WO2019100854A1 - 基于信用实现理赔的方法和装置 - Google Patents

基于信用实现理赔的方法和装置 Download PDF

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Publication number
WO2019100854A1
WO2019100854A1 PCT/CN2018/108926 CN2018108926W WO2019100854A1 WO 2019100854 A1 WO2019100854 A1 WO 2019100854A1 CN 2018108926 W CN2018108926 W CN 2018108926W WO 2019100854 A1 WO2019100854 A1 WO 2019100854A1
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WIPO (PCT)
Prior art keywords
user
credit
information
review
amount
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PCT/CN2018/108926
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English (en)
French (fr)
Inventor
郭玉锋
王彬
刘亚辉
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阿里巴巴集团控股有限公司
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Application filed by 阿里巴巴集团控股有限公司 filed Critical 阿里巴巴集团控股有限公司
Priority to EP18881090.7A priority Critical patent/EP3680840A4/en
Priority to SG11202004723TA priority patent/SG11202004723TA/en
Publication of WO2019100854A1 publication Critical patent/WO2019100854A1/zh
Priority to US16/806,781 priority patent/US20200211121A1/en
Priority to PH12020550458A priority patent/PH12020550458A1/en

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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
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management
    • 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
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management
    • G06Q10/103—Workflow collaboration or project management
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06N—COMPUTING ARRANGEMENTS BASED ON SPECIFIC COMPUTATIONAL MODELS
    • G06N20/00—Machine learning
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06N—COMPUTING ARRANGEMENTS BASED ON SPECIFIC COMPUTATIONAL MODELS
    • G06N5/00—Computing arrangements using knowledge-based models
    • G06N5/04—Inference or reasoning models
    • 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
    • G06Q30/00—Commerce
    • G06Q30/018—Certifying business or products
    • 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
    • G06Q40/03—Credit; Loans; Processing thereof
    • 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 specification relates to the field of Internet technologies, and in particular, to a method and apparatus for implementing claims based on credit.
  • the present specification provides a method and apparatus for implementing claims based on credit.
  • a method for claim settlement based on credit comprising:
  • a device for claim settlement based on credit comprising:
  • the credit determining unit determines the credit information of the user after receiving the claim request sent by the user;
  • a material uploading unit when the credit information satisfies a credit constraint condition, prompting the user to upload the claim material
  • a material review unit that reviews the claim materials uploaded by the user
  • a claim execution unit if the claim material passes the review, performing a claim operation for the user based on the claim material.
  • a device for claim settlement based on credit comprising:
  • a memory for storing machine executable instructions
  • the processor is caused to:
  • the present specification allows the user to claim and upload the claim material online when the credit information of the user satisfies the credit constraint condition, and can claim the user when the claim material uploaded by the user passes the audit.
  • the whole process does not require manual intervention, which can greatly improve the efficiency of claims and enhance the user's claim experience.
  • credit-based claims and intelligent online auditing of claims materials can effectively protect the interests of insurance companies and effectively avoid the economic losses caused by fraudulent insurance and other behaviors.
  • FIG. 1 is a schematic flow chart of a method for implementing claims based on credits according to an exemplary embodiment of the present specification.
  • FIG. 2 is a flow chart showing a method for realizing medical insurance claims based on credits according to an exemplary embodiment of the present specification.
  • FIG. 3 is a schematic structural diagram of an apparatus for implementing claims based on credit according to an exemplary embodiment of the present specification.
  • FIG. 4 is a block diagram of an apparatus for implementing claims based on credits, shown in an exemplary embodiment of the present specification.
  • first, second, third, etc. may be used in this specification to describe various information, such information should not be limited to these terms. These terms are only used to distinguish the same type of information from each other.
  • first information may also be referred to as the second information without departing from the scope of the present description.
  • second information may also be referred to as the first information.
  • word "if” as used herein may be interpreted as "when” or “when” or “in response to a determination.”
  • FIG. 1 is a schematic flow chart of a method for implementing claims based on credits according to an exemplary embodiment of the present specification.
  • the method for implementing claims based on credit may include the following steps:
  • Step 102 After receiving the claim request sent by the user, determine the credit information of the user.
  • the claim request may include: a medical insurance claim, a mobile phone shattering claim, a car insurance claim, etc., and the specification does not specifically limit this.
  • Step 104 When the credit information satisfies the credit constraint condition, prompting the user to upload the claim material.
  • the claim material is uploaded by a user who initiates the claim, and may include a payment invoice photo, an accident image photo, and the like.
  • Step 106 Review the claim material uploaded by the user.
  • Step 108 If the claim material passes the review, perform a claim operation for the user based on the claim material.
  • the corresponding claim amount may be calculated according to the claim material, and then the claim is made.
  • the embodiment can allow the user to claim and upload the claim material online when the credit information of the user satisfies the credit constraint condition, and can claim the user when the claim material uploaded by the user passes the audit.
  • the whole process does not require manual intervention, which can greatly improve the efficiency of claims and enhance the user's claim experience.
  • credit-based claims and intelligent online auditing of claims materials can effectively protect the interests of insurance companies and effectively avoid the economic losses caused by fraudulent insurance and other behaviors.
  • the credit-based claim-making method may be applied to a credit platform deployed by a credit service provider, the credit platform having a payment function, or the credit platform may invoke other platforms having a payment function to implement a payment operation.
