Ökonomische Bewertung und Optimierung des Automatisierungsgrades von Versicherungsprozessen

In the context of value and customer orientation there are various requirements concerning the process – especially in insurance companies: processes are meant to be standardized, automated, and flexible. It is in question whether a fast and cheap automated processing is preferred to manual handling. For which claims and which process steps is it of economic value to have the flexibility and the competence and ability to solve problems of human operators at your disposal? Various combinations, representing different degrees of automation, are possible. The different degrees of automation for the processing of an insurance claims are compared and resulting cash flows are determined. It is essential to include all consequences that can be attributed to a single process and to consider customer reactions and restrictions to the capacity of processing. Instead of using heuristic rules to decide on automation in practice, here the decision is flexible and depends on the given situation. Viewing an aggregated number of insurance claims it is possible to deduce information about the performance of the process. The model is exemplarily illustrated with help of a part of the process for handling own damage glass claims.     

Writing the claims for a patent

Most of the body of a patent is written in plain English. The exception is the claims section, which is the section of primary legal importance. The claims determine what aspects of the invention are protected by the patent. Attorneys write claims in claim language, a special style of writing. Claims are difficult to read when you are new to the patenting process and don't understand the basic structure and semantics of claim language. In this paper, the author explains the basic vocabulary and structure of a claim to demystify claim language.     

Filtering a Markov Modulated Random Measure

We develop a new exact filter when a hidden Markov chain influences both the sizes and times of a marked point process. An example would be an insurance claims process, where we assume that both the stochastic intensity of the claim arrivals and the distribution of the claim sizes depend on the states of an economy. We also develop the robust filter-based and smoother-based EM algorithms for the on-line recursive estimates of the unknown parameters in the Markov-modulated random measure. Our development is in the framework of modern theory of stochastic processes.      

机器学习模型在车险欺诈检测的研究进展

随着保险行业的蓬勃发展,保险欺诈问题也显得日趋严重。车险欺诈一直是保险欺诈的“重灾区”,对保险行业的发展至关重要。因此,车险欺诈检测技术一直是国内外学者研究的热点问题。鉴于我国在机动车辆保险欺诈检测技术方相对滞后,而国外的研究成果又较少对我国车险业务数据进行有效建模与分析,首次针对机器学习模型应用在车险欺诈检测的研究工作进行了文献调研,对二十多年来的研究工作进行系统化的归纳与总结。通过引入车险欺诈流程的简介,对专家系统与智能理赔系统在车险欺诈检测的流程进行了叙述;依次从国外和国内的角度介绍了机器学习模型应用在车险欺诈检测的具体研究进展,并进行了宏观的对比;基于国内某车险公司提供近5年来高质量的车险数据选取具有代表性的机器学习模型进行建模,并进行了全面的测试与分析;探讨了车险欺诈检测技术未来的研究方向。     

Understanding the social construction of crises: Comparing the crisis‐as‐claim model with securitization theory

Spector (2019) introduced the crisis‐as‐claim model to analyze the social construction of crises. Securitization theory offers insights that can complement this crisis‐as‐claim model. Both approaches share an interest in the crisis declarations of actors, the motivations behind such claims, and the public's evaluations of crisis claims. In addition, securitization theory helps us to understand how various actors negotiate crisis declarations, how certain practices can constitute a crisis reality, and how crisis perceptions enable the use of exceptional crisis response measures.     

