CN109801174B - Method, device, equipment and computer readable storage medium for processing claim data - Google Patents
Method, device, equipment and computer readable storage medium for processing claim data Download PDFInfo
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Abstract
The invention provides a method for processing claim data, which comprises the following steps: obtaining first spreadsheet data of batch claim cases; checking the first electronic form data in a multithreading mode based on a preset checking rule to obtain the data checking result of each claim case; displaying prompt information of data invalidation on the invalid data based on the data verification result, and obtaining second electronic form data of valid verification claim cases; extracting the claim data of each claim case from the second electronic form data one by one, and generating case codes for the claim data of each claim case; generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position. The invention also provides a claim data processing device, equipment and a computer readable storage medium. The invention can improve the processing efficiency of the small claim case.
Description
Technical Field
The present invention relates to the field of data processing, and in particular, to a method, apparatus, device, and computer readable storage medium for processing claim data.
Background
In the insurance industry, the processing flow of the claim case needs to be subjected to the operations of reporting, receiving, scanning, inputting, checking, settling and the like, and even the small claim case needs to be subjected to the steps to complete the complete flow of claim settlement, and pay the claim to the customer. For small-amount claim cases, such as the refund risk of a ticket, related claim information provided by a third party is recorded into a claim system by business personnel to report the claim, the claim system processes the claim report one by one, the small-amount claim cases relate to claim amount which is generally several or tens of elements, the claim amount is smaller, the number of claim cases is large, a longer waiting processing time exists between two adjacent claim cases in a mode of processing the claim cases one by one, the general claim case processing flow steps are more, the process is complex, more time is required for processing huge claim data, the claim processing efficiency is lower, and the prior art lacks a method for efficiently processing the small-amount claim cases.
Disclosure of Invention
The invention mainly aims to provide a method, a device, equipment and a computer readable storage medium for processing claim data, and aims to improve the processing efficiency of small claim cases.
In order to achieve the above object, the present invention provides a method for processing claim data, the method for processing claim data comprising the steps of:
acquiring first electronic form data of batch claim settlement cases based on the claim settlement data of batch claim settlement cases input by a first user on a preset electronic form template;
checking the first electronic form data in a multithreading mode based on a preset checking rule to obtain a data checking result of each claim case;
obtaining second electronic form data of valid claim case verification based on the data verification result, and displaying prompt information of invalid data for the invalid data;
extracting the claim data of each claim case from the second electronic form data one by one, and generating case codes for the claim data of each extracted claim case;
generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position.
Optionally, the first spreadsheet data includes at least an insurance policy number, an insured person's license number, an insured name, an insurance date, an claim liability, or an claim amount for each claim case.
Optionally, the preset storage location includes a preset personal storage location where the location information is associated with the identity information of the first user, and the step of storing each case information in the preset storage location includes:
receiving a viewing instruction triggered by a second user for viewing the claim case information processed by the first user, wherein the viewing instruction comprises the identity information of the first user;
determining a storage position of the case settling information processed by the first user according to the position information associated with the identity information of the first user;
and acquiring corresponding case settling information from a storage position of the case settling information processed by the first user, and displaying the acquired case settling information.
Optionally, the step of checking the first electronic form data in a multithreading manner based on a preset checking rule to obtain a data checking result of each claim case includes:
based on a first preset repeatability verification rule, carrying out pairwise comparison on the data of each claim case in the first electronic form data in a multithreading mode, and determining whether two or more consistent claim case data exist;
if the data are consistent, determining that the claim case with consistent data is a repeated input claim case;
And determining the data verification result of any one of the repeatedly-recorded claims to be valid, and determining the data verification results of other repeatedly-recorded claims except the valid data verification to be invalid.
Optionally, the step of checking the first electronic form data in a multithreading manner based on a preset checking rule to obtain a data checking result of each claim case includes:
comparing the data of each claim case in the first electronic form data with the pre-stored case information in a multithreading mode based on a second preset repeatability verification rule, and determining whether the claim cases matched with the pre-stored case information exist in the first electronic form data;
if the data of the claim case matched with the pre-stored case information is checked, the data check result of the claim case matched with the pre-stored case information is determined to be invalid.
Optionally, the step of checking the first electronic form data in a multithreading manner based on a preset checking rule to obtain a data checking result of each claim case includes:
comparing the data of each claim case in the first electronic form data with the historical effective electronic form data in a multithreading mode based on a third preset repeatability verification rule, and determining whether the claim case matched with the historical effective electronic form data exists in the first electronic form data;
And if so, determining the data verification result of the claim case matched with the historical electronic table data as verification invalidation.
Optionally, the step of checking the first electronic form data in a multithreading manner based on a preset checking rule to obtain a data checking result of each claim case includes:
comparing the claim settlement amount of each claim settlement case in the first electronic form data with a preset amount threshold value in a multithreading mode based on a preset claim settlement amount verification rule, and determining whether the claim settlement amount is larger than the preset amount threshold value;
if the claim amount is larger than the preset amount threshold, determining that the data verification result of the claim case with the claim amount larger than the preset amount threshold is invalid.