  • the credit-based claim-based method can also be applied to an insurance platform deployed by an insurance company, the insurance platform having a user credit evaluation function, or the insurance platform can invoke other third-party credit evaluation functions to obtain credit information of the user.
  • the method for realizing claims based on credit can also be implemented by a credit platform and an insurance platform.
  • the credit platform provides a credit evaluation function
  • the insurance platform provides the review and claim operation function of the claim materials, and the specification does not specifically limit this. .
  • the physical carrier of the credit platform and the insurance platform are usually servers or server clusters deployed by related service providers.
  • the method for implementing medical insurance claims based on credit may include the following steps:
  • Step 202 After receiving the claim sent by the user, the insurance platform acquires the credit information of the user from the credit platform.
  • the user initiates a claim request through the insurance platform as an example for description.
  • a claim type for example, a medical insurance claim.
  • the insurance platform may determine the identity of the user based on the login information of the user, for example, an ID number, a name, etc., without the user re-entering the identity information.
  • the user may be authenticated first, for example, the user may take a photo of the face to determine whether it is a user operation.
  • the user may be authenticated in other manners, for example, the mobile phone number verification, the address verification, and the like.
  • the verification scheme provided in the related art may be referred to.
  • the types of claims that need to be authenticated can be preset.
  • the authentication type can be set for the types of claims with relatively high amount of medical insurance claims, auto insurance claims, etc.
  • no authentication can be set.
  • the link after receiving the claim, the user's credit information can be directly obtained, and this description does not impose any special restrictions.
  • the insurance platform may obtain the credit information of the user from the credit platform through a calling interface provided by the credit platform.
  • the presentation form of the credit information may be a credit score, and the credit rating of the user may be visually determined based on the credit score, for example, credit or credit failure.
  • the credit qualification usually indicates that the user's credit is higher, and the fraud insurance probability is low; and the credit failure can generally indicate that the user's credit is poor and the fraud insurance probability is high.
  • the presentation form of the credit information may be a credit score and a credit rating, wherein the credit rating may include: credit pass, credit failure.
  • the credit rating of the user can be determined intuitively; based on the credit score, users with the same credit rating can be further distinguished.
  • the credit information may be determined by the credit platform after receiving the call of the insurance platform; the credit information may also be saved by the credit platform in advance, and the credit information to be saved when the insurance platform invokes Return to the insurance platform.
  • the credit platform may determine the credit information of the user according to information such as the user's asset information, the claim frequency, and the credit record. For example, information such as user resource information, claim frequency, and credit history may be numerically converted, and then the user's credit score may be determined by weighted averaging or the like.
  • the user's credit score may also be determined in other manners, which is not specifically limited in this embodiment.
  • Step 204 The insurance platform prompts the user to upload the claim material when the credit information satisfies the credit constraint condition.
  • the insurance platform may determine whether the credit information satisfies the credit constraint condition, for example, whether the credit score of the user is greater than a scoring threshold or the like.
  • the credit constraint condition may be preset by a staff member of the insurance platform, and the corresponding credit constraint conditions may be the same or different for different claim types.
  • the determination process of whether the credit information satisfies the credit constraint condition may also be implemented by the credit system.
  • the credit constraint condition may be configured in the credit system in advance, and the credit system determines the credit information after obtaining the user. The judgment result is returned to the insurance platform, and this embodiment does not particularly limit this.
  • the insurance platform may prompt the user to upload the claim material.
  • the insurance platform may send a message for uploading the claim material to the client software used by the user, when the user confirms the message.
  • the client software can call the camera for image acquisition.
  • the claim materials corresponding to different claim categories are generally different.
  • the claim materials corresponding to the medical insurance claims may include: payment invoices, case certificates, and the like.
  • Claim materials for auto insurance claims may include: insurance photos, maintenance invoices, etc.
  • Claims for mobile phone screens can include: photos of broken screen phones.
  • the claim material may be specified by the insurance platform, and the user may upload according to the regulations.
  • Step 206 The insurance platform uses the living body detection technology to detect whether the uploading path of the claim material is a real shooting.
  • the insurance platform can use the living body detection technology to detect whether the uploading path of the claim material is a real shooting.
  • the user is prompted to shake the claim material, etc., to prove that the claim material is really in the user's hands.
  • the above-mentioned living body detection process may be implemented by an insurance platform, or may be implemented by a client that interfaces with the insurance platform, and the embodiment does not particularly limit this.
  • step 206 may be continued.
  • the prompt information may be output to the user to prompt the user to re-upload.
  • Step 208 The insurance platform identifies the authenticity of the claim material when the uploading path of the claim material is real shooting.
  • the authenticity of the claim material can be further identified.
  • the invoice information of the payment invoice can be identified by AI (Artificial Intelligence) technology, for example, the invoice number, the invoice header, the payer name, and the like.
  • AI Artificial Intelligence
  • the insurance platform can invoke the interface provided by the tax system to identify the authenticity of the payment invoice.
  • step 210 may be performed.
  • the credit platform may be notified to negatively update the credit information of the user.
  • the AI technique can be used to identify whether the case certificate has a corresponding doctor signature, a hospital official seal, etc., and can be identified according to the requirements of the real case certificate.
  • Step 210 If the claim material passes the review, the insurance platform calculates the claim amount corresponding to the claim material.
