Study On Insurance Claims Management Based On Risk Control

Vehicle insurance is the leading product of Y Insurance Company Shaanxi Branch, whichaccounts for about86%in Y Insurance Company Shaanxi Branch, so the business results ofvehicle insurance will directly determine the performance of the company. For improving themanagement quality of vehicle insurance, the role of claim settlement quality appears asimportant as sticking to strict control over the underwriting quality. The key of claimsettlement control and management is to strengthen the research on the occurrence rule ofhigh-risk cases and summarize the types of high-risk cases and their main risk points;meanwhile, based on the idea of risk control and management, the procedure of claimsettlement should also be reorganized. It will have a very positive role in improving themanagement performance of vehicle insurance of Shaanxi Branch to strengthen the researchon the control and management of high-risk cases of vehicle insurance. Through the datastatistics and analysis about claim settlement cases, it is made clear that strengthening thecontrol and management of high-risk vehicle insurance cases is the key element for YInsurance Company Shaanxi Branch to control the rise of loss ratio. In terms of the insurancebusiness of the motor vehicles, it’s also advisable to establish the new development strategyof vehicle insurance business, enhance the underwriting management of vehicle insurance andcontrol the overall loss ratio level through the identification of high-risk cases and theirsystem management so as to ensure a healthy and sustainable development of companybusiness.At present, the claim settlement control and management of Y Insurance CompanyShaanxi Branch depends on the amount involved in the case to distinguish the case level; atthe same time, the corresponding legal authorization of cases is supported. The procedures ofclaim settlement are carried out through the authorization setting of the amount. This kind ofmanagement mode cannot reflect the discovery, identification, control and management ofclaim settlement as to the risks of cases. In this paper, tools like trend index analysis, industry index analysis, type analysis of high-risk cases are applied to screen high-risk claimsettlement cases in a comprehensive and multi-dimensional way. The follow-up trackingreview of cases is strengthened and the validation verification is carried out on the new claimsettlement model so as to improve the reliability of new claim settlement model.The research of this paper aims at finding out the law of high-risk cases of vehicleinsurance and using the data analysis based on behavior characteristics and models for thehigh-risk cases of vehicle insurance so as to determine the types of high-risk cases of vehicleinsurance and take corresponding measures of control and management. Through themechanism of risk discovery, it is summarized that small-amount high-risk cases, serious cardamage cases, operating truck cases and cases involving injury are the focus of the claimsettlement control and management of Y Insurance Company Shaanxi Branch. Themanagement of the above4types of cases is strengthened to get the corresponding risk points.At the same time, based on the idea of risk control and management, the claim settlementprocedure is re-constructed so as to realize the automatic discovery mechanism of high-riskclaim settlement cases, sequentially establish the case risk control and management engine inthe new claim settlement system and achieve the automatic system reminding and launchingfor the end users of high-risk cases. Meanwhile, the relevant history information of claimsettlement cases is shown. In this way, the rising trend of loss ratio of Y Insurance CompanyShaanxi Branch will be effectively controlled so as to make the company fulfill thetransformation from the payer of insurance to the manager of claim settlement risk.