With the development of science and technology, how to integrate new technologies such as big data and artificial intelligence into products and services to improve customer service quality has become an important issue for life insurance companies.

Recently, Ping An Life has innovatively launched the "AI intelligent automatic decision-making model", which realizes the "full-process manual-free" claims review operation, and builds a new industry-leading claims review model to provide customers with time-saving, worry-free and money-saving claims services.

Currently, “labor-free” cases in Ping An Life’s claim settlement review operations account for 1%, and the proportion is expected to increase to 20% by the end of this year.

  In the traditional review mode, claims cases need to manually check up to 30 types of claims data one by one, and make liability judgments based on more than 1,000 product responsibilities and terms. At the same time, it is necessary to consider various differences such as local medical insurance policies and designated hospitals to complete the compensation amount. In terms of calculation, there are pain points such as low review efficiency, long case timeliness, and high error risk.

"AI intelligent automatic decision-making model" through the application of AI technology, the original manual review of claims cases, the AI ​​model completes the process of automatic review of claims data, active identification of liability risks and automatic calculation of compensation amount, and the whole process is realized without manual intervention. It has the characteristics of "fast aging, excellent risk control and low cost".

  Specifically, in terms of timeliness, the "AI intelligent automatic decision-making model" uses AI to intelligently read claims data, and the timeliness of reviewed cases has been increased from the original 0.5-2 days to the second level, which greatly shortens the time for customers from claim settlement to claim. Wait time.

In terms of risk control, the model collects 4 million claims cases and builds a disease library and accident scene library covering more than 5,000 diseases. Through the massive aggregation of claims risk points and independent judgment, the uncertainty of relying on manual experience for risk judgment in the past has been changed. more accurate risk management and control.

In terms of cost, with the effective application of AI models, the claims settlement team will also be transformed from a “human-scale” operation team to a “knowledge-intensive” expert team, greatly improving production capacity and efficiency.

In addition, the claims expert team will also serve as an "AI trainer" to continuously train the AI ​​model and continuously optimize the model algorithm and audit accuracy.

  Liu Qiang, Deputy General Manager of the Claims Operation Team of the Customer Service Department of Ping An Life, introduced that before the "AI intelligent automatic decision-making model" is launched, a large amount of claim information, such as identity information, bank cards, diagnosis and treatment information, etc., needs to be checked for case review. Reading the insurance liability and liability exemption of different products, and calculating the amount of compensation in combination with local medical insurance policies, designated hospitals and other differentiated information, deductibles, etc., is time-consuming and labor-intensive and prone to errors.

Now the "AI intelligent automatic decision-making model" will automatically check the basic information of the case, save the time for case review, and will also provide certain claims settlement reminders in some areas that are easily overlooked. When calculating the amount of compensation, manual calculations are reduced, errors are avoided, and work is improved. efficiency.

"The claims settlement team saves time in checking basic information and making adjustments, and has more time and energy to focus on risk assessment and customer service, thus giving play to greater professional value."

  Shi Weiyu, deputy general manager of Ping An Life, said that the "AI intelligent automatic decision-making model" proves the feasibility of applying AI technology in the direction of claims review operations. With the expansion of the application scale, it will lead a revolution in the backup operation mode of insurance companies.

Ping An Life will increase the proportion of AI audits to 20% by the end of this year, and strive to exceed 50% in the next three years, so as to truly give full play to the role of technology and digitalization in operational services and create a more extreme experience for customers.

  "With the help of digital empowerment, Ping An Life has built an intelligent claims settlement system centered on 'flash claims' and 'smart advance claims', and has continued to create warm claims settlement services. Claim settlement is not just a simple payment of insurance money, Driven by technology, we can resolve risks for customers in a timely manner, so that customers can get a better feeling, speed and warmth." Shi Weiyu said.

According to the data, as of 2021, Ping An Life has accumulated over 6.28 million 30-minute quick compensation cases, with a compensation amount exceeding 13.2 billion yuan; the accumulated number of smart pre-compensation cases exceeded 52,000, with an amount exceeding 1.96 billion yuan.

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