  • the claim amount corresponding to the claim material may be calculated.
  • OCR Optical Character Recognition
  • OCR Optical Character Recognition
  • the fee category (Class A, Class B or Class C) and the corresponding amount of each fee in the payment invoice can be identified, and then the corresponding claim amount is calculated based on the medical insurance type insured by the user.
  • the degree of the broken screen may also be identified based on the image processing technology, and then the corresponding claim amount is calculated. This embodiment will not be repeated here.
  • Step 212 When the claim amount does not exceed the self-service claim limit amount, the insurance platform claims the user based on the claim amount.
  • the insurance platform can determine whether the claim amount exceeds the self-service claim limit amount.
  • the self-service claim limit amount is usually set by the insurance company according to the claim type.
  • the user can be directly paid, for example, the claim amount is transferred to the account bound by the user.
  • the claim can be transferred to manual processing for the staff to further check.
  • the insurance platform may further return the claim result to the credit platform after processing the user's claim for claim, and the credit platform may update the user's credit information.
  • the credit platform can positively update the user's credit information.
  • the credit platform may negatively update the user's credit information, and subsequently prohibit the user from making online claims.
  • the present embodiment can implement online claim settlement, which is convenient for the user and has high claim efficiency.
  • credit-based claims and intelligent online auditing of claims materials can effectively protect the interests of insurance companies, effectively avoid the economic losses caused by fraudulent insurance and other behaviors, and save a lot of labor costs.
  • the information interaction between the user and the insurance platform and the credit platform described in the present specification generally refers to the terminal device used by the user, or the client software loaded in the terminal device and the insurance platform and the credit platform. Information exchange.
  • the present specification also provides an embodiment of a device for implementing claims based on credit.
  • Embodiments of the apparatus based on credit implementation claims can be applied to a server.
  • the device embodiment may be implemented by software, or may be implemented by hardware or a combination of hardware and software.
  • the processor of the server in which it is located reads the corresponding computer program instructions in the non-volatile memory into the memory.
  • FIG. 3 a hardware structure diagram of a server in which the device for implementing claims based on credit is located, except for the processor, memory, network interface, and non-volatile memory shown in FIG.
  • the server where the device is located in the embodiment may also include other hardware according to the actual function of the server, and details are not described herein again.
  • FIG. 4 is a block diagram of an apparatus for implementing claims based on credits, shown in an exemplary embodiment of the present specification.
  • the credit-based claim-making apparatus 300 may be applied to the server shown in FIG. 3, including: a credit determining unit 301, a material uploading unit 302, a material review unit 303, a claims execution unit 304, and a credit.
  • the credit determining unit 301 determines the credit information of the user after receiving the claim request sent by the user;
  • the material uploading unit 302 prompts the user to upload the claim material when the credit information satisfies the credit constraint condition
  • the material review unit 303 reviews the claim materials uploaded by the user
  • the claim execution unit 304 if the claim material passes the review, performs a claim operation for the user based on the claim material.
  • the material review unit 303 :
  • the material review unit 303 when the claim material is a payment invoice, the material review unit 303:
  • the authenticity of the payment invoice is identified based on the invoice information.
  • the claim execution unit 304 :
  • the user is claimed based on the claim amount.
  • the credit update unit 305 updates the credit information of the user negatively if the claim material fails the review.
  • the identity verification unit 306 authenticates the user after receiving the claim request sent by the user; and when the user passes the identity verification, the notification credit determining unit performs the step of determining the credit information of the user.
  • the credit determining unit 301 determines the credit information of the user according to the asset information, the claim frequency, and the credit record of the user.
  • the device embodiment since it basically corresponds to the method embodiment, reference may be made to the partial description of the method embodiment.
  • the device embodiments described above are merely illustrative, wherein the units described as separate components may or may not be physically separate, and the components displayed as units may or may not be physical units, ie may be located A place, or it can be distributed to multiple network units. Some or all of the modules may be selected according to actual needs to achieve the objectives of the present specification. Those of ordinary skill in the art can understand and implement without any creative effort.
  • the system, device, module or unit illustrated in the above embodiments may be implemented by a computer chip or an entity, or by a product having a certain function.
  • a typical implementation device is a computer, and the specific form of the computer may be a personal computer, a laptop computer, a cellular phone, a camera phone, a smart phone, a personal digital assistant, a media player, a navigation device, an email transceiver, and a game control.
  • the present specification further provides a credit-based claim-making apparatus, the credit-based claim-making apparatus comprising: a processor and a memory for storing machine-executable instructions.
  • the processor and the memory are usually connected to each other by an internal bus.
  • the device may also include an external interface to enable communication with other devices or components.
  • the processor by reading and executing the machine-executable instructions stored in the memory corresponding to credit-based claims-based logic, the processor is caused to:
  • the reviewing the user-applied claim materials includes:
  • the authenticity of the claim material is determined, including:
  • the authenticity of the payment invoice is identified based on the invoice information.
  • the performing the claim operation for the user based on the claim material includes:
  • the user is claimed based on the claim amount.
  • it also includes:
  • the method further includes:
  • the step of determining the credit information of the user is performed when the user is authenticated.
  • the determining the user's credit information includes:
  • the credit information of the user is determined according to the user's asset information, the claim frequency, and the credit history.
