大数据时代的我国人身保险业务反欺诈机制创新研究  

Research on Anti-fraud Mechanism Innovation of Life Insurance Business in China in the Era of Big Data

作　　者：陈铭豪 曹斯蔚 Chen Minghao;Cao Siwei

机构地区：[1]浙江财经大学,浙江杭州310018 [2]中国人民大学财政金融学院,北京100872

出　　处：《保险职业学院学报》2022年第5期75-83,共9页Journal of Insurance Professional College

基　　金：国家社会科学基金一般项目“推动经济高质量发展的财政管理体制优化研究”(19BJY216);中国人民大学科学研究基金(中央高校基本科研业务费专项资金资助)项目“新绩效考核制度下中国式政府竞争对地方政府行为的影响及其福利效应研究”(20XNL002)。

摘　　要：近年来,保险欺诈现象频发,并表现出有组织、有预谋、隐蔽性强等新特征,传统的反欺诈机制已无法应对日益严峻的保险欺诈现状。本文分析了我国人身保险业务反欺诈机制存在的问题,并借鉴美国、澳大利亚等地区在保险欺诈数据应用方面的先进经验,提出在保险公司、保险经纪公司和政府层面上分别构建完备的内部共享数据库和核保、理赔、查勘全流程数字化智能平台,赋能一线查勘作业人员,建立健全的客户信息保密制度;加强与科技公司合作,共建“反保险欺诈数据平台”;利用区块链技术,构建全行业的保险大数据平台,加强数据安全监管等政策建议。After the epidemic,the growth of insurance premium income of insurance companies across the country shows a weak trend,followed by frequent insurance fraud,which shows new characteristics such as organization,premeditation and strong concealment.Under the new situation,the traditional anti-fraud mechanism has been unable to cope with the increasingly severe insurance fraud.This paper analyzes the existing problems in the anti-fraud mechanism of the personal insurance business in China,and draws on the advanced experience in the application of insurance fraud data from the United States,Australia and other regions.Some policy suggestions are proposed,such as building a complete internal shared database and a digital intelligent platform for the whole process of underwriting,claim settlement and survey respectively at the level of insurance companies,insurance brokers and the government,empower the front-line survey operators and establish a sound customer information confidentiality system,strengthening cooperation with technology companies to build an"Anti-insurance Fraud Data Platform",using blockchain technology to build an industry-wide insurance big data platform and strengthening data security supervision.

关 键 词：大数据 区块链 反欺诈机制 信息壁垒 个人信息安全保护 

分 类 号：F840.62[经济管理—保险]