Research And Development Of Whole Process Quality Control System For Auto Insurance Claims SIU

Auto insurance is the main source of income for most property insurance companies in China,and auto insurance losses are as high as 60%.In order to reduce the loss rate,it is necessary to analyze the whole vehicle insurance compensation process and improve the quality of operations in the process.Fraud issue in car insura nce claims generally is one of the most important reasons caused the quality problem of car insurance claims.Aware of the seriousness of the fraud,more and more insurance company hope to reduce the harm of car insurance fraud,and improve the quality of claims by using information technologies.This paper focuses on the fraud initial recognition model,solution of data quality problems,based on this,design and implement a system of SIU total process quality monitoring in car insurance claims.Mainly works on four aspects list as follows:(1)divide the fraud mainly into two types: hard fraud and soft fraud.As to the hard fraud,by using the expert system and the logistic regression method,we establish two sets of hard fraud identification model,which applied throughout the claims process.O nce high-risk cases identified,the compensation process would be frozen,and a case independent investigation would be put into action.As to the soft fraud,the expert system is used to construct the soft fraud identification model,which can be used to reduce the compensation amount;(2)study and analyse intensively on the category and source of the data quality issues in insurance companies.And improve the data quality by application of unified data ETL(extraction,cleaning,transformation,business analysis,and loading)process,and online real-time data quality detection and instant exception data mark methods;(3)propose a closed-loop and continuous mprovement solution for the issue of over-timeincrement of deviation between the data model and the real situations,by setting marks,statistical analysis,optimization models and perfecting the investigation guide,thus keep the system operation effective;(4)design a system of SIU quality monitoring system by software design method,the system is finally applied through code development,function test and performance test,and analyze the application effect.This paper designs a system of SIU total process quality monitoring in car insurance claims.In this system,the anti-fraud process is embedded into auto insurance claims process to achieve the target of risk monitoring,fraud identification,warning and investigation.By the application of continuously-improved-fraud identification model and anti-fraud investigation platform,the system not only improves the anti fraud level of insurance companies,improves the efficiency of anti fraud operation,but also acts as a deterrent to fraud behavior,improves the cost of fraud and reduces the probability of fraud.