  • the present specification further provides a computer-readable storage medium having stored thereon a computer program, the program being executed by the processor to implement the following steps:
  • a method for claim settlement based on credit comprising:
  • the reviewing the user-applied claim materials includes:
  • the authenticity of the claim material is determined, including:
  • the authenticity of the payment invoice is identified based on the invoice information.
  • the performing the claim operation for the user based on the claim material includes:
  • the user is claimed based on the claim amount.
  • it also includes:
  • the method further includes:
  • the step of determining the credit information of the user is performed when the user is authenticated.
  • the determining the user's credit information includes:
  • the credit information of the user is determined according to the user's asset information, the claim frequency, and the credit history.

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Abstract

一种基于信用实现理赔的方法和装置（300）。该方法包括：在接收到用户发送的理赔请求后，确定所述用户的信用信息（S102）；当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料（S104）；对所述用户上传的理赔材料进行审核（S106）；若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作（S108）。

Description

基于信用实现理赔的方法和装置 技术领域
本说明书涉及互联网技术领域，尤其涉及一种基于信用实现理赔的方法和装置。
背景技术
近年来，随着人们生活水平的提高，保险行业发展速度，然而随之也带来了理赔挑战。目前，各种理赔流程都十分繁琐，需要申请人提供大量的材料，然后由人工审核申请人提交的材料，例如，审核材料是否作假等，这就导致理赔效率低下、理赔体验差等问题。
发明内容
有鉴于此，本说明书提供一种基于信用实现理赔的方法和装置。
具体地，本说明书是通过如下技术方案实现的：
一种基于信用实现理赔的方法，包括：
在接收到用户发送的理赔请求后，确定所述用户的信用信息；
当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
对所述用户上传的理赔材料进行审核；
若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
一种基于信用实现理赔的装置，包括：
信用确定单元，在接收到用户发送的理赔请求后，确定所述用户的信用信息；
材料上传单元，当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
材料审核单元，对所述用户上传的理赔材料进行审核；
理赔执行单元，若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
一种基于信用实现理赔的装置，包括：
处理器；
用于存储机器可执行指令的存储器；
其中，通过读取并执行所述存储器存储的与基于信用实现理赔的逻辑对应的机器可执行指令，所述处理器被促使：
在接收到用户发送的理赔请求后，确定所述用户的信用信息；
当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
对所述用户上传的理赔材料进行审核；
若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
由以上描述可以看出，本说明书可在用户的信用信息满足信用约束条件时，允许用户在线理赔、上传理赔材料，并可在用户上传的理赔材料通过审核时，对用户进行理赔。整个过程无需人工介入，一方面可大大提高了理赔效率，提升用户的理赔体验。另一方面，基于信用的理赔以及理赔材料的智能在线审核还可有效保障保险公司的利益，有效避免骗保等行为给保险公司带来的经济损失。
附图说明
图1是本说明书一示例性实施例示出的一种基于信用实现理赔的方法的流程示意图。
图2是本说明书一示例性实施例示出的一种基于信用实现医保理赔的方法的流程示意图。
图3是本说明书一示例性实施例示出的一种用于基于信用实现理赔的装置的一结构示意图。
