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ESTIMATION METHOD AND APPARATUS FOR CLAIM SETTLEMENT RESERVE, STORAGE MEDIUM AND TERMINAL DEVICE

机译:索赔结算储备,存储介质和终端设备的估计方法和装置

摘要

The present application discloses an estimation method and apparatus for claim settlement reserve, a computer-readable storage medium and a terminal device, for solving the problems that the estimation result of claim settlement reserve is easily affected by the professional standard and working experience of an estimation personnel and an estimation efficiency is low. The estimation method comprises: acquiring a case to be estimated; acquiring accident information about the case to be estimated; determining, according to the accident information, a claim settlement insurance product of an insurance policy corresponding to the case to be estimated; determining whether the claim settlement insurance product is a healthcare insurance product; if the claim settlement insurance product is a healthcare insurance product, then calculating the claim settlement reserve of the case to be estimated according to the average indemnity amount and the number of insurance products for the insurance policy; and if the claim settlement insurance product is not a healthcare insurance product, then calculating the coverage of the insurance policy under the claim settlement insurance product, and calculating the claim settlement reserve of the case to be estimated according to the calculated coverage and a pre-set indemnity ratio of the claim settlement insurance product.
机译:本申请公开了一种理赔准备金的估计方法,装置,计算机可读存储介质和终端设备,用于解决理赔专业的标准和工作经验容易影响理赔准备金的估计结果的问题。人员和估计效率低。估计方法包括:获取要估计的病例;以及获取有关待估计案件的事故信息;根据事故信息,确定与待估算病例相对应的保险单的理赔保险产品;确定索赔结算保险产品是否为医疗保险产品;如果理赔保险产品是医疗保险产品,则根据平均赔付金额和该保险单的保险产品数量计算要估算的案件的理赔准备金;如果索赔结算保险产品不是医疗保险产品,则计算该索赔结算保险产品下的保险单的承保范围,并根据计算得出的承保范围和设定理赔保险产品的赔付率。

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