寿险公司短期健康险理赔风险管理对策研究

Strategies on Short-term Health Insurance Claims Risk Management Life Insurance Company

我国人身保险市场上的健康保险业务与其他险种相比发展缓慢,且在理赔时往往因医疗机构等第三方配合度低、患者过度治疗等因素存在各类理赔风险隐患,使得保险公司在这一险种业务上的赔付率过高。因此,对理赔过程进行风险管理并制定相应对策是非常必要的。在可改进的范围内,公司可以减少因理赔各环节风险因素可能带来的不必要赔付,降低赔付率,提高续保率,创造良好的收益。

Health insurance business in the life insurance market is in a slow development compared with other types of insurance, and there are diverse potential risks in its claiming due to the factors such as the unwilling cooperation of medical institutions and other third parties and over-treatment of patients. Hence, the insurance companies has always kept a high loss ratio on this type of insurance business. It is very necessary to carry out the risk management on the claims process and make up relevant strategies. Within the improvable domain, the companies can reduce the needless losses resulting from risks in claims links and the loss ratio, raise the renewal ratio of insurance, and make favorable benefits.