图4是本说明书一示例性实施例示出的一种基于信用实现理赔的装置的框图。
具体实施方式
这里将详细地对示例性实施例进行说明，其示例表示在附图中。下面的描述涉及附图时，除非另有表示，不同附图中的相同数字表示相同或相似的要素。以下示例性实施例中所描述的实施方式并不代表与本说明书相一致的所有实施方式。相反，它们仅是与如所附权利要求书中所详述的、本说明书的一些方面相一致的装置和方法的例子。
在本说明书使用的术语是仅仅出于描述特定实施例的目的，而非旨在限制本说明书。 在本说明书和所附权利要求书中所使用的单数形式的“一种”、“所述”和“该”也旨在包括多数形式，除非上下文清楚地表示其他含义。还应当理解，本文中使用的术语“和/或”是指并包含一个或多个相关联的列出项目的任何或所有可能组合。
应当理解，尽管在本说明书可能采用术语第一、第二、第三等来描述各种信息，但这些信息不应限于这些术语。这些术语仅用来将同一类型的信息彼此区分开。例如，在不脱离本说明书范围的情况下，第一信息也可以被称为第二信息，类似地，第二信息也可以被称为第一信息。取决于语境，如在此所使用的词语“如果”可以被解释成为“在……时”或“当……时”或“响应于确定”。
图1是本说明书一示例性实施例示出的一种基于信用实现理赔的方法的流程示意图。
请参考图1，所述基于信用实现理赔的方法可以包括以下步骤：
步骤102，在接收到用户发送的理赔请求后，确定所述用户的信用信息。
在本实施例中，所述理赔请求可以包括：医保理赔请求、手机碎屏险理赔请求、车险理赔请求等，本说明书对此不作特殊限制。
步骤104，当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料。
在本实施例中，所述理赔材料由发起理赔请求的用户上传，可包括付款发票照片、事故图像照片等。
步骤106，对所述用户上传的理赔材料进行审核。
在本实施例中，可检测理赔材料是否是通过真实拍摄上传，还可检测理赔材料的真伪，例如，付款发票的真伪等。
步骤108，若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
在本实施例中，若确定所述理赔材料通过审核，则可以根据所述理赔材料计算对应的理赔金额，然后进行理赔。
由以上描述可以看出，本实施例可在用户的信用信息满足信用约束条件时，允许用户在线理赔、上传理赔材料，并可在用户上传的理赔材料通过审核时，对用户进行理赔。整个过程无需人工介入，一方面可大大提高了理赔效率，提升用户的理赔体验。另一方面，基于信用的理赔以及理赔材料的智能在线审核还可有效保障保险公司的利益，有效 避免骗保等行为给保险公司带来的经济损失。
在本说明书中，所述基于信用实现理赔的方法可以应用在信用服务提供商部署的信用平台，所述信用平台具有支付功能，或者所述信用平台可以调用具有支付功能的其他平台实现支付操作。
所述基于信用实现理赔的方法也可以应用在保险公司部署的保险平台中，所述保险平台具有用户信用评估功能，或者所述保险平台可调用其他第三方信用评估功能获取用户的信用信息。
所述基于信用实现理赔的方法也可以由信用平台和保险平台配合实现，例如，由信用平台提供信用评估功能，由保险平台提供理赔材料的审核与理赔操作功能等，本说明书对此不作特殊限制。
其中，上述信用平台、保险平台的物理载体通常都是相关服务提供商部署的服务器或者服务器集群。
下面以理赔请求是医保理赔请求为例，对本说明书的具体实现过程进行描述。
请参考图2，本实施例提供的基于信用实现医保理赔的方法可以包括以下步骤：
步骤202，保险平台在接收到用户发送的理赔请求后，从信用平台获取所述用户的信用信息。
在本实施例中，以用户通过保险平台发起理赔请求为例进行说明。用户在发起理赔请求时，可以选择理赔类型，例如：医保理赔。
当然，若用户对其他保险进行理赔，则可对应选择其他的理赔类型，例如，车险理赔、运费险理赔等，本说明书对此不作特殊限制。
在本实施例中，保险平台在接收到上述理赔请求后，可以基于用户的登录信息确定用户的身份，例如，身份证号、姓名等，无需用户重新输入身份信息。
在本实施例中，针对理赔金额相对较高的理赔类型，在接收到理赔请求后，可以先对用户进行身份验证，例如，让用户拍摄脸部照片，以判断是否为本人操作。当然，也可以采用其他的方式对用户进行身份验证，例如，手机号码验证、地址验证等，可以参考相关技术中提供的验证方案，本实施例在此不再一一赘述。
上述需要进行身份验证的理赔类型可预先设置，例如，针对医保理赔、车险理赔等金额相对较高的理赔类型可以设置身份验证环节；针对运费险等金额相对较低的理赔类 型可以不设置身份验证环节，在接收到理赔请求后，可直接获取用户的信用信息，本说明对此不作特殊限制。
在本实施例中，保险平台可以通过信用平台提供的调用接口来从信用平台获取所述用户的信用信息。
在一个例子中，所述信用信息的展现形式可以为信用评分，基于信用评分可直观确定用户的信用等级，例如，信用合格或信用不合格。其中，信用合格通常可表示用户的信用较高，骗保概率低；而信用不合格通常可表示用户的信用较差，骗保概率高。
在另一个例子中，所述信用信息的展现形式可以为信用评分和信用等级，其中，该信用等级可以包括：信用合格、信用不合格。基于该信用等级，可以直观确定用户的信用等级；基于该信用评分，可以对信用等级相同的用户进行进一步区分。
在本实施例中，所述信用信息可以由信用平台在接收到保险平台的调用后进行确定；所述信用信息也可以由信用平台预先确定后保存，当保险平台调用时，将保存的信用信息返回给保险平台。
在本实施例中，信用平台可以根据用户的资产信息、理赔频率和信贷记录等信息确定所述用户的信用信息。例如，可将用户的资源信息、理赔频率和信贷记录等信息进行数值化转换，然后可通过加权平均等方式确定用户的信用评分。
