金融学院知识库

随着人口老龄化趋势加剧、宏观经济的逐步恢复，我国的人身保险业务迎来新的发展契机，尤其是商业健康险、短期医疗险等险种具有更大的发展空间。据测算，全球每年有20%以上的保险赔款涉及欺诈行为，保险欺诈是全球保险业都面临的一个难点和痛点，各国采用各种手段进行防范，但仍收效甚微。在人身保险欺诈中，多以隐瞒病史、假死、身份欺诈等多种形式出现，给保险公司的人身保险业务带来极大压力。近年来以人工智能、大数据、物联网和区块链为代表的新一代信息技术发展迅猛，为人身保险反欺诈工作提供了新的思路和技术支撑，有助于保险公司数字化转型升级。

本文主要采用案例分析法和归纳总结法，先从人身保险欺诈和新一代信息技术相关理论出发；对传统模式下的人身保险反欺诈状况进行研究，发现传统模式下保险公司普遍具有核保形式主义严重、理赔调查不彻底、保险公司之间存在信息孤岛等问题；然后对新一代信息技术在人身保险反欺诈中的优势和应用现状进行分析；再结合太平金科案例介绍当下人工智能、大数据、物联网等技术是如何在人身保险反欺诈中进行应用的。

研究发现，新一代信息技术运用在人身保险反欺诈时，普遍存在相关法律与监管不完善、数据的准确性和完整性、信息层面存在行业外数据共享不足、信息安全和隐私保护、技术标准和规范不统一等问题。针对以上问题，向保险机构、监管机构、保险协会等相关主体提出完善反欺诈法律与监督体系、构建基于征信系统的保险欺诈惩戒机制、加快信息共享，强化反保险欺诈外部联动机制、提高欺诈识别模型的准确性和可解释性、注重信息安全建设和隐私保护、确保底层数据的准确性和完整性、制定统一的技术标准和规范等相关建议，以期对人身保险反欺诈工作有所参考和借鉴意义。

With the aging of the population and the gradual recovery of the macro economy, China's personal insurance business has ushered in a new development opportunity, especially commercial health insurance, short-term medical insurance and other insurance has a greater development space. It is estimated that more than 20% of the world's annual insurance claims involve fraud, insurance fraud is a difficult and painful point faced by the global insurance industry, countries adopt various means to prevent, but still have little effect. In the life insurance fraud, the concealment of medical history, faked death, identity fraud and other forms appear, which brings great pressure to the life insurance business of insurance companies. In recent years, the new generation of information technology represented by artificial intelligence, big data, Internet of Things and blockchain has developed rapidly, providing new ideas and technical support for anti-fraud work in life insurance, and contributing to the digital transformation and upgrading of insurance companies.

This paper mainly adopts case analysis and summary method, starting from the theory of personal insurance fraud and new generation information technology; By studying the anti-fraud status of life insurance under traditional mode, it is found that insurance companies generally have serious underwriting formalism, incomplete claims investigation, and information island among insurance companies. Then the advantages and application status of new generation information technology in life insurance anti-fraud are analyzed. Combined with the case of Taiping Jinke, it introduces how the current artificial intelligence, big data, Internet of things and other technologies are applied in life insurance anti-fraud.

The research finds that when the new generation of information technology is applied in life insurance anti-fraud, there are generally problems such as imperfect laws and supervision, accuracy and integrity of data, insufficient data sharing outside the industry at the information level, information security and privacy protection, and inconsistent technical standards and norms. In view of the above problems, it proposes to improve the anti-fraud law and supervision system, build an insurance fraud punishment mechanism based on the credit information system, and accelerate information sharing to insurance institutions, regulators, insurance associations and other relevant subjects. Strengthen the external linkage mechanism of anti-insurance fraud, improve the accuracy and interpretability of fraud identification model, pay attention to information security construction and privacy protection, ensure the accuracy and integrity of underlying data, and formulate unified technical standards and norms, so as to provide reference and reference for the anti-fraud work of personal insurance.