be evaluated in the history policy information, wherein the logic parameter is used to reflect the situation in which the insured participates in the medical item in the claim case; the statistical unit is configured to match the preset evaluation logic according to the logic parameter, and The evaluation result of the claim case corresponding to the logical parameter is counted, and the preset evaluation logic is used to reflect the relationship between different logical parameters and different evaluation scores.

Further, the parsing unit includes: an extracting module, configured to extract logical parameters corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute in the claim information and the historical policy information; the determining module is configured to: Determining whether the value of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively greater than a preset upper limit value, and/or less than a preset lower limit value; a module, configured to determine, by the determining module, that the value of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively less than a preset upper limit value, and/or greater than a preset The lower limit value is the number of logical parameter configuration intervals corresponding to the number of times, the number of types, the type of the fee, and the attribute type, and the number of intervals is used to distinguish the corresponding preset evaluation logic formula Parameters.

Further, the statistic unit includes: a calculation module, configured to calculate, according to the preset evaluation logic formula, an evaluation score corresponding to the logic parameter of the number of times in different interval numbers, where the preset evaluation logic formula is

Where i is the number of intervals, x is the value of the logical parameter of the number of times; and the calculation module is further configured to calculate the evaluation score corresponding to the logical parameter of the number type according to the preset evaluation logic formula by using different interval numbers, The preset evaluation logic formula is

Where i is the interval number, y is the value of the logical parameter of the number type; and the calculation module is further configured to calculate the evaluation score corresponding to the logical parameter of the fee type by using different preset numbers according to the preset evaluation logic formula, The preset evaluation logic formula is

Where i is the number of intervals, z is the value of the logical parameter of the cost type; and the calculation module is further configured to calculate an evaluation score corresponding to the logical parameter of the attribute type by using different preset numbers according to the preset evaluation logic formula, The preset evaluation logic formula is

Where i is the number of intervals, l is the value of the logical parameter of the attribute type, and the statistic module is configured to statistically obtain the type of the number of times, the type of the number, the type of the fee, and the number according to a preset interval weight vector The evaluation result of the evaluation score corresponding to the attribute type.

Further, the device further includes: a generating unit, configured to generate an interval weight vector corresponding to the claim case according to the different claim product information, wherein the weight value corresponding to the fee type in the interval weight vector is sequentially greater than the number of times, The weight corresponding to the type and attribute type.

Further, the apparatus further includes: a comparing unit, configured to compare the evaluation result with a preset claim amount; and a determining unit, configured to: if the comparison result is that the evaluation result is greater than three points of the preset claim amount Second, the claim case is determined as a risk claim case and an early warning message is sent.

According to still another aspect of the present application, a storage medium is provided, in which at least one executable instruction is stored, the executable instruction causing a processor to perform an operation corresponding to the evaluation method of the risk claim described above.

According to still another aspect of the present application, a server is provided, including: a processor, a memory, a communication interface, and a communication bus, wherein the processor, the memory, and the communication interface complete mutual communication through the communication bus The memory is configured to store at least one executable instruction that causes the processor to perform an operation corresponding to the evaluation method of the risk claim described above.

With the above technical solution, the technical solution provided by the embodiment of the present application has at least the following advantages:

The present application provides a method and device for evaluating risk claims, first obtaining claim information and historical policy information of the insured in the claim case, and then parsing the claim information and the logical parameters to be evaluated in the historical policy information. The logic parameter is used to reflect the situation in which the insured participates in the medical item in the claim case, and then matches the preset parameter according to the logical parameter, and collects the evaluation result of the claim case corresponding to the logical parameter, the pre- The evaluation logic is used to reflect the relationship between different logical parameters and different evaluation scores. Compared with the existing nuclear damage personnel in the review of claim cases, all of them are manually reviewed, and it is easy to miss some high-risk cases. Compared with the claim information and historical policy information, the embodiment of the present application analyzes the claims related to the claims case. Logical parameters, matching the logic parameters with the preset evaluation logic, obtaining the evaluation results, realizing the computer automatically calculating the evaluation results, without human operation, ensuring that each claim case is evaluated according to a standard, thereby improving the efficiency of the claim case evaluation.

The above description is only an overview of the technical solutions of the present application, and the technical means of the present application can be more clearly understood, and the above and other objects, features and advantages of the present application can be more clearly understood. The following is a specific embodiment of the present application.

DRAWINGS

Various other advantages and benefits will become apparent to those skilled in the art from a The drawings are only for the purpose of illustrating the preferred embodiments and are not intended to be limiting. Throughout the drawings, the same reference numerals are used to refer to the same parts. In the drawing:

FIG. 1 is a flowchart of a method for evaluating risk claims provided by an embodiment of the present application;

FIG. 2 is a flowchart of another method for evaluating risk claims provided by an embodiment of the present application;

FIG. 3 is a block diagram of an apparatus for evaluating risk claims provided by an embodiment of the present application;

FIG. 4 is a block diagram of another apparatus for evaluating risk claims provided by an embodiment of the present application;

FIG. 5 is a schematic structural diagram of a server provided by an embodiment of the present application.

Detailed ways

Exemplary embodiments of the present disclosure will be described in more detail below with reference to the accompanying drawings. While the embodiments of the present invention have been shown in the drawings, the embodiments Rather, these embodiments are provided so that this disclosure will be more fully understood and the scope of the disclosure will be fully disclosed.

