人身意外伤害险和健康险理赔系统设计本科学位论文.docVIP

 人身意外伤害险和健康险理赔系统 摘要 人身意外伤害保险，又称为意外或伤害保险。是指投保人向保险公司缴纳一定金额的保费，当被保险人在保险期限内遭受意外伤害，并以此为直接原因造成死亡或残废时，保险公司按照保险合同的约定向保险人或受益人支付一定数量保险金的一种保险。健康险 健康险，是指保险公司通过疾病保险、医疗保险、失能收入损失保险和护理保险等方式对因健康原因导致的损失给付保险金的保险。 由于保险公司意健险业务的迅速发展、产品种类及业务类型不断多样化，录单的智能化，意健险的理赔各环节流程均需要优化，原有系统越来越难以满足实际业务的需要。例如，新流程中支持多条件快速查询出险人信息、同一被保险人一次事故多张保单在同一赔案下处理、批次理赔、出险的批次导入，各环节下的赔案信息查询，同一赔案下出多张理算书，各环节均可提起理赔调查、理赔过程中提交二次核保等。由于意外险比一般财产保险业务的盈利高，效益好，规模稳定，管理成本低，所以在国外是产险公司竞相争夺的业务领域，国内意外险市场的竞争也会迅速激烈起来，所以业务会越来越多，这就要求案件的处理要快速、精确、风险评估。 关键字 人身意外保险  Personal accident insurance and health insurance Abstract Personal accident insurance, also called as accident insurance or casualty insurance refers to the insurance that the policy holder pays a certain amount of premium to the insurer. When accidental injuries are incurred and hence cause death or dismemberment to the insured, the insurer reimburses a certain amount of premium contracted to the insured or beneficiary. Health insurance refers to insurance coverage that the insurer reimburse for the loss incurred by health issues by disease insurance, medical insurance, disability income insurance and care insurance. Due to the fast expansion of the lines of business of accident and health insurance as well as a growing number of products and business types, automatic documentation and all procedures for claims need to be optimized, while the previous system falls behind the actual needs. For example, new procedures support multi-condition inquiry for information of the insured, management of multi-policies for the same insured under one accident in the claim settlement, batch claims, batch import of policies, inquiry for claims information, the creation of multi-adjustment letters, the initiation of claim investigation during the process and filing re-underwriting in claims, etc. As the line of business of accident insurance enjoys a greater profit, a more stable scale and a lower cost in management than that of common property insurance, it has becomes a highly competitiv