当然，也可以采用其他方式确定用户的信用评分，本实施例对此不作特殊限制。
步骤204，保险平台在所述信用信息满足信用约束条件时，提示所述用户上传理赔材料。
基于前述步骤202，在获取到用户的信用信息后，保险平台可以判断该信用信息是否满足信用约束条件，例如，判断用户的信用评分是否大于评分阈值等。
其中，所述信用约束条件可以由保险平台的工作人员预先设置，针对不同的理赔类别，对应的信用约束条件可以相同，也可以不同。
在本实施例中，信用信息是否满足信用约束条件的判断过程也可以由信用系统来实现，例如，可预先在信用系统中配置信用约束条件，信用系统在获取到用户的信用信息后进行判断，并将判断结果返回给保险平台，本实施例对此不作特殊限制。
在本实施例中，在用户的信用信息满足信用约束条件时，保险平台可以提示用户上传理赔材料，例如，保险平台可以发送上传理赔材料的消息给用户使用的客户端软件， 当用户确认该消息时，客户端软件可以调用摄像头，以进行图像采集。这部分的处理与实现可以参照相关技术，本实施例在此不再一一赘述。
在本实施例中，不同的理赔类别对应的理赔材料通常不同。
其中，医保理赔对应的理赔材料可以包括：付款发票、病例证明等。车险理赔的理赔材料可以包括：出险照片、维修发票等。手机碎屏险的理赔材料可以包括：碎屏手机的照片等。所述理赔材料可以由保险平台规定，用户根据规定上传即可。
步骤206，保险平台利用活体检测技术检测所述理赔材料的上传途径是否为真实拍摄。
在本实施例中，为了避免用户通过图片处理技术对作假材料进行处理，以骗取保费等问题，保险平台可以利用活体检测技术检测理赔材料的上传途径是否为真实拍摄。
例如，在调用摄像头后，提示用户抖一抖理赔材料等，以证明理赔材料真的在用户手中。
其中，上述活体检测过程可以由保险平台来实现，也可以由与保险平台对接的客户端来实现，本实施例对此不作特殊限制。
在本实施例中，若确定所述理赔材料的上传途径为真实拍摄，可以继续执行步骤206。
若确定所述理赔材料的上传途径不是真实拍摄，则可以输出提示信息给用户，以提示用户重新上传。
步骤208，保险平台在所述理赔材料的上传途径是真实拍摄时，识别所述理赔材料的真伪。
基于前述步骤206的判断结果，当所述理赔材料的上传途径是真实拍摄时，可以确定该理赔材料真的在用户手中，而非用户采用图片来骗取保费。
在本实施例中，可进一步识别所述理赔材料的真伪。
以理赔材料是付款发票为例，可以采用AI(Artificial Intelligence，人工智能)技术识别所述付款发票的发票信息，例如，发票号、发票头、付款人姓名等信息。
基于识别到的信息，保险平台可以调用税务系统提供的接口识别所述付款发票的真伪。
若确定所述付款发票真实，则可以确定所述付款发票通过审核，进而可以执行步骤210。
若确定所述付款发票是伪造的，则可以确定付款发票未通过审核，用户涉嫌骗保，可以通知信用平台负向更新用户的信用信息。
在另一个例子中，若理赔材料是病例证明，则可以采用AI技术识别该病例证明是否有对应的医生签字、医院公章等，具体可以根据真实病例证明的要求进行识别。
当然，在本实施例中，除AI技术之外，也可以采用其他技术识别理赔材料的真伪，本实施例对此不作特殊限制。
步骤210，若所述理赔材料通过审核，则保险平台计算所述理赔材料对应的理赔金额。
基于前述步骤208的识别结果，若确定理赔材料通过审核，则可以确定本次理赔是真实理赔，不涉嫌骗保。
在本实施例中，可以计算所述理赔材料对应的理赔金额。例如，可采用OCR(Optical Character Recognition，光学字符识别)技术识别付款发票中的付款金额，并计算对应的理赔金额。
在医保理赔中，基于OCR技术，可识别出付款发票中各项费用的费用类别(甲类、乙类或丙类)和对应的金额，然后基于用户投保的医疗险种，计算对应的理赔金额。
当然，在其他例子中，若理赔类别是手机碎屏险理赔，则也可以基于图像处理技术识别碎屏的程度，然后计算对应的理赔金额，本实施例在此不再一一赘述。
步骤212，当所述理赔金额不超过自助理赔限制金额时，保险平台基于所述理赔金额对所述用户进行理赔。
基于前述步骤210，保险平台在计算得到理赔金额后，可以判断该理赔金额是否超过自助理赔限制金额。其中，所述自助理赔限制金额通常由保险公司根据理赔类别进行设置。
当理赔金额不超过自助理赔限制金额时，可以直接对用户进行赔付，例如，将理赔金额转到用户绑定的账号中。
当理赔金额超过自助理赔限制金额时，为确保保险公司的利益，可以将该理赔请求转到人工处理，以便工作人员进行进一步核对。
当然，也可以不设置上述自助理赔限制金额，本实施例对此不作特殊限制。
在本实施例中，保险平台还可以在处理完毕用户的理赔请求后，将理赔结果返回给信用平台，由信用平台来更新用户的信用信息。
例如，若用户成功理赔，信用平台可以正向更新用户的信用信息。
再例如，若用户涉嫌骗保，信用平台可以负向更新用户的信用信息，后续禁止用户进行在线理赔等。
由以上描述可以看出，本实施例可实现在线理赔，对于用户而言，操作方便、理赔效率高。对于保险公司而言，基于信用的理赔以及理赔材料的智能在线审核可有效保障保险公司的利益，有效避免骗保等行为给保险公司带来的经济损失，同时节省大量的人力成本。
需要说明的是，本说明书中记载的用户与保险平台、信用平台之间的信息交互通常是指用户使用的终端设备、或该终端设备中装载的客户端软件与保险平台、信用平台之间的信息交互。
与前述基于信用实现理赔的方法的实施例相对应，本说明书还提供了基于信用实现理赔的装置的实施例。