The embodiment of the present application provides a method for evaluating risk claims, as shown in FIG. 1 , the method includes:

101. Obtain the claim information and historical policy information of the insured in the claim case. Wherein, the insured refers to a person who has the right to claim the insurance premium after the occurrence of the insured event according to the effective insurance contract, and the claim case is a case arising from the insured person's insured item specified in the insured product. The claim information includes all information generated by the insured in the claim case, such as the time when the insured product is accident insurance, the time of the accident, the cause of the accident, and a series of treatment information produced at the designated hospital after the accident occurred. The information in the present application is not specifically limited. The historical policy information is all information generated by the insured from the initiating time to the current time period regarding the insured product, such as the insured product, the standard premium of the insured product, the effective time of the insured, the expiration time, and the underwriting The time and the application time, if there is a claim case, the claim amount of the claim case, the cause of the claim case, and the like, the embodiment of the present application does not specifically limit. It should be noted that when the customer is insured, the insured is the person who delivers the premium. The insured and the insured may be the same person, or may not be the same person. One insured may insure multiple people, that is, when the customer is insured. An insured customer generates a policy corresponding to a policy number, in which the policy includes information for the insured to insure all insured persons, and each insured generates a sub-order corresponding to a sub-order number, for the embodiment of the present application The policy information of the insured may be a separate policy information, or may be a sub-single information corresponding to the insured, which is not specifically limited in this embodiment. In addition, after the insured has generated the claim case, the claim information will be saved, and finally the historical policy information will be obtained, and since each insured person corresponds to a policy number, the history policy information can be obtained through the policy number.

102. Parse the claim information and the logical parameter to be evaluated in the historical policy information. Wherein, the logic parameter is used to reflect the situation in which the insured participates in the medical item in the claim case, because the meaning of the insurance company exists is to make risk claims for the customer, especially for the health insurance product, after the customer has a claim case, Generally, it is necessary to treat certain medical items, and the insurance company will pay for the expenses incurred by these medical items. However, the production of a large number of medical items may not be within the scope of claims for insurance products, and it is necessary to claim claims. And the policy information is evaluated by the insured in the medical project. Therefore, the logical parameter may include information such as the time, the number of times, the content, the fee, and the like of the insured person participating in the medical project, such as one month (this time + history all cases) The number of visits to the same disease within one state (one visit: the same hospital on the same day), the number of hospitals visited within one month (this state + all cases of history), the number of hospital visits within one month (this + history of all cases) The time of the second outbreak is abnormal (from the time when my policy is effective), the time of this insurance Abnormal (from the end of my policy), this treatment is an overseas clinic (hospital property), the time of this outpatient visit, the history of all cases, the rules of mutual exclusion rules (the insured), physical therapy (cost type) fees ( With the hospital) public, physical therapy (cost type) costs (with the hospital) private, Chinese medicine treatment costs, Chinese medicine treatment times (number of visits: the same hospital on the same day), Chinese herbal medicine single cost, hospitalization expenses, inspection and inspection fees accounted for the total cost Proportion, whether to use medical insurance card (social security bill), whether there is third-party payment (clear to the field in the bill), historical case E-transformation (WeChat, APP) claims application amount, historical case E-based claim application amount (cumulative), Hospitalization days (single), public outpatient application amount (high-end), private outpatient application amount (high-end), public hospitalization application amount (high-end), private hospitalization application amount: (high-end), insured personnel accounted for the first-time personnel ratio, The number of surrenders is equal to the number of people insured in the first period, the number of underwriting options is MHD and the number of people insured in the first insured policy, the group with only hospitalization responsibility for the policy (high-end, per capita premium), and the underwriting option is non-MHD The first phase of the insured and the policy number, the embodiment of the present application is not specifically limited. It should be noted that, since the content and data corresponding to the logical parameters are stored in the database, when the logical parameters are parsed, the corresponding logical parameters may be extracted through the storage identifiers of the various parameters in the claim information and the historical policy information, and then parsed. Specific data corresponding to these parameters, such as the amount of public outpatient applications (high-end) is 5,000 yuan.

103. Match the logic parameter according to the preset evaluation logic, and collect an evaluation result of the claim case corresponding to the logic parameter. The preset evaluation logic is configured to reflect a relationship between different logical parameters and different evaluation scores, wherein the evaluation score is a score for evaluating each logical parameter. Generally, the data of each logical parameter may be divided into scores. Range, in order to determine the score according to the content of each range, for example, the logical parameter is the number of visits to the same disease within one month (this time + all cases of history) (one visit: the same hospital on the same day), the logical parameters parsed corresponding The data is 3 times, and the corresponding logical parameters have a score range of 2 points for 2 times, 3 points for 2 or 3 times, 4 points for 4 times, and 5 points for 5 times or more. The higher the score, the higher the risk of the claims case. However, since the logical parameters include not only the parameters of the order type but also the parameters of the number, cost, attribute, etc., the data of the logical parameters of each type corresponds to the range of division. Different, so the evaluation results need to be counted according to the scores of all logical parameters, so that the staff can use the evaluation results to determine whether the current claim case is a dangerous claim case. It should be noted that the scores obtained by each logical parameter need to be counted, and the average value can be calculated for the summation, and then the average value is judged whether the average value exceeds a specific risk value, and if it is exceeded, it is determined as a risk claim case, and is performed to the technician. Early warning.

The application provides a method for evaluating risk claims, and the existing nuclear damage personnel are manually audited, and it is easy to miss some high-risk cases. The embodiment of the present application passes the claims according to the claims. The information and historical policy information analyzes the logical parameters related to the claim case, matches the logical parameters with the preset evaluation logic, obtains the evaluation result, and realizes the computer automatically calculates the evaluation result without manual operation, ensuring that each claim case is in accordance with a standard. Conduct an assessment to improve the efficiency of claims assessments.

The embodiment of the present application provides another method for evaluating risk claims, as shown in FIG. 2, the method includes:

201. Obtain the claim information and historical policy information of the insured in the claim case. This step is the same as the method of step 102 shown in FIG. 1, and details are not described herein again.