In addition, to achieve the above object, the present invention also provides a claim data processing apparatus, including:
the first obtaining module is used for obtaining first electronic form data of batch claim settlement cases based on the claim settlement data of batch claim settlement cases input by the first user on the preset electronic form template;
the verification module is used for verifying the first electronic form data in a multithreading mode based on a preset verification rule to obtain a data verification result of each claim case;
A second obtaining module for obtaining second electronic form data of valid claim case based on the data verification result and displaying data invalid prompt information for invalid data
A first generation module for extracting the claim data of each claim case from the second electronic form data one by one and generating case codes for the claim data of each extracted claim case
The second generation module is used for generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position.
In addition, in order to achieve the above object, the present invention also provides a claim data processing apparatus, which includes a processor, a memory, and a claim data processing program stored on the memory and executable by the processor, wherein the claim data processing program, when executed by the processor, implements the steps of the claim data processing method as described above.
In addition, in order to achieve the above object, the present invention also provides a computer-readable storage medium having stored thereon a claim data processing program, wherein the claim data processing program, when executed by a processor, implements the steps of the claim data processing method as described above.
The invention provides a method, a device, equipment and a computer readable storage medium for processing claim data, wherein the method for processing the claim data comprises the following steps: acquiring first electronic form data of batch claim settlement cases based on the claim settlement data of batch claim settlement cases input by a first user on a preset electronic form template; checking the first electronic form data in a multithreading mode based on a preset checking rule to obtain a data checking result of each claim case; obtaining second electronic form data of valid claim case verification based on the data verification result, and displaying prompt information of invalid data for the invalid data; extracting the claim data of each claim case from the second electronic form data one by one, and generating case codes for the claim data of each extracted claim case; generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position. According to the method, batch receiving and processing of the claim case are achieved based on the preset electronic form template and the multithreading data processing mode, data processing efficiency is improved, case codes are generated on the valid claim case data after verification is conducted on the data based on the preset data verification rule of the small claim case, case information is generated on the basis of the case codes, the claim data and the case forming identification, batch case forming of the claim case is completed, accordingly case data providing links are simplified, complex auditing links are avoided, meanwhile, the validity of the data and the reliability of the case forming information are guaranteed through data verification, and meanwhile the processing efficiency of the small claim case is improved while reliable case processing results are obtained.
Drawings
FIG. 1 is a schematic diagram of a hardware architecture of a claim data processing device according to an embodiment of the present invention;
FIG. 2 is a flowchart illustrating a first embodiment of a method for processing claim data according to the present invention;
FIG. 3 is a flowchart illustrating a second embodiment of a method for processing claim data according to the present invention;
FIG. 4 is a flowchart illustrating a third embodiment of a method for processing claim data according to the present invention;
FIG. 5 is a flowchart illustrating a method for processing claim data according to a fourth embodiment of the present invention;
FIG. 6 is a flowchart illustrating a method for processing claim data according to a fifth embodiment of the present invention;
FIG. 7 is a flowchart illustrating a method for processing claim data according to a sixth embodiment of the present invention;
FIG. 8 is a schematic diagram of functional blocks of a claim data processing apparatus according to the present invention;
the achievement of the objects, functional features and advantages of the present invention will be further described with reference to the accompanying drawings, in conjunction with the embodiments.
Detailed Description
It should be understood that the specific embodiments described herein are for purposes of illustration only and are not intended to limit the scope of the invention.
The claim data processing method related to the embodiment of the invention is mainly applied to claim data processing equipment, and the claim data processing equipment can be personal computers (personal computer, PC), portable computers, mobile terminals and other equipment with data processing functions.
Referring to fig. 1, fig. 1 is a schematic hardware structure of a claim data processing apparatus according to an embodiment of the present invention. In an embodiment of the invention, the claim data processing apparatus may include a processor 1001 (e.g., a central processing unit Central Processing Unit, CPU), a communication bus 1002, a user interface 1003, a network interface 1004, and a memory 1005. Wherein the communication bus 1002 is used to enable connected communications between these components; the user interface 1003 may include a Display screen (Display), an input unit such as a Keyboard (Keyboard); the network interface 1004 may optionally include a standard wired interface, a WIreless interface (e.g., WIreless-FIdelity, WI-FI interface); the memory 1005 may be a high-speed random access memory (random access memory, RAM) or a stable memory (non-volatile memory), such as a disk memory, and the memory 1005 may alternatively be a storage device independent of the processor 1001. Those skilled in the art will appreciate that the hardware configuration shown in fig. 1 is not limiting of the invention and may include more or fewer components than shown, or may combine certain components, or a different arrangement of components.
With continued reference to FIG. 1, the memory 1005 of FIG. 1, which is a computer-readable storage medium, may include an operating system, a network communication module, and a claims data processing program. In fig. 1, the network communication module may be used to connect to a server and perform data communication with the server; and the processor 1001 may call the claim data processing program stored in the memory 1005 and execute the claim data processing method provided by the embodiment of the present invention.
The embodiment of the invention provides a method for processing claim data.
Referring to fig. 2, fig. 2 is a flowchart of a first embodiment of the claim data processing method according to the present invention.
