Research On A Company's Short Term Health Insurance Claims Practice Risk Management

With the progress of science and technology and the development of the times,China's medical reform is also ongoing,the medical system is constantly improved,and health business insurance also ushered in a new round of challenges and opportunities.More and more types of insurance,insurance institutions have sprung up,competition is fierce.But such a phenomenon exists in the health insurance,which is too much attention to the exhibition industry,but ignore the claims,the internal management of the insurance company is not very standardized,blindly pursuing market share,and share premium growth,regardless of the company's overall operating efficiency,often allow non health insurance to health,to to improve the health of customers through non underwriting rate.Rather than health claims risk too high to make medical expenses has been increasing year by year,the insurance company health insurance payment amount is always high,and there is no obvious decline,relative performance lagged settlement risk management and control,has become the various insurance companies,especially the short board and the difficulties faced by life insurance companies.The insurance company's current health insurance claims practice risk management means to control short-term health insurance payment rate,set the value range of health and will set its claims KPI assessment indicators,as one of the annual assessment based on the Claims Officer,its performance,assessment,salary,promotion linked.In the practical work of claims,short-term health insurance payment rate is reflected in the more actual expenditure and expected claims payments is consistent,if the abnormal data indicates the actual payment of health insurance and the expected differences,the risk of loss more than expected,and not the specific content,accurate prompt risk specific procedures and reasons.The insurance company is difficult to conduct risk identification,evaluation and risk management in accordance with the steps of estimation,it is difficult to find specific risk management techniques.Insurance companies need more effective health insurance claims practice risk management methods.With the help of engineeringinsurance practice risk research articles,with domestic and foreign outstanding past claims management experience,a comprehensive analysis of health insurance claims of A insurance company,according to the steps of risk management,explore a set of scientific,operational,engineeringinsurance practice simple risk identification step model with A,health insurance status,find the links and reasons of claims practice specific risks exist,the implementation of risk management technology,help to improve the daily management of the short board of the company,to defuse the risks.It is hoped that the simple identification procedure model and management and control measures of A company's claims practice risk can provide reference for other insurance companies with health insurance business to provide practice risk management experience.