202. Extract logical parameters corresponding to the number of times, the type of the number, the type of the fee, and the type of the attribute in the claim information and the historical policy information. For the embodiment of the present application, since not all the claim events and the historical policy information include all the logical parameters, and the data in the logical parameters are not all specific values, such as whether the logical parameter is whether to use the medical insurance card ( Social security bill), the corresponding data is “yes or no”, so the logical parameters need to be classified to make an accurate score when evaluating the score according to the logical parameters. For example, the number of types can include the number of visits to the same disease within one month (this time + all cases of history) (one visit: the same hospital on the same day), the number of Chinese medicine treatments (number of visits: same hospital on the same day), historical case E ( WeChat, APP) number of claims application, the number of types is less than one month (this + history of all cases) the number of hospitals, within one month (this + history of all cases) the number of treatments, this time out of the abnormal time ( The time from the effective date of my policy), the abnormal time of this insurance (from the end of my policy), the number of hospital stays (single), the underwriting option is MHD and the number of first-time insurance policies, the underwriting option is non-MHD policy and the first of the policy The number of insured persons, the cost type is physical therapy (cost type) fee (with hospital) public, physical therapy (cost type) fee (with hospital) private, Chinese medicine treatment fee, Chinese herbal medicine single fee, historical case E-based claim application amount ( Accumulated), public outpatient application amount (high end), private outpatient application amount (high end), public hospitalization application amount (high end), private hospitalization application amount: (high end ), the policy is only the group responsible for hospitalization (high-end, per capita premium), the type of attribute is the overseas treatment (hospital attribute), the time of this outpatient visit, the history of all cases, the rule of mutual exclusion rules (the insured) Whether to use the medical insurance card (social security bill), whether there is a third-party payment (clear to the field in the bill), the number of the insured personnel in the first-time personnel, and the number of surrenders in the first-phase insurance, the embodiment does not do Specifically limited. Generally, the logical parameters are stored in the form of fields and the like in the database. In order to accurately extract different types of logical parameters, the storage identifiers of different types of logical parameters can be searched to simplify the extraction step.

203. Determine whether the values of the logical parameters corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively greater than a preset upper limit value, and/or less than a preset lower limit value. . For the embodiment of the present application, in order to avoid serious distortion of data in the logic parameter, an upper limit value and/or a lower limit value need to be set, so that the data of the current logic parameter can be used to evaluate the claim risk. The preset upper limit value and/or the lower limit value are preset values of the technician according to different types of logic parameters, for example, the number of types of logic parameters is within one month (this time + history all case states) The preset upper limit of the number of hospitals to be treated is 8. When the number of hospitals in the insured's claims information is 10 in one month, it is greater than the preset upper limit. For the insured's hospital The data is obviously unreasonable and requires early warning to the underwriters who handle the claims.

204. If the value is less than the preset upper limit value, and/or is greater than the preset lower limit value, the logical parameter configuration corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute respectively The number of intervals. The interval number is used to distinguish parameters corresponding to the preset preset evaluation logic formula. Since different types of logic parameters use the preset evaluation logic formula to evaluate the score, the data corresponding to each logical parameter needs to be replaced by a formula that can be matched. The calculated value, therefore, it is necessary to divide the number of intervals for each logical parameter. Preferably, the logical parameters of the number type, the number type, and the cost type can be divided into five interval numbers, wherein the number of times and the number type are insured. The importance of judging the risk of claim in the claim case is the second most important. The number of times and the number of each type are 1, 2, 3, 4, and 5. The importance of determining the risk of claim in the insurance claim case is The most important, the cost type is 6, 7, 8, 9, and 10, respectively. It is not important to determine the importance of the claim risk in the insurance claim case for the attribute type, and the number of each type of the attribute type is 0. 1, 2, 0, 0, for example, the attribute type logic parameter is whether to use the medical insurance card (social security bill), the data is "yes and no", for "yes" The number of intervals is 0, and the number of intervals for "No" is 2; the number of logical parameters of this type is abnormal for this time (from the time when the policy is effective), and the data are "more than 7 months, 5-6 months, Within 3-4 months, 1-2 months, and 1 month, the number of intervals of "more than 7 months" is 1, and so on. The cost type logic parameter is the cost of traditional Chinese medicine treatment. The data are respectively 0-300. 300-500, 500-700, 700-900, 900 or more", "0-300," the interval number is divided into 6, and so on, and the embodiment of the present application is not specifically limited. By assigning interval numbers to different types of logical parameters, the logical parameters of different data are converted into parameters that can be replaced in the preset evaluation logic formula for formula operations. It should be noted that the current risk claim evaluation method can be embedded into any insurance management system in the form of a calculation module to connect with the database storing the insurance customer information, and obtain data for calculation. In addition, the number of intervals that need to be configured in the current step 204 may be pre-configured in the system cache. When each logical parameter to be evaluated is received, the number of intervals of the logical parameter is determined according to the specific data of the logical parameter, and the specific program is compiled. The embodiment is not specifically limited. For the embodiment of the present application, if the value is greater than the preset upper limit value, and/or is less than the preset lower limit value, the logic parameter is reported to the display interface, and is not used as a parameter in the preset evaluation logic formula. Operation.

