| With the rapid development of China’s insurance industry and the continuous enhancement of public health awareness,commercial health insurance has developed rapidly,and the competition among insurance companies in the field of commercial health insurance has become more and more fierce.In the case of serious homogeneity of products in the insurance market,the era of traditional products and expenses has come to an end,and the focus of competition has quietly turned into innovative technologies,management capabilities and service ability.In recent years,internet,big data,artificial intelligence,face recognition,cloud computing,blockchain,and other information technologies have been gradually applied to various industries and fields,and the insurance industry is determined in its products price,precision marketing,intelligent customer service and other aspects of the integration of cutting-edge technology more in-depth and mature.But as one of the two traditional core businesses of insurance companies,claims settlement has not been better integrated with science and technology innovation.There are still problems,such as complicated business process,low service efficiency and service quality,poor medical cost control ability and low risk management level.So,talking about quotient industry health insurance claims management and new technology integration innovation,help to improve the health insurance claims status quo,promote health insurance claims into the long-term health development.Claims management ability for the long-term development of the insurance company has a significant impact,taking life insurance company G as an example,through carding life insurance G claims management present situation,find out the problems existing in the current health insurance claims management,analysis the reasons of the existence of problems,and using the theory of process re-engineering,ASME method,ESEIA method and the theory of insurance business,to claim the core business system,combined with large data,artificial intelligence,face recognition,wearable devices,cloud computing,chain blocks,such as digital science and technology,build claim straight pay,health management and fraud as one of the claims management system.This paper put forward the concrete scheme of internal construction claims management system and calls forstrengthening cooperation with other insurance companies and external agencies,actively seeking support from policies and regulations,and jointly establishing a medical data which can share platform and information so as to solve business process trivial,low efficiency,time consumption,low level of risk control,service single and other problems,improve the cost control ability,risk control level and customer service ability of life insurance company G,reduce the cost of claim settlement,meet the diversified needs of the customers,promote the reform and transformation of commercial health insurance to achieve a win-win situation for insurance company and customers.It also points out that we should pay attention to the challenges faced by the application of digital technology,attach great importance to new risks in the application of science and technology,protect personal information security,actively cultivate new claims management complex talents,and help the transformation and upgrading of commercial health insurance.Currently,life insurance company G is in a critical period of strategic transformation,inside the company are actively research methods and ways to improve the quality of health insurance claims service.At the same time,the company has taken a series of measures to simplify the claims business process,improve the quality and efficiency of health claims.Therefore,it is of practical significance to study the restructuring of health insurance claims management system,and it can also provide reference and practical guidance for other life insurance companies’ claims management. |
PDF Full Text Request