车险反欺诈问题研究——以 D 保险公司为例

LZUFE-KMS > 金融学院

作者	葛倩文
姓名汉语拼音	Ge Qianwen
学号	2019000005006
培养单位	兰州财经大学
电话	13523090932
电子邮件	geqianwen827@qq.com
入学年份	2019-9
学位类别	专业硕士
培养级别	硕士研究生
一级学科名称	保险
学科代码	0255
第一导师姓名	张宗军
第一导师姓名汉语拼音	Zhang Zongjun
第一导师单位	兰州财经大学
第一导师职称	教授
题名	车险反欺诈问题研究——以 D 保险公司为例
英文题名	Research on anti fraud of automobile insurance -- Taking D insurance company as an example
关键词	反欺诈车险保险公司理赔实务
外文关键词	Anti-fraud ; Auto insurance ; Insurance company ; Claim settlement practice
摘要	保险欺诈作为保险理赔中的常态化现象，已严重影响了保险公司的正常稳健经营，破坏了保险市场的正常秩序及社会的诚信体系，尤其在机动车辆保险理赔中影响更甚。为了减少不必要损失，应重视并尽快解决车险欺诈问题。目前我国宏观层面对车欺诈问题已采取了法律、行业监管等措施，微观层面各财险公司也借助科技赋能将反欺诈、反渗漏作为理赔工作的关键环节，一定程度上达到了减损目的，缓解了部分欺诈风险，但车险欺诈问题仍屡禁不止。本文在当前背景下对车险反欺诈问题进行研究，在梳理相关定义和理论的基础上，总结我国车险欺诈及反欺诈的现状，并以 D 保险公司为例研究车险反欺诈工作实务，包括以反欺诈模型为主导的理赔工作和风险管控、人员管理及工作方法上的经验。随后分析了D 公司车险反欺诈工作的困境，其中内部困境为：道德风险防不胜防、车险渗漏问题不易把控、理赔人员队伍不整齐、成本受限系统仍需优化；外部困境为：关联机构合作不密切、理赔诉讼案件判定标准不统一、数据共享仍有局限性。最后针对这些困境提出了相应的解决建议，内部方面：多种形式宣传反欺诈观念，推行欺诈征信记录、明确讲解条款责任，优化车险反渗漏工作、适量减轻查勘工作强度，加强心理建设和技能培训、做好风险管理提升效率，降低欺诈风险控制成本；外部方面：深化多方合作机制，促进反欺诈取证工作、组织设立研讨会，邀请专家交流解惑、推动数据共享互联，前置管控欺诈风险。以点带面，以此对我国保险行业及保险公司的车险反欺诈工作提供借鉴与启示。
英文摘要	As a normal phenomenon in insurance claim settlement, insurance fraud has seriously affected the normal and steady operation of insurance companies, and damaged the normal order of insurance market and social integrity system, especially in motor vehicle insurance claim settlement. In order to reduce unnecessary losses, we should pay attention to and solve the problem of auto insurance fraud as soon as possible. At present, China's macro level has taken legal, industry supervision and other measures to deal with the problem of vehicle fraud. At the micro level, property insurance companies also take anti-fraud and anti-leakage as the key link of claim settlement with the help of science and technology, which has achieved the purpose of reducing losses to a certain extent and alleviated some fraud risks, but the problem of vehicle insurance fraud is still prohibited repeatedly. This paper studies the anti-fraud of auto insurance under the current background, summarizes the current situation of auto insurance fraud and anti-fraud in China on the basis of combing the relevant definitions and theories, and takes D insurance company as an example to study the anti-fraud practice of auto insurance, including claims settlement led by anti-fraud model and experience in risk control, personnel management and working methods. Then the paper analyzes the difficulties of D company's auto insurance anti-fraud work, among which the internal difficulties are: the moral hazard is hard to be prevented, the leakage of auto insurance is not easy to control, the team of claim settlement personnel is not neat, and the cost limited system still needs to be optimized; The external difficulties are: the cooperation between relevant institutions is not close, the judgment standards of claims litigation cases are not unified, and data sharing is still limited. Finally, the corresponding solutions to these difficulties are put forward. Internal aspect: publicize the anti-fraud concept in various forms, promote the fraud credit record, clearly explain the terms and responsibilities, optimize the anti-leakage work of vehicle insurance, appropriately reduce the intensity of survey work, strengthen psychological construction and skill standard training, do a good job in risk management and improve efficiency, reduce fraud risk and control costs; External aspect: deepen multi-party cooperation mechanism, promote anti-fraud evidence collection, organize seminars, invite experts to communicate, promote data sharing and interconnection, and pre control fraud risks. Fan out from point to area, so as to produce reference and enlightenment for the anti-fraud work of automobile insurance in China's insurance industry and insurance companies.
学位类型	硕士
答辩日期	2022-05-29
学位授予地点	甘肃省兰州市
研究方向	保险经营管理
语种	中文
论文总页数	77
参考文献总数	59
馆藏号	0004344
保密级别	公开
中图分类号	F84/59
文献类型	学位论文
条目标识符	http://ir.lzufe.edu.cn/handle/39EH0E1M/32050
专题	金融学院
推荐引用方式 GB/T 7714	葛倩文. 车险反欺诈问题研究——以 D 保险公司为例[D]. 甘肃省兰州市. 兰州财经大学,2022.

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