205a. Calculate, according to the preset evaluation logic formula, an evaluation score corresponding to the logical parameter of the number of times in different interval numbers. Wherein the preset evaluation logic formula is

Where i is the number of intervals and x is the value of the logical parameter of the number type. For example, the logical parameter is the public hospitalization application amount (high end), and the cost of the customer 1 found in the database in the claim event and the historical policy information is 25,000 yuan, and the current logical parameter is determined according to the number of intervals corresponding to the type of the fee type. The number of intervals is 8, and 25000 and 8 are brought into the preset evaluation logic formula to obtain an evaluation score of about 76. In order to improve the accuracy of the risk assessment of claims, it is necessary to calculate an evaluation score for each logical parameter in order to determine the risk of the claim case based on the scores of all the logical parameters. It should be noted that the preset evaluation logic formula is stored in the calculation module in the form of program code, and when the calculation program is started, the operation is directly performed according to each logic parameter, and the evaluation scores of all the logic parameters are obtained.

For the embodiment of the present application, the evaluation score corresponding to the logical parameter of the number type is calculated by different interval numbers according to the preset evaluation logic formula 205b along with the step 205a. Wherein the preset evaluation logic formula is

Where i is the number of intervals and y is the value of the logical parameter of the number type. Step 205b is the same as the specific implementation method of step 205a, and will not be described again.

For the embodiment of the present application, the evaluation score corresponding to the logical parameter of the fee type is calculated by different interval numbers according to the preset evaluation logic formula 205c along with the step 205a. Wherein the preset evaluation logic formula is

Where i is the interval number and z is the value of the logical parameter of the expense type. Step 205c is the same as the specific implementation method of step 205a, and will not be described again.

For the embodiment of the present application, the evaluation score corresponding to the logical parameter of the attribute type is calculated in different interval numbers according to the preset evaluation logic formula 205d along with the step 205a. Wherein the preset evaluation logic formula is

Where i is the number of intervals and l is the value of the logical parameter of the attribute type. Step 205d is the same as the specific implementation method of step 205a, and will not be described again.

206. The estimation result of the evaluation score corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute is obtained according to a preset interval weight vector. In order to improve the evaluation effect again, a interval full-time is configured for each type of logical parameter, and the preset interval weight vector is a vector, for example, a=[a1, a2, a3, a4], and a1 is a fee type. The weight corresponding to the interval number, a2 is the weight corresponding to the number of interval types, a3 is the weight corresponding to the number of interval types, and a4 is the weight corresponding to the interval number of the attribute type, wherein the underwriting can be based on the claim case The personnel determine the accuracy of the evaluation results of different interval numbers in the evaluation. A1 in the weight vector is determined as the column vector, that is, a a1 can be a column vector, including the weights corresponding to the five interval numbers. Preferably, the specific value of the weight is the same as the size of the interval number, that is, the evaluation score of each logical parameter needs to be multiplied by the same weight as the interval corresponding to each logical parameter to obtain an evaluation result. No specific restrictions. The general preset interval weight vector may be determined by the underwriting personnel of the insurance company according to the historical claim risk data, which is not specifically limited in the embodiment of the present application. In addition, the statistical method is to multiply the evaluation score corresponding to each logical parameter and the interval weight vector to obtain an evaluation result for comparison.

Further, before step 206, the embodiment of the present application further includes: generating an interval weight vector corresponding to the claim case according to the different claim product information, wherein the weight value corresponding to the fee type in the interval weight vector is sequentially greater than the number of times, The weight corresponding to the type and attribute type. Among them, because the insurance company's risk assessment for claims cases is still based on fees, the order of weights is a1>a2>a3>a4. In addition, because different insurance products have different claims effects in claims cases, such as the large claims insurance claims risk is much larger than the small insurance corresponding claims risk. Generally, when the interval number matches, but does not meet the situation of a1>a2>a3>a4, the other information may be determined according to the information corresponding to the claim product in the claim case or the historical policy information to determine the interval in the risk-free claim case. The weight vector is used as a reference to directly generate the corresponding interval weight vector. The embodiment of the present application does not specifically limit, and no manual matching is required, thereby reducing manual operations and saving costs.

207. Compare the evaluation result with a preset claim amount. It should be noted that, by using the preset evaluation logic formula, the data of each logical parameter can be directly converted into an amount of money, that is, the preset evaluation logic formula is used as a form data for converting all types of data into a certain range, so as to facilitate The insurance company compares the amount of claims most concerned in the claims case to determine whether it is a risk claim case. The preset claim amount is the maximum amount that should be paid in different claims products, which is not specifically limited in the embodiment of the present application.

208. If the comparison result is that the evaluation result is greater than two-thirds of the preset claim amount, the claim case is determined as a risk claim case, and the warning information is sent. In order to make the calculated evaluation result accurately determine whether it is a risk claim case, if it is greater than two-thirds of the setting, it can be accurately determined as a risk claim case, and an early warning is issued to the underwriting personnel, so that the underwriter can proceed to the next step. If the audit is not more than two-thirds of the preset claim amount, the current claim case is a normal claim case and will not be reviewed, so as to reduce the steps of human handling, thereby improving the efficiency of risk claim case evaluation.

The present application provides another method for evaluating risk claims. The embodiment of the present application analyzes the logical parameters related to the claim case according to the claim information and the historical policy information, and sets the number of intervals of the logical parameters as parameters of the preset evaluation logic formula. Perform calculations to obtain the evaluation scores of each logical parameter, calculate the evaluation results by weight calculation, and compare with the preset claims amount to determine whether it is a risk claim case, and realize the computer automatically calculate the evaluation result without human intervention, ensuring each The claim cases are evaluated according to a standard, and the data of all the logical parameters are converted into the amount by the preset evaluation logic formula, thereby realizing the purpose of comparing the different values in the claim case into the form of the amount, thereby improving The efficiency of claims assessment.

Further, as an implementation of the method shown in FIG. 1 , the embodiment of the present application provides an apparatus for evaluating risk claims. As shown in FIG. 3 , the apparatus includes: an obtaining unit 31, an analyzing unit 32, and a statistics unit 33.