In this embodiment, the method for processing claim data includes the following steps:
step S10, acquiring first electronic form data of batch claim settlement cases based on claim settlement data of batch claim settlement cases input by a first user on a preset electronic form template, wherein the first electronic form data at least comprises the insurance policy number, the insured person license number, the insured person name, the insurance date, the claim liability or the claim amount of each claim settlement case;
the embodiment can be applied to the field of data processing in the insurance industry. In the insurance industry, the processing flow of the claim case needs to be subjected to the operations of reporting, receiving, scanning, inputting, checking, settling and the like, and even the small claim case needs to be subjected to the steps to complete the complete flow of claim settlement, and pay the claim to the customer. For small claim cases, such as the ticket refund danger of a ticket, related claim information provided by a third party is input into a claim system by business personnel to report the claim, the claim system processes the claim reports one by one, the small claim cases relate to the claim amount which is generally several or tens of elements, the claim amount is small, the number of the claim cases is large, a longer waiting processing time exists between two adjacent claim reports in a mode of reporting the cases one by one, more time is required for processing huge claim data, and the claim processing efficiency is low.
In this embodiment, the first user refers to an actual operation processor who sorts the original data based on the small claims case, and uploads the data to the system, which may be a business person who processes the small claims case. The first spreadsheet data refers to the first user uploading the system for the first time, the spreadsheet data not verified. In this embodiment, the electronic form template may be designed in advance for the business personnel to perform data entry, and in the electronic form template, data options corresponding to the case elements such as the insurance policy number, the insured person license number, the insured name, the insurance date, the claim liability, the claim amount, and the like are included, and the business personnel may enter the case elements of one or more cases in each row of forms below the data options, where each row of forms corresponds to the case element of one claim case. A claims system is created to enable processing of small claims cases. The electronic form template can be stored in the claim settlement system in advance so that business personnel can download the electronic form template from the claim settlement system and perform data input. After the user records the case element data sets of the cases into the E electronic form to obtain the electronic form data of the claim-settling case, an instruction for importing the electronic form data can be triggered through an importing button preset in the claim-settling system, and when the importing instruction triggered by the service personnel is received, the electronic form data selected by the service personnel are obtained, so that claim-settling processing is performed based on the obtained electronic form data. In this embodiment, the data source of the business personnel may be a collaborative third party, such as a fare insurance claim of a travel website. The reimbursement responsibilities can include options such as whether the reimbursement responsibilities are insurance, specific reimbursement responsibilities grade information, specific responsibilities type information based on responsibilities born by the insurance company, such as refund responsibilities type information or seven-day return freight responsibilities. Determining and inputting by service personnel; the reimbursement amount refers to reimbursement amount information determined by the business personnel based on reimbursement agreements and entered into the electronic form.
Further, in this embodiment, an electronic form data editing button may be preset in the claim system, and when an editing instruction triggered by the business personnel through the electronic form data editing button is received, the electronic form data editing button enters a display interface of the electronic template to allow the business personnel to enter element information of the claim case. And when receiving an instruction for importing the electronic form data triggered by a business person through a preset importing button, acquiring the electronic form data of the electronic template display interface.
Step S20, checking the first electronic form data in a multithreading mode based on a preset checking rule to obtain a data checking result of each claim case;
based on the steps, after the first electronic form data is obtained, case element data under element names are extracted row by row, a plurality of claim settlement processing threads are established based on a multithreading processing mode, and each case element data is checked by the established plurality of claim settlement processing threads. The check rules include, but are not limited to, the following two:
check rule 1), repeatedly checking the data, judging whether repeated claim information exists,
specifically, insured name information of claim data of each row in the first electronic form data can be obtained, insured person information of each row is compared and matched, identical insured person information is identified, for identical insured person information, the data verification result of any one of the same row of tables in the first electronic form data can be obtained as verification valid, the withdrawal date and the reimbursement responsibility information of the reimbursement items of the same insured person are compared, whether the withdrawal date and the reimbursement responsibility information of the reimbursement items are consistent is determined, and if the withdrawal date and the reimbursement responsibility information of the reimbursement items of the same reimbursement person are consistent, for example, the reimbursement responsibility information of the same reimbursement item is the reimbursement items of the same reimbursement item, the data verification result of any one of the reimbursement items is determined as verification valid, and the data verification results of other reimbursement items which are repeatedly input are determined as invalid.
Further, the electronic form data imported by the business personnel can be compared with the claim elements of the claim case settlement information of the settlement in the preset historical time period in the claim settlement system, whether the insured person information, the insurance date information and the claim compensation responsibility information exist in the case or not is determined, whether the case identical to the imported case exists in the case or not is determined, if so, the fact that the repeated report information of the case exists in the electronic form data is determined, and the data verification result of the claim case matched with the pre-stored settlement information is determined to be invalid.
In addition, the electronic form data can also include uploading time information of the form, electronic form data uploaded by different business staff can be compared, the claim settlement system can compare the electronic form with the received electronic form data in a preset time period in the process of checking the data of one electronic form, whether repeated case data exist or not is determined based on the comparison method and the comparison result of the elements, if so, the data check result of the repeated case corresponding to the electronic form at the later time is determined to be invalid in check based on the time information of the obtained electronic form data.
