| The insurance industry is an important part of the social security system.It realizes the function of economic compensation through operating risks.The insurance industry is also an important part of the financial system.The rapid growth of China's insurance industry has continued for nearly ten years.Therefore,the insurance industry has also become One of the fastest-growing industries in China.In 2020 alone,China's original premium income reached 4,525.734 billion yuan.After China became the second largest insurance market in 2017,this year's high premium income has once again consolidated that position.The personal insurance industry is highly competitive.Health insurance accounts for about 24% of the life insurance premium market share.The growth rate of health insurance premiums is 15.66%,and health insurance is the fastest-growing type of insurance.With the improvement of national health management awareness in China,the demand for health insurance is increasing day by day,Provides favorable conditions for the vigorous development of China's health insurance market.The insurance industry is based on the principle of utmost integrity,and the foundation in the industry is "integrity" and "commitment." However,fraud in the insurance industry is more than any other industry.With the continuous development of the insurance industry,the number of insurance fraud cases has increased sharply,and fraud methods have emerged in an endless stream.Insurance fraud is summarized as the insured,the insured or the beneficiary who falsely report the insurance incident,deliberately forge the insurance incident,and pass after the insurance incident occurs.Falsification of accident certification materials and other evidence to fabricate the cause of the accident,or misrepresent the extent of the loss after the accident,in order to seek insurance money.The direct consequence of insurance fraud is to affect the insurance company's compensation expenditure,thereby affecting the insurance company's core solvency ?The insurer's prudent operation plan will inevitably pass on the rising cost of compensation to the policyholder,resulting in a lose-lose result.Since 2017,the country's health insurance fraud cases have shown a significant increase,and their fraud methods have become more specialized and scaled Even,health insurance fraud has formed a collusion group involving insurance companies,hospital medical records rooms,and fraudsters.Artificial intelligence and the insurance industry have a high degree of natural fit,so the insurance industry is also one of the industries with the most extensive and profound application of artificial intelligence technology.The timely use of AI will help China seize the development opportunities of insurance technology and master core technologies.In particular,the insurance industry Characterized by its particularity and strong professionalism,it will bring high standards and strict requirements to the application of artificial intelligence in the insurance industry.The integration of the two will contribute to the improvement of production conversion rate and the upgrading of artificial intelligence technology.In addition,artificial intelligence technology comprehensively uses insurance technology big data and other technologies to pave the way for the development of the insurance industry at the technical level,and will produce disruptive changes to the development of the insurance industry.Greatly improve the ability of insurance institutions to identify,prevent and control risks Promote China's supply-side structural reforms,and promote the industrial upgrading and leapfrog development of the insurance industry.Actively using artificial intelligence and health insurance technology can reduce the operating costs of insurance companies' health insurance business.The use of artificial intelligence can effectively identify And prevent health insurance fraud,thereby reducing operating costs,saving labor costs,and improving operating efficiency.The saved costs can be reinvested in the operation of insurance companies,improving service quality and strengthening the core competitiveness of the company,thus forming a virtuous circle.Based on the significance of health insurance anti-fraud for the development of life insurance companies and the entire insurance industry,this article takes the ARGUS intelligent anti-fraud platform as an example.It uses comparative analysis,collating literature analysis,and case analysis to study the existence of anti-fraud in China's health insurance To summarize and learn from the experience of anti-fraud in health insurance with the help of artificial intelligence in foreign countries,and to make suggestions on anti-fraud in domestic health insurance.Artificial intelligence can improve the accuracy of risk control through the continuous evolution and iteration of machines,and generate responses to various New fraud countermeasures.Research and prevention of health insurance fraud has become an urgent topic in the insurance industry.The health insurance industry uses feasible fraud prevention methods and antifraud strategies,uses multi-dimensional data to identify fraud risks,and uses intelligent technology to build The intelligent health insurance anti-fraud system is of great significance for promoting the rapid and stable development of China's health insurance market. |
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