An Empirical Study On Risk Management Of Insurance Claim Settlement In Insurance Company

Branch in Chinese PICC Hebei province all products,motor vehicle insurance sales is particularly prominent,accounting for about 75%of the Chinese PICC Hebei branch,can be said that the result of auto insurance operation directly determines the company's operating results.In order to improve the quality of auto insurance management,it is very important to pay attention to the quality of the claims while strictly ensuring the quality of the insurance.The key is to strengthen the research of claims management and control of high risk claims case occurrence regularity,sort out the types of high risk cases and the main risk points,at the same time thinking claims of reengineering risk management based on high risk cases in order to claim control.Through the statistics and analysis of claims data clearly strengthen the high risk of auto insurance cases control Chinese PICC A branch control effect ratio of core elements increased,only through the identification and control system for high risk cases,strengthen the management of insurance auto insurance business,the overall loss ratio control level,in order to protect the company the overall business healthy and sustainable development.At present,Chinese insurance company insurance claims management is worth to A amount to distinguish the case level,formulate the corresponding work flow,permissions to claim the amount of job flow distribution,while supporting the corresponding legal authorization.The main defects of this kind of management model are reflected in the risk that cannot be effective and proactive to achieve,identify and control the high-risk cases of claims.In this paper,through the use of trend index analysis,industry indicators analysis,high-risk cases type qualitative and quantitative analysis tools,comprehensive and multi-dimensional screening of cases of high risk claims cases.Strengthen the follow-up review of the case,verify the validity of the new claims operation model,and improve the reliability of the new claims operation model.This study found that high risk insurance case law,and use the analysis of behavior characteristics and model based on the data for high risk insurance cases,so as to determine the type of high risk insurance cases,and corresponding control measures.Through the risk discovery mechanism,sorting out small high-risk cases,major car damage cases,truck cases and cases involving human injury,is the focus of claims management and control of PICC A branch.Strengthen the management of the above four types of cases,sort out the corresponding risk points,and at the same time based on risk management ideas,reengineering claims process.So as to realize the automatic discovery mechanism of high risk cases.The article suggests that the established risk control in the engine case claims the new operating system,realize the system of automatic operation terminal users high risk cases that also launched joint related historical claims information.Effective control of China PICC A branch of the rising rate of loss,and thus enable the company to achieve the transition from the insurance payer to claims risk managers.