In the process of carrying out repeatability verification on data, parameters of each character of the data are respectively matched with parameters of leaf nodes in a parallel index tree, each leaf node of the parallel index tree corresponds to one character, the parameters of the leaf nodes at least comprise the character string length of the data where the character is located and the position of the character in the character string, then whether the data are repeated with stored data is judged according to the matching result of each character, and if not, the parameters of each character of the data are stored in the parallel index tree as parameters of the leaf nodes.
A verification rule 2) compares the claim amount in the case data of each row of the electronic form with a preset amount threshold value, and determines whether the claim amount in the electronic form is matched with the preset amount threshold value; the preset amount threshold can be set according to the warranty of the small-amount claim settlement agreement, and the fact that the claim amount is matched with the preset amount threshold means that the claim amount is smaller than or equal to the preset amount threshold. In the verification rule, when the electronic form data are obtained, comparing a list of numerical values of the claim amount in the electronic form data with a preset amount threshold value, determining whether the numerical value of the claim amount is smaller than or equal to the preset amount threshold value, if the numerical value of the claim amount is smaller than or equal to the preset amount threshold value, determining that the claim amount is matched with the preset amount threshold value, and verifying that the data verification result is effective. The value of the claim amount is larger than a preset amount threshold, the fact that the claim amount in the electronic form is not matched with the preset amount threshold is determined, and the data verification result is that verification is invalid.
Step S30, second electronic form data of valid claim cases are obtained based on the data verification result, and prompt information of invalid data is displayed for invalid data;
the second electronic form data in this embodiment refers to data of claim cases that are obtained by screening and effective in verification based on a verification result after the first electronic form data is verified based on a preset verification rule.
Redundant repeated case information and case data which are not checked and are invalid and are not matched with a preset amount threshold value can be displayed on a current display interface in the form of prompt information, and the prompt information comprises characters of reasons for failing to check and corresponding specific case information. And the table corresponding to the first electronic table data can be displayed, and the corresponding abnormal case information is marked in the electronic table. The electronic form displaying the case data with invalid verification can be set to be in an editable state for the business personnel to modify and edit, the user can delete or modify the data which does not pass the verification through a preset function button, such as the operation of modifying the compensation amount, and the like, and then the user modified data is checked again.
And for the valid verification claim case data, the valid verification claim case data can be extracted on the basis of reserving the format of the electronic form template, and the valid verification second electronic form data can be obtained.
Step S40, extracting the claim data of each claim case one by one from the second electronic form data, and generating case codes for the claim data of each extracted claim case;
case coding refers to coding information which is generated based on data of each claim case and corresponds to the claim case one by one. For example, if each row of data in the electronic form is data of one claim case, a corresponding case code may be generated for each row of data, respectively. The case code may include information such as an identification code identifying the claim case as a small claim case, the identity of the insured, the order number of the processes, and a digital code of the policy number.
And S50, generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position.
In this embodiment, the preset case identification refers to a preset identification for marking the case of claim as a case-setting state, so that the user or the system can identify the case state, and the preset case identification can be a specific letter identification, for example, "F" in "finish", or a specific vocabulary, for example, "case-setting". The case setting information can be a case setting report or a case setting text which passes through a preset standardized field or format through the claim data, the case code and the preset case setting identifier. Taking the case settling information as an example of a case settling report, a case settling report template can be designed in advance, and when the information such as the claim settling data, the case coding, the case settling presetting and the like of one claim settling case is obtained, the obtained information is respectively filled in the corresponding positions in the report template, and the case settling report of the claim settling case is generated. After the case report is generated, the case report is stored in a storage position of a preset case report for relevant users to check.
In the embodiment, first electronic form data of batch claim settlement cases are obtained based on claim settlement data of batch claim settlement cases input by a first user on a preset electronic form template; checking the first electronic form data in a multithreading mode based on a preset checking rule to obtain a data checking result of each claim case; obtaining second electronic form data of valid claim case verification based on the data verification result, and displaying prompt information of invalid data for the invalid data; extracting the claim data of each claim case from the second electronic form data one by one, and generating case codes for the claim data of each extracted claim case; generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position. According to the method, batch receiving and processing of the claim case are achieved based on the preset electronic form template and the multithreading data processing mode, data processing efficiency is improved, case codes are generated on the valid claim case data after verification is conducted on the data based on the preset data verification rule of the small claim case, case information is generated on the basis of the case codes, the claim data and the case forming identification, batch case forming of the claim case is completed, accordingly case data providing links are simplified, complex auditing links are avoided, meanwhile, the validity of the data and the reliability of the case forming information are guaranteed through data verification, and meanwhile the processing efficiency of the small claim case is improved while reliable case processing results are obtained.
Referring to fig. 3, fig. 3 is a flowchart illustrating a second embodiment of the claim data processing method according to the present invention.
Based on the above embodiment, in this embodiment, the preset storage location includes a preset personal storage location where the location information is associated with the identity information of the first user, and step S50 includes:
step S60, receiving a viewing instruction triggered by a second user for viewing the claim case information processed by the first user, wherein the viewing instruction comprises the identity information of the first user;
based on the above embodiments, in this embodiment, the location information refers to storage address path information of each storage location, and the identity information of the first user may be account information of the login system of the first user. A specific case formation information storage position, that is, a preset personal storage position, may be allocated in advance for each user, so as to store case formation information processed by the corresponding user, and correlate identity information such as account information of the user with position information of the personal storage position. The second user of the embodiment refers to a user who needs to view or audit the case information of the first user, for example, the upper part of a salesman. The second user can trigger an instruction for viewing the case information processed by the specific first user through a preset viewing function button in the system, wherein the viewing instruction comprises identity information of the first user of the viewing object.
