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the core of the "second claim" service is that it uses generative big model technology combined with rich medical and insurance knowledge to read medical documents and understand insurance terms, and shorten the review time to seconds through multi-step reasoning of claim conclusions. the core of this technology is that it integrates rich medical and insurance knowledge, and simulates the thinking framework of claims experts through the big model thinking chain method, looking for key clues step by step, and then giving review conclusions through reasoning. this enables the "second claim" service to achieve zero human involvement in medical insurance claims and automatic review in seconds.
as the first pilot insurance company, sunshine property & casualty insurance has applied the "instant compensation" service of the ant insurance platform to its good medical insurance series of products, and has achieved a second-level review of 81% of outpatient insurance and 50% of inpatient medical insurance claims. this means that after the user completes medical treatment at the hospital and submits an online application offline, as long as the materials are complete, the system will complete the claim review and inform the result within 30 seconds.
xueying gai, deputy general manager of the internet division of sunshine property & casualty insurance, said that with the application of big model technology, the "second claim" service can effectively reduce the pressure on claim reviewers, focus human resources on the review of complex claim applications, and improve the review efficiency of complex claim applications. pilot data shows that currently, the average review efficiency of eligible medical insurance claims is 25 seconds, and the number of claims service people per month is tens of thousands.
the "second-level" medical insurance service has brought new changes to the medical insurance field through technological innovation. with the further development of technology and the continuous expansion of application scenarios, it is believed that the "second-level" medical insurance service will further promote the development of the medical insurance market and bring users a faster and more efficient claims experience.