本说明书基于信用实现理赔的装置的实施例可以应用在服务器上。装置实施例可以通过软件实现，也可以通过硬件或者软硬件结合的方式实现。以软件实现为例，作为一个逻辑意义上的装置，是通过其所在服务器的处理器将非易失性存储器中对应的计算机程序指令读取到内存中运行形成的。从硬件层面而言，如图3所示，为本说明书基于信用实现理赔的装置所在服务器的一种硬件结构图，除了图3所示的处理器、内存、网络接口、以及非易失性存储器之外，实施例中装置所在的服务器通常根据该服务器的实际功能，还可以包括其他硬件，对此不再赘述。
图4是本说明书一示例性实施例示出的一种基于信用实现理赔的装置的框图。
请参考图4，所述基于信用实现理赔的装置300可以应用在前述图3所示的服务器中，包括有：信用确定单元301、材料上传单元302、材料审核单元303、理赔执行单元304、信用更新单元305以及身份验证单元306。
其中，信用确定单元301，在接收到用户发送的理赔请求后，确定所述用户的信用信息；
材料上传单元302，当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
材料审核单元303，对所述用户上传的理赔材料进行审核；
理赔执行单元304，若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
可选的，所述材料审核单元303：
利用活体检测技术检测所述理赔材料的上传途径是否为真实拍摄；
当所述理赔材料的上传途径是真实拍摄时，识别所述理赔材料的真伪；
若所述理赔材料真实，则确定所述理赔材料通过审核。
可选的，当所述理赔材料是付款发票时，所述材料审核单元303：
采用AI技术识别所述付款发票的发票信息；
根据所述发票信息识别所述付款发票的真伪。
可选的，所述理赔执行单元304：
计算所述理赔材料对应的理赔金额；
当所述理赔金额不超过自助理赔限制金额时，基于所述理赔金额对所述用户进行理赔。
信用更新单元305，若所述理赔材料未通过审核，则负向更新所述用户的信用信息。
身份验证单元306，在接收到用户发送的理赔请求后，对所述用户进行身份验证；并当所述用户通过身份验证时，通知信用确定单元执行确定所述用户的信用信息的步骤。
可选的，所述信用确定单元301，根据用户的资产信息、理赔频率和信贷记录确定所述用户的信用信息。
上述装置中各个单元的功能和作用的实现过程具体详见上述方法中对应步骤的实现过程，在此不再赘述。
对于装置实施例而言，由于其基本对应于方法实施例，所以相关之处参见方法实施例的部分说明即可。以上所描述的装置实施例仅仅是示意性的，其中所述作为分离 部件说明的单元可以是或者也可以不是物理上分开的，作为单元显示的部件可以是或者也可以不是物理单元，即可以位于一个地方，或者也可以分布到多个网络单元上。可以根据实际的需要选择其中的部分或者全部模块来实现本说明书方案的目的。本领域普通技术人员在不付出创造性劳动的情况下，即可以理解并实施。
上述实施例阐明的系统、装置、模块或单元，具体可以由计算机芯片或实体实现，或者由具有某种功能的产品来实现。一种典型的实现设备为计算机，计算机的具体形式可以是个人计算机、膝上型计算机、蜂窝电话、相机电话、智能电话、个人数字助理、媒体播放器、导航设备、电子邮件收发设备、游戏控制台、平板计算机、可穿戴设备或者这些设备中的任意几种设备的组合。
与前述基于信用实现理赔的方法的实施例相对应，本说明书还提供一种基于信用实现理赔的装置，该基于信用实现理赔的装置包括：处理器以及用于存储机器可执行指令的存储器。其中，处理器和存储器通常借由内部总线相互连接。在其他可能的实现方式中，所述设备还可能包括外部接口，以能够与其他设备或者部件进行通信。
在本实施例中，通过读取并执行所述存储器存储的与基于信用实现理赔的逻辑对应的机器可执行指令，所述处理器被促使：
在接收到用户发送的理赔请求后，确定所述用户的信用信息；
当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
对所述用户上传的理赔材料进行审核；
若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
可选的，所述对用户上传的理赔材料进行审核，包括：
利用活体检测技术检测所述理赔材料的上传途径是否为真实拍摄；
当所述理赔材料的上传途径是真实拍摄时，识别所述理赔材料的真伪；
若所述理赔材料真实，则确定所述理赔材料通过审核。
可选的，当所述理赔材料是付款发票时，所述识别所述理赔材料的真伪，包括：
采用AI技术识别所述付款发票的发票信息；
根据所述发票信息识别所述付款发票的真伪。
可选的，所述基于所述理赔材料执行针对所述用户的理赔操作，包括：
计算所述理赔材料对应的理赔金额；
当所述理赔金额不超过自助理赔限制金额时，基于所述理赔金额对所述用户进行理赔。
可选的，还包括：
若所述理赔材料未通过审核，则负向更新所述用户的信用信息。
可选的，在接收到用户发送的理赔请求后，还包括：
对所述用户进行身份验证；
当所述用户通过身份验证时，执行确定所述用户的信用信息的步骤。
可选的，所述确定用户的信用信息，包括：
根据用户的资产信息、理赔频率和信贷记录确定所述用户的信用信息。
与前述基于信用实现理赔的方法的实施例相对应，本说明书还提供一种计算机可读存储介质，所述计算机可读存储介质上存储有计算机程序，该程序被处理器执行时实现以下步骤：
一种基于信用实现理赔的方法，包括：
在接收到用户发送的理赔请求后，确定所述用户的信用信息；
当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
对所述用户上传的理赔材料进行审核；
若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
可选的，所述对用户上传的理赔材料进行审核，包括：
利用活体检测技术检测所述理赔材料的上传途径是否为真实拍摄；
当所述理赔材料的上传途径是真实拍摄时，识别所述理赔材料的真伪；