Step S70, determining the storage position of the case settling information processed by the first user according to the position information associated with the identity information of the first user;
when receiving the checking instruction, extracting the identity information of the first user in the checking instruction, determining the position information associated with the identity information according to the extracted identity information of the first user, and determining the storage position of the data to be checked by the second user according to the position information.
S80, acquiring corresponding case settling information from a storage position of the case settling information processed by the first user, and displaying the acquired case settling information.
And when the storage position of the data to be checked by the second user is determined, acquiring stored case making information from the storage position, and displaying the acquired case making information on a display interface of the current operation terminal of the second user. In this embodiment, a specific time length may be preset, and when a user-triggered viewing instruction is received, a time starting point may be calculated from the time when the instruction is received as a time end point based on the preset time length, and the case information between the time starting point and the time end point may be acquired and displayed.
In this embodiment, the preset storage location includes a preset personal storage location where the location information is associated with the identity information of the first user, and receives a viewing instruction triggered by the second user to view the claim case information processed by the first user, where the viewing instruction includes the identity information of the first user; determining a storage position of the case settling information processed by the first user according to the position information associated with the identity information of the first user; and acquiring corresponding case settling information from a storage position of the case settling information processed by the first user, and displaying the acquired case settling information. By the method, the case settling information of the specific first user is checked by the relevant user.
Further, fig. 4 is a schematic flow chart of a third embodiment of the method for processing claim data according to the present invention.
Based on the above embodiment, in the present embodiment, step S20 includes:
step S90, comparing the data of each claim case in the first electronic form data in a pair-wise manner based on a first preset repeatability check rule, and determining whether two or more consistent claim case data exist;
in this embodiment, the first preset repeatability verification rule refers to a verification rule for determining whether a repeated claim case exists in the claim cases corresponding to the first spreadsheet data. The method comprises the steps of obtaining insured name information of claim settlement data of each row in first electronic form data, comparing and matching insured information of each row, identifying identical insured information, obtaining the date information of the insurance emergence or the claim liability information of the same row of tables in the first electronic form data for identical insured information, comparing the date of the insurance emergence and the claim liability information of claim settlement cases of identical insured persons, and determining whether the two information are consistent or not, so as to determine whether two or more than one piece of continuous claim settlement case data exist in the first electronic form data.
Step S100, if the data are consistent, determining that the data are repeated;
if the date of the adventure and the information of the reimbursement responsibility of the reimbursement cases of the same insured person are consistent, for example, the information of the reimbursement responsibility of the same date of the adventure is the ticket refund responsibility of the same class, the two reimbursement cases are determined to be the reimbursement cases of the reimbursement.
Step S110, determining the data verification result of any one of the repeatedly-recorded claims to be valid, and determining the data verification results of other repeatedly-recorded claims except the valid claims to be invalid.
When the repeated input claim cases are determined, the data verification result of any one of the repeated input claim cases is determined to be valid in verification, and the data verification results of other repeated input claim cases except the valid claim cases are determined to be invalid in verification. Specifically, if each row of data in the electronic form corresponds to one claim case, where two or more rows of claim cases corresponding to data are repeated entry claim cases, the data verification result of the first row of claim cases with the row number may be determined to be valid, and the data verification results of other rows of repeated entry claim cases are determined to be invalid.
In the embodiment, the data of each claim case in the first electronic form data are compared in pairs based on a first preset repeatability verification rule in a multithreading mode, and whether two or more consistent claim case data exist is determined; if the data are consistent, determining that the claim case with consistent data is a repeated input claim case; and determining the data verification result of any one of the repeatedly-recorded claims to be valid, and determining the data verification results of other repeatedly-recorded claims except the valid data verification to be invalid. By the method, the fact that the data verification result of redundant claim settlement cases in the repeated input claim settlement cases in the first electronic form data is determined to be invalid is achieved, repeated settlement case information is avoided, and repeated compensation is avoided.
Further, fig. 5 is a flowchart of a fourth embodiment of the method for processing claim data according to the present invention.
Based on the above embodiment, in the present embodiment, step S20 includes:
step S120, comparing the data of each claim case in the first electronic form data with the pre-stored case information in a multi-thread mode based on a second preset repeatability check rule, and determining whether the claim case matched with the pre-stored case information exists in the first electronic form data;
Based on the above embodiments, in the present embodiment, the second duplication verification rule refers to a verification rule that determines whether or not the claim case corresponding to the first table data and the claim case corresponding to the case settlement information are duplicate claim cases. For the case of claim of the deposited case, the corresponding deposited information may be stored in a pre-stored deposited information database, in which the deposited information may be classified and stored based on the information such as the deposited time or the deposited place, and specifically, the deposited information of the same month may be stored in the same storage address path. In the process of checking the first electronic form data, electronic form data imported by business personnel are compared with the claim elements of the claim case settling information of the settling in the history time period preset in the claim settling system one by taking the claim settling case as a unit, whether the case with the consignee information, the risky date information and the reimbursement responsibility information consistent with the imported case elements exists in the settling information is determined, and accordingly whether the case identical with the imported case exists in the cases is determined.
