数字化赋能理赔模式升级,平安人寿实现免人工AI审核新突破
中国山东网—感知山东6月20日讯随着科技的数字式升寿实审核发展,如何把大数据和人工智能等新技术应用融入产品和服务中,化赋提升客户服务质量,赔模破成为寿险公司的安人重要课题。近日,现免新突平安人寿创新推出“AI智能自动决策模型”,人工实现理赔审核作业 “全流程免人工”,数字式升寿实审核构建了业内领先的化赋理赔审核新模式,为客户打造省时、赔模破省心、安人省钱的现免新突理赔服务。当前平安人寿理赔案件审核作业“免人工”案件占比1%,人工预计今年年底占比将提升至20%。数字式升寿实审核
在传统审核模式下,化赋理赔案件需要人工对多达30余类理赔资料进行逐一核对,赔模破依据逾千种产品责任及条款进行责任判断,同时需考虑地方医保政策、定点医院等多种差异完成赔付金额计算,存在审核效率低、案件时效长、差错风险高等痛点。“AI智能自动决策模型”通过AI技术的应用,将原来由人工审核的理赔案件,由AI模型完成理赔资料自动审核、责任风险的主动识别及赔付金额自动计算等流程,全程实现无人工干预,具有“时效快、风控优、成本低”的特点。
具体来看,在时效方面,“AI智能自动决策模型”通过AI智能读取理赔资料,审核的案件时效由原0.5-2天时间提升至秒级,极大缩短客户从理赔申请到获赔的等待时长。在风控方面,该模型汇集400万理赔案例,构建涵盖超过5000种疾病的疾病库和意外场景库,通过理赔风险点的海量聚合和自主判断,改变了过去依赖人工经验进行风险判断的不确定性,风险管控更精准。在成本方面,随着AI模型的有效应用,理赔队伍也将从“人力规模型”的作业团队转变为“知识密集型”的专家团队,产能和效率得到大幅提升。此外,理赔专家团队也将作为“AI训练师”,对AI模型进行持续训练,不断优化模型算法和审核精度。
平安人寿客户服务部理赔作业团队副总经理刘强介绍,在“AI智能自动决策模型”上线之前,审核案件需要对大量理赔资料进行核对,比如身份信息、银行卡、诊治资料等,还要不停翻阅不同产品的保险责任、责任免除,结合当地医保政策、定点医院等多种差异化信息、免赔额等计算赔付金额,耗时耗力也容易出现差错。现在 “AI智能自动决策模型”会自动核对案件基本信息,节省案件审核时间,一些容易忽视的地方也会进行一定的理赔提示,理算赔付金额时减少人为计算,避免差错的产生,提高了工作效率。“理赔作业团队节省了核对基本信息和理算的时间,拥有更多时间和精力放在风险评估和客户服务上,从而发挥更大的专业价值。”
平安人寿副总经理史伟玉表示,“AI智能自动决策模型”证明了AI技术在理赔审核作业应用方向的可行性,随着应用规模的扩大,将引领保险公司后援作业模式的一次变革。平安人寿在今年年底将把AI审核的比例提高到20%,未来3年力争超过50%,真正发挥科技及数字化在运营服务中的作用,为客户打造更极致的体验。
“借助数字化赋能,平安人寿已构建了以‘闪赔’、‘智能预赔’为中心的智能理赔体系,持续打造有温度的理赔服务。理赔,不仅仅是简单的支付一笔保险金,更是在科技驱动下,及时为客户化解风险,让客户得到更好的感受,有速度更有温度。”史伟玉表示。数据显示,截至2021年,平安人寿30分钟闪赔案件累计超628万件,赔付金额超132亿元;智能预赔累计件数超5.2万件,金额超19.6亿元。
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