CN-122023025-A - Insurance data processing method, apparatus, device and storage medium

CN122023025ACN 122023025 ACN122023025 ACN 122023025ACN-122023025-A

Abstract

The embodiment of the disclosure provides an insurance data processing method, device, equipment and storage medium, and specifically discloses an insurance data processing method, device and equipment and storage medium, wherein the insurance data comprises structural data and image files related to the structural data, the insurance data to be processed is audited based on preset audit rules, the preset audit rules at least comprise one of a normative check rule for auditing whether preset logic specifications and format specifications are met, a repeated check rule for auditing whether the normative check rules are repeated with the existing insurance data and an image audit rule for auditing whether the audited data are consistent with analysis information, first insurance data which do not pass through the audit in the insurance data to be processed are revised, the revised first insurance data are audited through the preset audit rules, format conversion is carried out on second insurance data which pass through the audit in the insurance data to be processed according to a preset format, and the second insurance data after format conversion are stored.

Inventors

XIAO XIAO
ZENG YONGSHENG
HOU JINHONG

Assignees

中国人民财产保险股份有限公司

Dates

Publication Date: 20260512
Application Date: 20260105

Claims (10)

1. A method of insurance data processing, comprising: The method comprises the steps of acquiring insurance data to be processed, wherein the insurance data comprises structured data and an image file associated with the structured data, and the structured data at least comprises one of insurance policy identification data, medical expense data and insurance claim data; The method comprises the steps of processing insurance data to be processed, checking the insurance data to be processed based on preset checking rules, wherein the preset checking rules at least comprise one of a normalization check rule for checking whether preset logic specifications and format specifications are met, a repeated check rule for checking whether the verification is repeated with the existing insurance data and an image checking rule for checking whether the verification is consistent with analysis information; Correcting first insurance data which do not pass the audit in the insurance data to be processed, auditing the corrected first insurance data through a preset audit rule, performing format conversion on second insurance data which pass the audit in the insurance data to be processed according to a preset format, and storing the second insurance data after the format conversion.
2. The method of claim 1, wherein prior to auditing the insurance data to be processed based on preset auditing rules, the method further comprises at least one of: acquiring a logic expression which is input by a user and consists of a data field, a logic operator and a fixed value, and determining the rule auditing rule according to the logic expression; Acquiring a plurality of data fields designated by a user and used for jointly judging whether the data fields are repeated or not, and determining the repeated check rule according to the designated data fields; The method comprises the steps of obtaining analysis rules and consistency comparison rules configured by a user for the image file, and determining the image auditing rules according to the analysis rules and the consistency comparison rules, wherein the analysis rules are used for determining a mode of locating and identifying key field information from the image file, and the consistency comparison rules are used for determining a mode of comparing the key field information with the identified key field information.
3. The method of claim 2, wherein the obtaining the logical expression of the data field, the logical operator, and the fixed value input by the user comprises: The logic expression configured by the user based on the insurance calculation formula is obtained, wherein the insurance calculation formula is determined based on insurance business rules and is used for calculating standard insurance claim amount, and the logic expression is used for checking whether an actual claim amount field in data to be audited is consistent with the standard insurance claim amount.
4. The method of claim 1, wherein the preset auditing rules include the repeated verification rules, and wherein auditing the insurance data to be processed based on the preset auditing rules includes: combining values of a plurality of specified fields of any one of the insurance data to be processed; Comparing the combined field value with the field combination corresponding to the existing insurance data to obtain a comparison result; and if the comparison result indicates that the values of the designated fields are the same, determining that any one of the safety data is repeated data, and determining that any one of the safety data is the first safety data.
5. The method of claim 1, wherein the preset auditing rules include the image auditing rules, and wherein auditing the insurance data to be processed based on the preset auditing rules includes: Analyzing the image file of any insurance data in the insurance data to be processed by an optical character recognition technology, and taking the recognized field information as the analysis information; Comparing the field information in the analysis information with the corresponding field content in any one of the security data in a consistency manner, and verifying the invoice information when the analysis information comprises the invoice information; And under the conditions of consistency comparison and invoice verification, determining that any insurance data passes image verification, and determining any insurance data as the second insurance data.
6. The method of claim 1, wherein the modifying the first security data and auditing the modified first security data with a preset auditing rule includes: determining data to be corrected according to the audit rule that the first insurance data does not pass; Displaying the data to be corrected, and receiving correction operation for the data to be corrected, wherein the correction operation comprises modification and deletion; After finishing the correction operation of the data to be corrected, updating the first security data according to the corrected data to be corrected; And auditing the updated first insurance data through a preset auditing rule, and converting the first insurance data into the second insurance data after the auditing is passed.
7. An insurance data processing device, comprising: The system comprises an acquisition module, a processing module and a payment module, wherein the acquisition module is used for acquiring insurance data to be processed, the insurance data comprises structured data and an image file associated with the structured data, and the structured data at least comprises one of insurance policy identification data, medical expense data and insurance claim data; The verification module is used for verifying the insurance data to be processed based on preset verification rules, wherein the preset verification rules at least comprise one of a normalization verification rule for verifying whether the preset logic specification and format specification are met, a repeated verification rule for verifying whether the verification rule is repeated with the existing insurance data and an image verification rule for verifying whether the verification rule is consistent with analysis information, and the analysis information is obtained after the analysis of the associated image file; The processing module is used for correcting the first insurance data which does not pass the verification in the insurance data to be processed, verifying the corrected first insurance data through a preset verification rule, converting the format of the second insurance data which passes the verification in the insurance data to be processed according to a preset format, and storing the second insurance data after the format conversion.
8. An electronic device comprising a memory, a processor and a computer program stored on the memory and executable on the processor, the computer program implementing the steps of the method according to any one of claims 1 to 6 when executed by the processor.
9. A computer readable storage medium for storing computer executable instructions which when executed by a processor implement the steps of the method of any one of the preceding claims 1 to 6.
10. A computer program product, characterized in that it comprises a computer program which, when executed by a processor, implements the steps of the method according to any of the preceding claims 1 to 6.