若所述理赔材料真实，则确定所述理赔材料通过审核。
可选的，当所述理赔材料是付款发票时，所述识别所述理赔材料的真伪，包括：
采用AI技术识别所述付款发票的发票信息；
根据所述发票信息识别所述付款发票的真伪。
可选的，所述基于所述理赔材料执行针对所述用户的理赔操作，包括：
计算所述理赔材料对应的理赔金额；
当所述理赔金额不超过自助理赔限制金额时，基于所述理赔金额对所述用户进行理赔。
可选的，还包括：
若所述理赔材料未通过审核，则负向更新所述用户的信用信息。
可选的，在接收到用户发送的理赔请求后，还包括：
对所述用户进行身份验证；
当所述用户通过身份验证时，执行确定所述用户的信用信息的步骤。
可选的，所述确定用户的信用信息，包括：
根据用户的资产信息、理赔频率和信贷记录确定所述用户的信用信息。
上述对本说明书特定实施例进行了描述。其它实施例在所附权利要求书的范围内。在一些情况下，在权利要求书中记载的动作或步骤可以按照不同于实施例中的顺序来执行并且仍然可以实现期望的结果。另外，在附图中描绘的过程不一定要求示出的特定顺序或者连续顺序才能实现期望的结果。在某些实施方式中，多任务处理和并行处理也是可以的或者可能是有利的。
以上所述仅为本说明书的较佳实施例而已，并不用以限制本说明书，凡在本说明书的精神和原则之内，所做的任何修改、等同替换、改进等，均应包含在本说明书保护的范围之内。

Claims (15)

  1. 一种基于信用实现理赔的方法，包括：
    在接收到用户发送的理赔请求后，确定所述用户的信用信息；
    当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
    对所述用户上传的理赔材料进行审核；
    若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
  2. 根据权利要求1所述的方法，所述对用户上传的理赔材料进行审核，包括：
    利用活体检测技术检测所述理赔材料的上传途径是否为真实拍摄；
    当所述理赔材料的上传途径是真实拍摄时，识别所述理赔材料的真伪；
    若所述理赔材料真实，则确定所述理赔材料通过审核。
  3. 根据权利要求2所述的方法，当所述理赔材料是付款发票时，所述识别所述理赔材料的真伪，包括：
    采用AI技术识别所述付款发票的发票信息；
    根据所述发票信息识别所述付款发票的真伪。
  4. 根据权利要求1所述的方法，所述基于所述理赔材料执行针对所述用户的理赔操作，包括：
    计算所述理赔材料对应的理赔金额；
    当所述理赔金额不超过自助理赔限制金额时，基于所述理赔金额对所述用户进行理赔。
  5. 根据权利要求1所述的方法，还包括：
    若所述理赔材料未通过审核，则负向更新所述用户的信用信息。
  6. 根据权利要求1所述的方法，在接收到用户发送的理赔请求后，还包括：
    对所述用户进行身份验证；
    当所述用户通过身份验证时，执行确定所述用户的信用信息的步骤。
  7. 根据权利要求1所述的方法，所述确定用户的信用信息，包括：
    根据用户的资产信息、理赔频率和信贷记录确定所述用户的信用信息。
  8. 一种基于信用实现理赔的装置，包括：
    信用确定单元，在接收到用户发送的理赔请求后，确定所述用户的信用信息；
    材料上传单元，当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
    材料审核单元，对所述用户上传的理赔材料进行审核；
    理赔执行单元，若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户 的理赔操作。
  9. 根据权利要求8所述的装置，所述材料审核单元：
    利用活体检测技术检测所述理赔材料的上传途径是否为真实拍摄；
    当所述理赔材料的上传途径是真实拍摄时，识别所述理赔材料的真伪；
    若所述理赔材料真实，则确定所述理赔材料通过审核。
  10. 根据权利要求9所述的装置，当所述理赔材料是付款发票时，所述材料审核单元：
    采用AI技术识别所述付款发票的发票信息；
    根据所述发票信息识别所述付款发票的真伪。
  11. 根据权利要求8所述的装置，所述理赔执行单元：
    计算所述理赔材料对应的理赔金额；
    当所述理赔金额不超过自助理赔限制金额时，基于所述理赔金额对所述用户进行理赔。
  12. 根据权利要求8所述的装置，还包括：
    信用更新单元，若所述理赔材料未通过审核，则负向更新所述用户的信用信息。
  13. 根据权利要求8所述的装置，还包括：
    身份验证单元，在接收到用户发送的理赔请求后，对所述用户进行身份验证；并当所述用户通过身份验证时，通知信用确定单元执行确定所述用户的信用信息的步骤。
  14. 根据权利要求8所述的装置，
    所述信用确定单元，根据用户的资产信息、理赔频率和信贷记录确定所述用户的信用信息。
  15. 一种基于信用实现理赔的装置，包括：
    处理器；
    用于存储机器可执行指令的存储器；
    其中，通过读取并执行所述存储器存储的与基于信用实现理赔的逻辑对应的机器可执行指令，所述处理器被促使：
    在接收到用户发送的理赔请求后，确定所述用户的信用信息；
    当所述信用信息满足信用约束条件时，提示所述用户上传理赔材料；
    对所述用户上传的理赔材料进行审核；
    若所述理赔材料通过审核，则基于所述理赔材料执行针对所述用户的理赔操作。
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