The obtaining unit 31 is configured to obtain the claim information and the historical policy information of the insured in the claim case; the obtaining unit 31 is configured to perform the function module for obtaining the claim information and the historical policy information of the insured in the claim case for the risk claim evaluation device. . The parsing unit 32 is configured to parse the claim information and the logical parameter to be evaluated in the historical policy information, where the logic parameter is used to reflect the situation in which the insured participates in the medical item in the claim case; the parsing unit 32 is The risk claim evaluation device performs a function module that parses the claim information and the logical parameter to be evaluated in the history policy information. The statistic unit 33 is configured to perform matching on the logical parameter according to the preset evaluation logic, and collect the evaluation result of the claim case corresponding to the logical parameter, where the preset evaluation logic is used to reflect different logical parameters and different evaluation scores. Relationship between. The statistic unit 33 performs, for the risk claim evaluation device, a function module that matches the preset parameter according to the logic parameter, and counts the evaluation result of the claim case corresponding to the logic parameter.

The application provides a risk claim evaluation device, and the existing nuclear damage personnel in the review of the claims case are manually audited, and it is easy to miss some high-risk cases. The information and historical policy information analyzes the logical parameters related to the claim case, matches the logical parameters with the preset evaluation logic, obtains the evaluation result, and realizes the computer automatically calculates the evaluation result without manual operation, ensuring that each claim case is in accordance with a standard. Conduct an assessment to improve the efficiency of claims assessments.

Further, as an implementation of the method shown in FIG. 2, the embodiment of the present application provides another apparatus for evaluating risk claims. As shown in FIG. 4, the apparatus includes: an obtaining unit 41, an analyzing unit 42, and a statistics unit 43. The generating unit 44, the comparing unit 45, and the determining unit 46.

The obtaining unit 41 is configured to obtain claim information and historical policy information of the insured in the claim case; the parsing unit 42 is configured to parse the claim information and the logical parameter to be evaluated in the historical policy information, where the logical parameter is used In response to the situation in which the insured participates in the medical item in the claim case; the statistical unit 43 is configured to match the preset parameter according to the logical parameter, and collect the evaluation result of the claim case corresponding to the logical parameter, Pre-set evaluation logic is used to reflect the relationship between different logic parameters and different evaluation scores.

Specifically, the parsing unit 42 includes: an extracting module 4201, configured to extract logical parameters corresponding to the order type, the number type, the fee type, and the attribute type in the claim information and the historical policy information; the determining module 4202 And determining whether the value of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively greater than a preset upper limit value, and/or less than a preset lower limit. a value; a configuration module 4203, configured to determine, by the determining module 4202, that the value of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively less than a preset upper limit value, and And if the value is greater than the preset lower limit value, the number of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively configured, and the number of the interval is used to distinguish the replacement Set the parameters corresponding to the evaluation logic formula.

Specifically, the statistic unit 43 includes: a calculation module 4301, configured to calculate, according to the preset evaluation logic formula, an evaluation score corresponding to the logical parameter of the number of times in different interval numbers, where the preset evaluation logic formula is

Where i is the number of intervals, x is the value of the logical parameter of the number of times; and the calculating module 4301 is further configured to calculate the evaluation score corresponding to the logical parameter of the number type according to the preset evaluation logic formula by using different number of intervals, The preset evaluation logic formula is

Where i is the number of intervals, y is the value of the logical parameter of the number type; and the calculating module 4301 is further configured to calculate the evaluation score corresponding to the logical parameter of the fee type by using different preset numbers according to the preset evaluation logic formula. The preset evaluation logic formula is

Where i is the number of intervals, z is the value of the logical parameter of the cost type; and the calculation module 4301 is further configured to calculate the evaluation score corresponding to the logical parameter of the attribute type by using the preset evaluation logic formula in different interval numbers, The preset evaluation logic formula is

Where i is the number of intervals, l is the value of the logical parameter of the attribute type, and the statistic module 4302 is configured to statistically obtain the type of the number, the type of the number, the type of the fee, and the location according to a preset interval weight vector. The evaluation result of the evaluation score corresponding to the attribute type.

Further, the device further includes: a generating unit 44, configured to generate an interval weight vector corresponding to the claim case according to different claims product information, where the weight corresponding to the fee type in the interval weight vector is sequentially greater than the number of times, The weight of the number type and attribute type.

Further, the device further includes: a comparing unit 45, configured to compare the evaluation result with a preset claim amount; and a determining unit 46, configured to: if the comparison result is that the evaluation result is greater than the preset claim amount Two-thirds of the cases are identified as risk claims cases and sent early warning information.

The present application provides another risk claim evaluation device. The embodiment of the present application analyzes the logical parameters related to the claim case according to the claim information and the historical policy information, and sets the logical parameter configuration interval number as the parameter of the preset evaluation logic formula. Perform calculations to obtain the evaluation scores of each logical parameter, calculate the evaluation results by weight calculation, and compare with the preset claims amount to determine whether it is a risk claim case, and realize the computer automatically calculate the evaluation result without human intervention, ensuring each The claim cases are evaluated according to a standard, and the data of all the logical parameters are converted into the amount by the preset evaluation logic formula, thereby realizing the purpose of comparing the different values in the claim case into the form of the amount, thereby improving The efficiency of claims assessment.

Based on the method shown in FIG. 1 , correspondingly, the embodiment of the present application further provides a computer readable storage medium, where the computer program is stored, and when the program is executed by the processor, the following steps are implemented: obtaining a claim case Claim information and historical policy information of the insurer; parsing the logic information to be evaluated in the claim information and the historical policy information, wherein the logic parameter is used to reflect the situation in which the insured participates in the medical item in the claim case; The logical parameters are matched with the preset evaluation logic, and the evaluation result of the claim case corresponding to the logical parameter is used, and the preset evaluation logic is used to reflect the relationship between different logical parameters and different evaluation scores.