Description

Insurance data processing method, apparatus, device and storage medium Technical Field The present invention relates to the field of data processing technologies, and in particular, to a method, an apparatus, a device, and a storage medium for processing insurance data. Background In the field of social insurance claim data processing, an automatic processing flow is a key link for improving claim settlement efficiency and ensuring data accuracy and compliance, and especially aims at batch businesses such as major insurance, automatic settlement of original data, repeated verification and problem data screening are realized through a technical means, so that manual intervention can be obviously reduced, and the wind control level is optimized. At present, the claim settlement processing in the insurance industry generally depends on a manual operation mode that service personnel need to collect medical notes, structural information and other claim settlement materials one by one, and the notes are manually processed and checked through Excel and other tools to confirm the correctness of the claim settlement information, then the information is manually settled into claim settlement information, and the claim settlement information is imported into a claim settlement system to complete subsequent procedures. This approach is labor-intensive, with a linear and fixed process flow. However, the method has the obvious technical limitations that firstly, the efficiency is low, the manual processing of massive claim data is long, particularly when the number of cases is huge, business personnel need to input a large amount of time to collect and arrange, so that the waiting time of customers is prolonged, the satisfaction degree is influenced, secondly, the error risk and the moral risk are high, the error risk such as understanding difference or input error is easy to cause inaccurate or missing claim information, so that decision making errors or disputes are caused, furthermore, the labor cost is high and the standardization is lacking, the operation cost is greatly increased due to the large amount of manual participation, meanwhile, the consistency of the data is difficult to guarantee due to the difference of the processing modes of different business personnel, and the difficulty is brought to tracking and auditing. Disclosure of Invention The invention mainly aims to provide an insurance data processing method, an insurance data processing device, insurance data processing equipment and an insurance data storage medium, and aims to solve the problems of low processing efficiency, high operation risk and lack of standardization and auditability caused by completely relying on manual pen-by-pen verification and arrangement during the existing insurance claim data processing. In a first aspect, an embodiment of the present disclosure provides an insurance data processing method, including: The method comprises the steps of acquiring insurance data to be processed, wherein the insurance data comprises structured data and an image file associated with the structured data, and the structured data at least comprises one of insurance policy identification data, medical expense data and insurance claim data; The method comprises the steps of processing insurance data to be processed, checking the insurance data to be processed based on preset checking rules, wherein the preset checking rules at least comprise one of a normalization check rule for checking whether preset logic specifications and format specifications are met, a repeated check rule for checking whether the verification is repeated with the existing insurance data and an image checking rule for checking whether the verification is consistent with analysis information; Correcting first insurance data which do not pass the audit in the insurance data to be processed, auditing the corrected first insurance data through a preset audit rule, performing format conversion on second insurance data which pass the audit in the insurance data to be processed according to a preset format, and storing the second insurance data after the format conversion. In a second aspect, embodiments of the present disclosure provide an insurance data processing apparatus, including: The system comprises an acquisition module, a processing module and a payment module, wherein the acquisition module is used for acquiring insurance data to be processed, the insurance data comprises structured data and an image file associated with the structured data, and the structured data at least comprises one of insurance policy identification data, medical expense data and insurance claim data; The verification module is used for verifying the insurance data to be processed based on preset verification rules, wherein the preset verification rules at least comprise one of a normalization verification rule for verifying whether the preset logic specification and format specification are met,