Step S130, if the data of the claim case matched with the pre-stored case information is checked to be invalid.
Based on step S120, if cases exist in the case formation information, in which the insured person information, the date information of the adventure, and the reimbursement liability information are all consistent with the imported case elements, it is determined that case formation information repeated with the case formation is present in the electronic form data, and then the data verification result of the claim case matched with the pre-stored case formation information is determined as verification invalidation.
In this embodiment, comparing the data of each claim case in the first electronic form data with the pre-stored case information in a multithreading manner based on a second preset repeatability verification rule, and determining whether the claim case matched with the pre-stored case information exists in the first electronic form data; if the data of the claim case matched with the pre-stored case information is checked, the data check result of the claim case matched with the pre-stored case information is determined to be invalid. By the method, the data verification result of the claim case which is repeated with the case settling information in the first electronic form data is determined to be invalid in verification, and repeated case settling information is avoided, so that repeated reimbursement is avoided.
Further, fig. 6 is a schematic flow chart of a fifth embodiment of the method for processing claim data according to the present invention.
Based on the above embodiment, in the present embodiment, step S20 includes:
Step S140, comparing the data of each claim case in the first electronic form data with the historical effective electronic form data in a multithreading mode based on a third preset repeatability check rule, and determining whether the claim case matched with the historical effective electronic form data exists in the first electronic form data;
based on the above embodiment, in this embodiment, the third preset repeatability verification rule refers to a verification rule that determines whether the claim case corresponding to the first table data and the claim case corresponding to the history valid electronic table data are the repeated claim cases. In this embodiment, for the second spreadsheet data that is valid after each data verification, the format of the spreadsheet may be kept and stored in the preset database, and in the process of verifying the first spreadsheet data each time, the first spreadsheet data is compared with the historical valid spreadsheet data existing in the preset database, so as to determine whether the column allocation case corresponding to the first spreadsheet data is matched with the historical valid spreadsheet data, i.e. determine whether the first spreadsheet number has a claim case matched with the historical valid spreadsheet data.
And step S150, if the data of the claim case matched with the historical electronic table data exist, determining the data verification result of the claim case as invalid verification.
Based on step S140, if the claim case in the first electronic form data and the history valid electronic form data have the claim case matched with the history valid electronic form data, determining that the data verification result of the claim case matched with the history electronic form data is determined to be invalid.
In the embodiment, comparing the data of each claim case in the first electronic form data with the historical effective electronic form data in a multithreading mode based on a third preset repeatability verification rule, and determining whether the claim case matched with the historical effective electronic form data exists in the first electronic form data; and if so, determining the data verification result of the claim case matched with the historical electronic table data as verification invalidation. By the method, the data verification results of the repeated claim settlement cases in the first electronic table data and the historical effective electronic table data are determined to be invalid in verification, repeated case settlement information is avoided, and repeated compensation is avoided.
Further, fig. 7 is a flowchart of a sixth embodiment of the method for processing claim data according to the present invention. The application information includes identity information of the applicant, and step S20 includes:
step S160, comparing the claim amount of each claim case in the first electronic form data with a preset amount threshold value in a multithreading mode based on a preset claim amount checking rule, and determining whether the claim amount is larger than the preset amount threshold value;
based on the above embodiment, in this embodiment, the preset amount threshold may be set according to the guard amount of the small-amount claim settlement agreement, and the fact that the claim amount matches the preset amount threshold means that the claim amount is less than or equal to the preset amount threshold. In the verification rule, when the first electronic form data is obtained, comparing a column of numerical values of the claim amount in the first electronic form data with a preset amount threshold value, and determining whether the numerical value of the claim amount is larger than the preset amount threshold value.
Step S170, if the claim amount is greater than the preset amount threshold, determining that the data verification result of the claim case that the claim amount is greater than the preset amount threshold is invalid.
If the value of the claim amount is larger than the preset amount threshold, determining that the claim amount does not accord with the rule of the claim settlement agreement, and verifying that the data verification result of the claim case corresponding to the claim amount is invalid. If the value of the claim amount is smaller than or equal to the preset amount threshold, determining that the claim amount is matched with the preset amount threshold, and determining that the data verification result of the claim case corresponding to the claim amount is verification passing.
In this embodiment, a multithreading mode is adopted to compare the claim amount of each claim case in the first electronic form data with a preset amount threshold based on a preset claim amount verification rule, and whether the claim amount is larger than the preset amount threshold is determined; if the claim amount is larger than the preset amount threshold, determining that the data verification result of the claim case with the claim amount larger than the preset amount threshold is invalid. By the method, the first electronic form data can be verified based on the preset amount, the data verification result of the claim case with the claim amount larger than the preset amount is determined to be invalid in verification, and the non-small claim case is prevented from being processed according to the processing method of the small claim case.
In addition, the embodiment of the invention also provides a device for processing the claim data.
Referring to fig. 8, fig. 8 is a schematic diagram of functional modules of a first embodiment of the claim data processing apparatus according to the present invention.