As shown in FIG. 5, the server may include a processor 51, a communications interface 52, a memory 53, and a communication bus 54. Wherein: the processor 51, the communication interface 52, and the memory 53 complete communication with each other via the communication bus 54. The communication interface 54 is configured to communicate with network elements of other devices such as clients or other servers. The processor 51 is configured to execute a program, and specifically may perform related steps in the testing method embodiment of the application. In particular, the program can include program code, the program code including computer operating instructions. The processor 51 may be a central processing unit CPU, or an Application Specific Integrated Circuit (ASIC), or one or more integrated circuits configured to implement the embodiments of the present application.

The one or more processors included in the terminal may be the same type of processor, such as one or more CPUs; or may be different types of processors, such as one or more CPUs and one or more ASICs. The memory 53 is configured to store a program. The memory 53 may include a high speed RAM memory and may also include a non-volatile memory such as at least one disk memory. The program may be specifically configured to enable the processor 51 to: obtain the claim information and the history policy information of the insured in the claim case; and parse the claim information and the logical parameter to be evaluated in the historical policy information, the logic parameter The method for responding to the insured person participating in the medical item in the claim case; matching the preset parameter according to the logic parameter, and counting the evaluation result of the claim case corresponding to the logic parameter, where the preset evaluation logic is used The relationship between different logical parameters and different evaluation scores.

The algorithms and displays provided herein are not inherently related to any particular computer, virtual system, or other device. Various general purpose systems can also be used with the teaching based on the teachings herein. The structure required to construct such a system is apparent from the above description. Moreover, this application is not directed to any particular programming language. It should be understood that the content of the present application described herein may be implemented in a variety of programming languages, and the description of the specific language above is for the purpose of illustrating the preferred embodiments. In the description provided herein, numerous specific details are set forth. However, it is understood that the embodiments of the present application may be practiced without these specific details. In some instances, well-known methods, structures, and techniques are not shown in detail so as not to obscure the understanding of the description.

Similarly, the various features of the present application are sometimes grouped together into a single embodiment, in the above description of the exemplary embodiments of the present application, in order to simplify the disclosure and to facilitate understanding of one or more of the various inventive aspects. Figure, or a description of it. However, the method disclosed is not to be interpreted as reflecting the intention that the claimed invention requires more features than those recited in the claims. Rather, as the following claims reflect, inventive aspects reside in less than all features of the single embodiments disclosed herein. Therefore, the claims following the specific embodiments are hereby explicitly incorporated into the specific embodiments, each of which

Those skilled in the art will appreciate that the modules in the devices of the embodiments can be adaptively changed and placed in one or more devices different from the embodiment. The modules or units or components of the embodiments may be combined into one module or unit or component, and further they may be divided into a plurality of sub-modules or sub-units or sub-components. In addition to such features and/or at least some of the processes or units being mutually exclusive, any combination of the features disclosed in the specification, including the accompanying claims, the abstract and the drawings, and any methods so disclosed, or All processes or units of the device are combined. Each feature disclosed in this specification (including the accompanying claims, the abstract and the drawings) may be replaced by alternative features that provide the same, equivalent or similar purpose. In addition, those skilled in the art will appreciate that, although some embodiments described herein include certain features that are included in other embodiments and not in other features, combinations of features of different embodiments are intended to be within the scope of the present application. Different embodiments are formed and formed. For example, in the following claims, any one of the claimed embodiments can be used in any combination.

The various component embodiments of the present application can be implemented in hardware, or in a software module running on one or more processors, or in a combination thereof. Those skilled in the art will appreciate that a microprocessor or digital signal processor (DSP) may be used in practice to implement some or all of the functionality of some or all of the components of the risk claim evaluation method and apparatus in accordance with embodiments of the present application. . The application can also be implemented as a device or device program (e.g., a computer program and a computer program product) for performing some or all of the methods described herein. Such a program implementing the present application may be stored on a computer readable medium or may be in the form of one or more signals. Such signals may be downloaded from an Internet website, provided on a carrier signal, or provided in any other form.

It should be noted that the above-described embodiments are illustrative of the present application and are not intended to limit the scope of the application, and those skilled in the art can devise alternative embodiments without departing from the scope of the appended claims. In the claims, any reference signs placed between parentheses shall not be construed as a limitation. The word "comprising" does not exclude the presence of the elements or steps that are not recited in the claims. The word "a" or "an" preceding the <RTIgt; </ RTI> does not exclude the presence of a plurality of such elements. The application can be implemented by means of hardware comprising several distinct elements and by means of a suitably programmed computer. In the unit claims enumerating several means, several of these means can be embodied by the same hardware item. The use of the words first, second, and third does not indicate any order. These words can be interpreted as names.

