In the eyes of the industry, the traditional insurance audit link needs huge human support, and it has extremely high professional requirements and needs medical and pharmaceutical background. The labor cost of the audit team alone is not a small expenditure. Using claims rules instead of claims personnel can reduce the error rate and increase the limit of insurance claims. Take "good medical insurance" as an example. From June, 20 17 to September, 20 18, all claims for good medical insurance were made by offline mail, and the claims were completed within 15 days on average. By introducing intelligent compensation tools in the front end, optimizing the system and reducing rules and processes, the limitation of claims is reduced to about three days within three years, and at present, more than 90% cases are closed within two days.
In recent years, insurance companies pay more and more attention to user experience and improve the efficiency of insurance claims service. "Claim limit" is an important indicator reflecting the ability of insurance companies to claim compensation services. 202 1, the average claim limit of each insurance company is mostly within 2 days. However, this claim limitation is not what insurance consumers usually understand.
Li Yong pointed out that this prescription is the concept of average prescription, which is very different from the prescription perceived by users. The main reason may be that the composition of cases handled by various insurance companies is different, such as a large number of small outpatient cases, which are relatively low in complexity, so the payment time will be relatively short. For example, the overall handling of group insurance business is relatively simple, and there is a special person to collect it in the stagnation unit. After collection, it is processed in batches, and the user's perception is very slow.
In addition to the differences in various types of insurance, there is also the problem of statistical methods. Li Yong pointed out that we have seen that some insurance companies have collected all the claims materials online. After the audit is completed, the user will be asked to send the original, and the time when the original materials are received is the time when the materials are complete, so the time for closing the case will be more time-consuming and time-consuming.
It is worth mentioning that for some small cases, the insurance company's claim report can already make daily compensation or even second compensation. Li Yong took two insurance companies in the industry as examples. Company A promises to pay 1 day for less than 20,000 yuan, and company B promises to pay 1 day for less than 1 yuan. It is estimated that Company A can only cover about 35% of the cases, and less than 50% of users of Company B can feel it. Due to the existence of claim materials, it has been recalled many times.
Recently, at the online conference on the upgrade of ant insurance claims technology, a number of insurance agent claims leaders expounded their professional opinions on the pain points of claims including prescriptions.
According to Wiki, the head of the claims department of PICC Health Internet Insurance Division, the pain point of insurance claims lies in the difference between the growing claims expectation and the actual claims. Specifically, it mainly includes services that can be compensated, compensated quickly and compensated. In the past ten years, many peers have sought reasons for customers to claim compensation, announced their commitment to limit claims in the industry, and implemented services including advance payment.
Cai Liming, general manager of Ping An Health Insurance Claims Department, pointed out that the three major pain points of health insurance claims include that customers don't understand the reasons for refusing compensation, can't provide the materials required by insurance companies, and time limit. For the limit of claims, most insurance companies have been quick, but it is still an average limit. For more complicated cases, especially those that need to be investigated, the overall handling restrictions are still relatively slow. In the process of waiting, customers don't know whether they can get compensation, and there will be cases of calling for advice or urging compensation.
Wang Jianmin, general manager of the underwriting department of Guohua Life Insurance, said that medical insurance accounts for more than 90% of claims in the whole industry, and the amount is generally small claims. For this kind of insurance with high frequency and low compensation, customers pay more attention to the speed and convenience of application. On the one hand, no matter whether you can compensate or not, you can complete the claim application quickly and conveniently. On the other hand, how much you can lose, how much you can lose, and how to calculate, the conclusion is clearly displayed to customers. For critical illness insurance with low frequency and high compensation, the conclusion of claim is more important than the length of claim.
The China Insurance Association pointed out that at present, most insurance institutions have low online coverage of customer service claims, poor timeliness of claims and poor after-sales customer experience, which leads to the growth of Internet insurance business and the increase of customer complaints. In view of this situation, insurance companies should strengthen their online claims ability, improve the online coverage of customer claims, build differentiated service ability of customer service claims, optimize after-sales customer experience, and use advanced Internet technology to overcome the communication costs brought to consumers and insurers by the mass, fragmentation and innovation of Internet insurance.
"In the last 3-5 years, the biggest change in insurance claims is online claims service." Cai Liming said that thanks to the promotion of Internet insurance platforms such as Ant Insurance, customers can report cases and submit materials online, and insurance companies can give customers various operational guidelines in the process of online services. In terms of claims processing progress, customers can obtain information in real time, which greatly facilitates customers and has a very wide audience. In the past, customers needed offline service stores or unified customer service phone numbers to understand these services.
In Cai Liming's view, online claims service not only significantly improves the timeliness and efficiency of claims, but also promotes the standardization and transparency of claims standards and procedures in the insurance industry.
The 14th Five-Year Development Plan of Insurance Technology issued by insurance association of china shows that during the 14th Five-Year Plan period, the rate of promoting the industry to realize claim automation exceeded 40%. In Wang Jianmin's view, whether it is life insurance, health insurance or property insurance, the automation rate of industry claims is generally low. In recent years, the industry has actively explored refined scene design and refined customer experience in the field of science and technology. Taking the claim brain project as an example, in the scene of customer data uploading process, the application of AI technology can identify 107 kinds of medical and claim vouchers, and complete the clarity, integrity and identification of uploaded data.
For example, when users upload photos of "hospitalization certificate", the system will inform them that the file that should be uploaded is "hospitalization summary", and display the schematic diagram of hospitalization summary and how to obtain it. With the help of the claims brain, 90% of users can get approval at the first submission, which basically realizes the "one-time submission" of materials. It not only saves users' time and energy in the process of reporting cases, but also helps to improve the filing efficiency of insurance companies. Auditors can enter the salary process more quickly without having to review and return the application materials many times.
National business daily