In this embodiment, the claim data processing apparatus includes:
the first obtaining module is used for obtaining first electronic form data of batch claim settlement cases based on the claim settlement data of batch claim settlement cases input by the first user on the preset electronic form template;
The verification module is used for verifying the first electronic form data in a multithreading mode based on a preset verification rule to obtain a data verification result of each claim case;
a second obtaining module for obtaining second electronic form data of valid claim case based on the data verification result and displaying data invalid prompt information for invalid data
A first generation module for extracting the claim data of each claim case from the second electronic form data one by one and generating case codes for the claim data of each extracted claim case
The second generation module is used for generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position.
Wherein, each virtual function module of the claim data processing device is stored in the memory 1005 of the claim data processing device shown in fig. 1, and is used for implementing all functions of the claim data processing program; the modules, when executed by the processor 1001, may perform efficient processing for small claims cases.
Further, the claim data processing device further includes:
The receiving module is used for receiving a viewing instruction triggered by a second user for viewing the claim case information processed by the first user, wherein the viewing instruction comprises the identity information of the first user;
the determining module is used for determining the storage position of the case settling information processed by the first user according to the position information associated with the identity information of the first user;
the display module is used for acquiring corresponding case settling information from the storage position of the case settling information processed by the first user and displaying the acquired case settling information
Further, the verification module is further configured to:
based on a first preset repeatability verification rule, carrying out pairwise comparison on the data of each claim case in the first electronic form data in a multithreading mode, and determining whether two or more consistent claim case data exist;
if the data are consistent, determining that the claim case with consistent data is a repeated input claim case;
and determining the data verification result of any one of the repeatedly-recorded claims to be valid, and determining the data verification results of other repeatedly-recorded claims except the valid data verification to be invalid.
Further, the verification module is further configured to:
Comparing the data of each claim case in the first electronic form data with the pre-stored case information in a multithreading mode based on a second preset repeatability verification rule, and determining whether the claim cases matched with the pre-stored case information exist in the first electronic form data;
if the data of the claim case matched with the pre-stored case information is checked, the data check result of the claim case matched with the pre-stored case information is determined to be invalid.
Further, the verification module is further configured to:
comparing the data of each claim case in the first electronic form data with the historical effective electronic form data in a multithreading mode based on a third preset repeatability verification rule, and determining whether the claim case matched with the historical effective electronic form data exists in the first electronic form data;
and if so, determining the data verification result of the claim case matched with the historical electronic table data as verification invalidation.
Further, the verification module is further configured to:
comparing the claim settlement amount of each claim settlement case in the first electronic form data with a preset amount threshold value in a multithreading mode based on a preset claim settlement amount verification rule, and determining whether the claim settlement amount is larger than the preset amount threshold value;
If the claim amount is larger than the preset amount threshold, determining that the data verification result of the claim case with the claim amount larger than the preset amount threshold is invalid.
In addition, the embodiment of the invention also provides a computer readable storage medium.
The present invention stores a claim data processing program on a computer-readable storage medium, wherein the claim data processing program, when executed by a processor, implements the steps of the claim data processing method as described above.
The method implemented when the claim data processing program is executed may refer to various embodiments of the method for claim data processing according to the present invention, which are not described herein.
It should be noted that, in this document, the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or system that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or system. Without further limitation, an element defined by the phrase "comprising one … …" does not exclude the presence of other like elements in a process, method, article, or system that comprises the element.
The foregoing embodiment numbers of the present invention are merely for the purpose of description, and do not represent the advantages or disadvantages of the embodiments.
From the above description of the embodiments, it will be clear to those skilled in the art that the above-described embodiment method may be implemented by means of software plus a necessary general hardware platform, but of course may also be implemented by means of hardware, but in many cases the former is a preferred embodiment. Based on such understanding, the technical solution of the present invention may be embodied essentially or in a part contributing to the prior art in the form of a software product stored in a storage medium (e.g. ROM/RAM, magnetic disk, optical disk) as described above, comprising instructions for causing a terminal device (which may be a mobile phone, a computer, a server, an air conditioner, or a network device, etc.) to perform the method according to the embodiments of the present invention.
The foregoing description is only of the preferred embodiments of the present invention, and is not intended to limit the scope of the invention, but rather is intended to cover any equivalents of the structures or equivalent processes disclosed herein or in the alternative, which may be employed directly or indirectly in other related arts.