Claims

A method for evaluating risk claims, characterized by comprising:

Obtaining the claim information and historical policy information of the insured in the claim case;

Parsing the claim information and the logical parameter to be evaluated in the historical policy information, where the logic parameter is used to reflect the situation in which the insured participates in the medical item in the claim case;

Matching the logical parameter with the preset evaluation logic, and counting the evaluation result of the claim case corresponding to the logical parameter, the preset evaluation logic is used to reflect the relationship between different logical parameters and different evaluation scores.
The method according to claim 1, wherein the parsing the logic information to be evaluated in the claim information and the historical policy information comprises:

Determining, in the claim information and the historical policy information, a logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute; determining the type of the number of times, the type of the number, the type of the fee, and the Whether the values of the logical parameters corresponding to the attribute types are respectively greater than a preset upper limit value, and/or less than a preset lower limit value; if less than a preset upper limit value, and/or greater than a preset lower limit value, Then, the number of intervals is configured for the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute, and the number of the intervals is used to distinguish parameters corresponding to the preset preset evaluation logic formula.
The method according to claim 2, wherein the matching according to the logic parameter and the preset evaluation logic, and the evaluation result of the claim case corresponding to the logic parameter comprises:

Calculating an evaluation score corresponding to the logical parameter of the number of times according to a preset evaluation logic formula by using a different interval number, wherein the preset evaluation logic formula is
Where i is the number of intervals, x is the value of the logical parameter of the order type; and the evaluation score corresponding to the logical parameter of the number type is calculated according to the preset evaluation logic formula by different interval numbers, and the preset evaluation logic formula is
Where i is the interval number, y is the value of the logical parameter of the number type; and the evaluation score corresponding to the logical parameter of the fee type is calculated according to the preset evaluation logic formula with different interval numbers, and the preset evaluation logic formula is
Where i is the interval number, z is the value of the logical parameter of the expense type; and the evaluation score corresponding to the logical parameter of the attribute type is calculated according to the preset evaluation logic formula by different interval numbers, and the preset evaluation logic formula is
Where i is the number of intervals, and l is the value of the logical parameter of the attribute type; according to the preset interval weight vector, the evaluation of the number of times, the type of the number, the type of the fee, and the corresponding type of the attribute are obtained by statistics. The result of the evaluation of the score.
The method of claim 3, wherein the method further comprises:

The interval weight vector corresponding to the claim case is generated according to different claims product information, and the weight corresponding to the fee type in the interval weight vector is respectively greater than the weight corresponding to the number type, the number type, and the attribute type.
The method according to claim 1, wherein after the matching of the logical parameter with the preset evaluation logic and the evaluation result of the claim case corresponding to the logical parameter, the method further comprises:

Comparing the evaluation result with the preset claim amount; if the comparison result is that the evaluation result is greater than two-thirds of the preset claim amount, determining the claim case as a risk claim case and transmitting the warning information .
An apparatus for evaluating risk claims, comprising: an obtaining unit, configured to obtain claim information and historical policy information of an insured in a claim case; and an analyzing unit, configured to parse the claim information and the historical policy information a logical parameter to be evaluated, wherein the logical parameter is used to reflect a situation in which the insured participates in the medical item in the claim case; a statistical unit is configured to match the preset parameter according to the logical parameter, and count the logic The evaluation result of the claim case corresponding to the parameter, the preset evaluation logic is used to reflect the relationship between different logic parameters and different evaluation scores.
The apparatus according to claim 6, wherein the parsing unit comprises: an extracting module, configured to extract, in the claim information and the historical policy information, a number of times, a number type, a fee type, and an attribute type respectively Corresponding logic parameter; a determining module, configured to determine whether the value of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively greater than a preset upper limit value, and/ Or a lower limit of the preset value; the configuration module is configured to: if the determining module determines that the value of the logical parameter corresponding to the type of the number of times, the type of the number, the type of the fee, and the type of the attribute are respectively smaller than a preset And an upper limit value, and/or a value that is greater than a preset lower limit value, where the number of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively configured, the number of the intervals It is used to distinguish the parameters corresponding to the replacement preset evaluation logic formula.
The apparatus according to claim 7, wherein the statistical unit comprises: a calculating module, configured to calculate, according to a preset evaluation logic formula, an evaluation score corresponding to the logical parameter of the number of times in different interval numbers, the pre- Set the evaluation logic formula to
Where i is the number of intervals, x is the value of the logical parameter of the number of times; and the calculation module is further configured to calculate the evaluation score corresponding to the logical parameter of the number type according to the preset evaluation logic formula by using different interval numbers, The preset evaluation logic formula is
Where i is the interval number, y is the value of the logical parameter of the number type; and the calculation module is further configured to calculate the evaluation score corresponding to the logical parameter of the fee type by using different preset numbers according to the preset evaluation logic formula, The preset evaluation logic formula is
Where i is the number of intervals, z is the value of the logical parameter of the cost type; and the calculation module is further configured to calculate an evaluation score corresponding to the logical parameter of the attribute type by using different preset numbers according to the preset evaluation logic formula, The preset evaluation logic formula is
Where i is the number of intervals, l is the value of the logical parameter of the attribute type, and the statistic module is configured to statistically obtain the type of the number of times, the type of the number, the type of the fee, and the number according to a preset interval weight vector The evaluation result of the evaluation score corresponding to the attribute type.
The device according to claim 8, wherein the device further comprises: a generating unit, configured to generate an interval weight vector corresponding to the claim case according to the different claim product information, where the fee type corresponds to the interval weight vector The weights are respectively greater than the weights corresponding to the number of times, the number type, and the attribute type.
The apparatus according to claim 6, wherein the apparatus further comprises: a comparing unit, configured to compare the evaluation result with a preset claim amount; and a determining unit, configured to: if the comparison result is the evaluation result If it is greater than two-thirds of the preset claim amount, the claim case is determined as a risk claim case, and the warning information is sent.
A storage medium having a computer program stored thereon, wherein the method for evaluating a risk claim when the program is executed by the processor includes: obtaining claim information and historical policy information of the insured in the claim case; Determining, in the claim information, the logical parameter to be evaluated in the historical policy information, the logic parameter is used to reflect the situation in which the insured participates in the medical item in the claim case; and the logical parameter is matched with the preset evaluation logic, and The evaluation result of the claim case corresponding to the logical parameter is counted, and the preset evaluation logic is used to reflect the relationship between different logical parameters and different evaluation scores.
The storage medium according to claim 11, wherein the parsing the logic information to be evaluated in the claim information and the history policy information comprises: extracting the claim information and the history policy information and the number of times a logical parameter corresponding to each of the number type, the fee type, and the attribute type; determining whether the value of the logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute are respectively greater than a preset The upper limit value, and/or less than the preset lower limit value; if less than the preset upper limit value, and/or greater than the preset lower limit value, the number of times, the number type, the The cost type and the attribute type respectively correspond to the logical parameter configuration interval number, and the interval number is used to distinguish the parameter corresponding to the preset preset evaluation logic formula.
The storage medium according to claim 12, wherein the matching according to the logic parameter and the preset evaluation logic, and counting the evaluation result of the claim case corresponding to the logic parameter comprises: evaluating the logic formula according to the preset Calculating an evaluation score corresponding to the logical parameter of the number of times with different interval numbers, and the preset evaluation logic formula is
Where i is the number of intervals, x is the value of the logical parameter of the order type; and the evaluation score corresponding to the logical parameter of the number type is calculated according to the preset evaluation logic formula by different interval numbers, and the preset evaluation logic formula is
Where i is the interval number, y is the value of the logical parameter of the number type; and the evaluation score corresponding to the logical parameter of the fee type is calculated according to the preset evaluation logic formula with different interval numbers, and the preset evaluation logic formula is
Where i is the interval number, z is the value of the logical parameter of the expense type; and the evaluation score corresponding to the logical parameter of the attribute type is calculated according to the preset evaluation logic formula by different interval numbers, and the preset evaluation logic formula is
Where i is the number of intervals, and l is the value of the logical parameter of the attribute type; according to the preset interval weight vector, the evaluation of the number of times, the type of the number, the type of the fee, and the corresponding type of the attribute are obtained by statistics. The result of the evaluation of the score.
The storage medium according to claim 13, wherein the method further comprises: generating an interval weight vector corresponding to the claim case according to the different claim product information, wherein the weight value corresponding to the fee type in the interval weight vector is in turn The weights corresponding to the number of times, the number type, and the attribute type are respectively greater.
The storage medium according to claim 11, wherein after the matching of the logical parameter with the preset evaluation logic and the evaluation result of the claim case corresponding to the logical parameter, the method further comprises: Comparing the evaluation result with the preset claim amount; if the comparison result is that the evaluation result is greater than two-thirds of the preset claim amount, determining the claim case as a risk claim case and transmitting the warning information .
A server, characterized in that the apparatus comprises a storage medium and a processor, the storage medium is for storing a computer program; the processor is configured to execute the computer program to implement a risk claim evaluation method, including Obtaining claim information and historical policy information of the insured in the claim case; parsing the claim information and the logical parameter to be evaluated in the historical policy information, wherein the logic parameter is used to reflect the insured participates in the claim in the claim case The situation of the item; matching the logical parameter with the preset evaluation logic, and counting the evaluation result of the claim case corresponding to the logical parameter, wherein the preset evaluation logic is used to reflect between different logical parameters and different evaluation scores relationship.
The server according to claim 16, wherein the parsing the logic information to be evaluated in the claim information and the history policy information when the program is executed by the processor comprises: extracting the claim information and the a logical parameter corresponding to the number of times, the number of types, the type of the fee, and the type of the attribute in the historical policy information; determining the logical parameter corresponding to the number of times, the type of the number, the type of the fee, and the type of the attribute Whether the value is greater than a preset upper limit value, and/or less than a preset lower limit value; if it is less than a preset upper limit value, and/or greater than a preset lower limit value, The number of logical parameter configuration intervals corresponding to the number type, the fee type, and the attribute type respectively, and the interval number is used to distinguish parameters corresponding to the preset preset evaluation logic formula.
The server according to claim 17, wherein when the program is executed by the processor, the matching is performed according to the logic parameter and the preset evaluation logic, and the evaluation result of the claim case corresponding to the logical parameter is counted. The method includes: calculating, according to a preset evaluation logic formula, an evaluation score corresponding to the logical parameter of the number of times in different interval numbers, where the preset evaluation logic formula is
Where i is the number of intervals, x is the value of the logical parameter of the order type; and the evaluation score corresponding to the logical parameter of the number type is calculated according to the preset evaluation logic formula by different interval numbers, and the preset evaluation logic formula is
Where i is the interval number, y is the value of the logical parameter of the number type; and the evaluation score corresponding to the logical parameter of the fee type is calculated according to the preset evaluation logic formula with different interval numbers, and the preset evaluation logic formula is
Where i is the interval number, z is the value of the logical parameter of the expense type; and the evaluation score corresponding to the logical parameter of the attribute type is calculated according to the preset evaluation logic formula by different interval numbers, and the preset evaluation logic formula is
Where i is the number of intervals, and l is the value of the logical parameter of the attribute type; according to the preset interval weight vector, the evaluation of the number of times, the type of the number, the type of the fee, and the corresponding type of the attribute are obtained by statistics. The result of the evaluation of the score.
The server according to claim 18, wherein the implementing the method when the program is executed by the processor further comprises: generating an interval weight vector corresponding to the claim case according to the different claim product information, the interval weight vector The weights corresponding to the intermediate fee types are respectively greater than the weights corresponding to the number of times, the number of types, and the type of the attribute.
The server according to claim 16, wherein when the program is executed by the processor, the matching is performed according to the logic parameter and the preset evaluation logic, and the evaluation result of the claim case corresponding to the logic parameter is counted. Thereafter, the method further includes: comparing the evaluation result with a preset claim amount; if the comparison result is that the evaluation result is greater than two-thirds of the preset claim amount, determining the claim case as Risk claims cases and send warning messages.