Claims (6)
1. A method of processing claim data, the method comprising:
acquiring first electronic form data of batch claim settlement cases based on the claim settlement data of batch claim settlement cases input by a first user on a preset electronic form template;
checking the first electronic form data in a multithreading mode based on a preset checking rule to obtain a data checking result of each claim case;
obtaining second electronic form data of valid claim case verification based on the data verification result, and displaying prompt information of invalid data for the invalid data;
extracting the claim data of each claim case from the second electronic form data one by one, and generating case codes for the claim data of each extracted claim case;
generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position;
the step of checking the first electronic form data in a multithreading mode based on a preset checking rule to obtain the data checking result of each claim case comprises the following steps:
comparing the data of each claim case in the first electronic form data in a pair-wise manner based on a first preset repeatability check rule, and determining whether two or more consistent claim case data exist, wherein the first preset repeatability check rule comprises a check rule for determining whether repeated claim cases exist in claim cases corresponding to the first electronic form data;
If the data are consistent, determining that the claim case with consistent data is a repeated input claim case;
determining the data verification result of any one of the repeatedly recorded claims to be valid, and determining the data verification results of other repeatedly recorded claims except the valid data verification to be invalid;
comparing the data of each claim case in the first electronic form data with the pre-stored case information in a multithreading mode based on a second preset repeatability verification rule, and determining whether the claim cases matched with the pre-stored case information exist in the first electronic form data;
if so, determining the data verification result of the claim case matched with the pre-stored case information as invalid verification;
comparing the data of each claim case in the first electronic form data with the historical effective electronic form data in a multithreading mode based on a third preset repeatability verification rule, and determining whether the claim case matched with the historical effective electronic form data exists in the first electronic form data;
if so, determining the data verification result of the claim case matched with the historical valid electronic table data as verification invalid;
Comparing the claim settlement amount of each claim settlement case in the first electronic form data with a preset amount threshold value in a multithreading mode based on a preset claim settlement amount verification rule, and determining whether the claim settlement amount is larger than the preset amount threshold value;
if the claim amount is larger than the preset amount threshold, determining that the data verification result of the claim case with the claim amount larger than the preset amount threshold is invalid.
2. The claim data processing method of claim 1, wherein the first spreadsheet data includes at least an insurance policy number, an insured name, a date of emergence, an claim liability, or an amount of claim for each claim case.
3. The method of claim 1, wherein the predetermined storage locations comprise predetermined personal storage locations having location information associated with identity information of the first user, and wherein storing the respective case information in the predetermined storage locations comprises:
receiving a viewing instruction triggered by a second user for viewing the claim case information processed by the first user, wherein the viewing instruction comprises the identity information of the first user;
determining a storage position of the case settling information processed by the first user according to the position information associated with the identity information of the first user;
And acquiring corresponding case settling information from a storage position of the case settling information processed by the first user, and displaying the acquired case settling information.
4. A claim data processing apparatus, the claim data processing apparatus comprising:
the first obtaining module is used for obtaining first electronic form data of batch claim settlement cases based on the claim settlement data of batch claim settlement cases input by the first user on the preset electronic form template;
the verification module is used for verifying the first electronic form data in a multithreading mode based on a preset verification rule to obtain a data verification result of each claim case;
the second obtaining module is used for obtaining second electronic form data of valid claim case verification based on the data verification result and displaying prompt information of invalid data for the invalid data;
the first generation module is used for extracting the claim data of each claim case one by one from the second electronic form data and generating case codes for the claim data of each extracted claim case;
the second generation module is used for generating the case settling information of each claim settling case based on the claim settling data, the case codes and the preset case settling identification of each claim settling case, and storing each case settling information in a preset storage position;
The verification module is further configured to perform pairwise comparison on data of each claim case in the first electronic form data based on a first preset repeatability verification rule in a multithreading manner, and determine whether two or more identical claim case data exist, where the first preset repeatability verification rule includes a verification rule for determining whether the claim case corresponding to the first electronic form data exists or not; if the data are consistent, determining that the claim case with consistent data is a repeated input claim case; determining the data verification result of any one of the repeatedly recorded claims to be valid, and determining the data verification results of other repeatedly recorded claims except the valid data verification to be invalid;
the verification module is further used for comparing the data of each claim case in the first electronic form data with the pre-stored case information in a multi-thread mode based on a second preset repeatability verification rule, and determining whether the claim cases matched with the pre-stored case information exist in the first electronic form data; if so, determining the data verification result of the claim case matched with the pre-stored case information as invalid verification;
The verification module is further used for comparing the data of each claim case in the first electronic form data with the historical effective electronic form data in a multithreading mode based on a third preset repeatability verification rule, and determining whether the claim cases matched with the historical effective electronic form data exist in the first electronic form data; if so, determining the data verification result of the claim case matched with the historical valid electronic table data as verification invalid;
the verification module is further configured to compare the claim amount of each claim case in the first electronic form data with a preset amount threshold in a multithreading manner based on a preset claim amount verification rule, and determine whether the claim amount is greater than the preset amount threshold; if the claim amount is larger than the preset amount threshold, determining that the data verification result of the claim case with the claim amount larger than the preset amount threshold is invalid.
5. A claim data processing apparatus comprising a processor, a memory, and a claim data processing program stored on the memory and executable by the processor, wherein the claim data processing program, when executed by the processor, performs the steps of the claim data processing method of any one of claims 1 to 3.
6. A computer-readable storage medium, on which a claim data processing program is stored, wherein the claim data processing program, when executed by a processor, implements the steps of the claim data processing method of any one of claims 1 to 3.
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| CN111680693A (en) * | 2020-05-28 | 2020-09-18 | 泰康保险集团股份有限公司 | Method and device for batch processing of claim settlement services |
| CN111932196A (en) * | 2020-07-08 | 2020-11-13 | 泰康保险集团股份有限公司 | Case processing method, device and equipment and readable storage medium |
| CN112069182B (en) * | 2020-09-03 | 2025-01-10 | 中国平安财产保险股份有限公司 | Batch reporting method, device, equipment and storage medium |
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