利用大数据提高电力企业社会保险管理水平

中文摘要：随着信息数据的快速发展,我国的社会保险信息化建设正在稳步推进,社会保险信息化建设程度依赖于各企业社会保险基础管理水平,电力企业的社会保险基础管理虽然开展较早,但距离数据共享及精确管理还有很大差距,如何在工作中将人力资源大数据充分应用在社会保险专业工作中,实现数据共享,提升数据价值,提高管理水平成为亟待解决的课题。本论文研究探索如何更好的实现人力资源社会保险大数据的共享与关联,实现大数据的应用服务,更好地开展人力资源中社会保险管理水准,更好地服务于企业与员工提出了很好的研究和探索,大数据的共享提高使社会保险管理工作的上升到了新高度,大数据的全面利用将成为提升公司管理水平、增强公司管理效能的有效手段。     

Implementing a fuzzy expert system for ensuring information technology supply chain

In the business environment, information technology (IT) plays an important role for firms' performance. It provides information flow that makes the supply chain more robust and resilient without undermining its efficiency. Smart systems use artificial intelligence methods for solving problems and facilitating decision‐making through rule‐based deduction. Accordingly, these systems can present specialists' skills and simulate their thinking process. The primary goal of expert systems is to implement knowledge acquisition process by converting knowledge to wisdom. This process is vital for critical decision‐making regarding important issues such as determining necessities of a particular contract. Companies use professional liability insurance of the products and services to ensure the purchasers and prevent potential losses. Although this practice is highly prevalent, there is not any particular procedure for measuring necessities of contracts. The main purpose of this paper is to design a fuzzy expert system for measuring the necessities of professional contracts regarding insurance coverage and improve the supply chain management using IT. This system can measure and report these obligations, considering specifications of each project. Taking into perspective variety of professional services/products, we consider software as a type of professional contracts, extract its important indices and give it to the system as the input. After the necessary stages, the system produces a proper response and presents the generated response to the user. The software of this expert system is web based, and there are four operating layers in its architecture. We implemented this program in MS Visual Studio Framework with C#.NET programming language. Moreover, we implemented MS SQL‐Server Database Management.     

Reusing knowledge in embedded systems modelling

Model‐based design is a promising technique to improve the quality of software and the efficiency of the software development process. We are investigating how to efficiently model embedded software and its environment to verify the requirements for the system controlled by the software. The software environment consists of mechanical, electrical and other parts; modelling it involves learning how these parts work, deciding what is relevant to model and how to model it. It is not possible to fully automate these steps. There are general guidelines, but given that every modelling problem differs, much is left to the modeller's own preference, background and experience. Still, when the next generation of a system is designed, the new system will have common elements with its previous version. Therefore, lessons learned from the current model could inform future models. We propose a framework for identifying the non‐formal elements of knowledge, insights and a model itself, which can support modelling of the next system generation. We will present the application of our framework on an action research case – modelling mechanical parts of a paper‐inserting machine.     

参数在线自调整模糊控制算法研究

针对间歇式热处理炉温度控制对象的特性要求,提出了参数在线自调整模糊控制与智能积分相结合的一种新型模糊控制方法。该方法的基本思想是：在系统误差较大时,用参数在线自调整模糊控制算法以提高系统的响应;在系统误差较小时,加入智能积分作用以消除静态误差,智能积分的作用是有选择施加积分作用,克服了一般连续积分控制的缺点。文中论述了带智能积分参数在线自调整模糊控制器的设计及软件实现。通过在Matlab软件上的仿真分析表明该方法的合理性及可行性。     

The mathematics of patent claim analysis

In patent law most of the crucial legal questions such as patentability and infringement are linked to the patent claims. The European Patent Office regards patent claims as a set of independent features which are examined separately in a more or less formal way. The author has found that this approach allows for developing a simple mathematical model which treats patent claim features as logical statements and patent claims as compound statements wherein the individual statements are connected by logical connectives. The proposed mathematical model provides a uniform system for examining various legal questions that are dealt with separately under current case law, moreover, it allows for developing an expert system for resolving complex legal situations and for automating the evaluation of a large number of patent claim variants that is currently not possible.     

基于一体化社保基金征管系统设计与实现

系统分析目前社保基金征收管理工作中普遍存在的业务和技术问题，针对存在的问题研究解决关键性技术问题的方法、内容和目标。从系统信息整合技术的角度设计了各部门之间的管理监控的数据流程；应用面向体系结构和中间件技术，设计统一的数据交换接口、数据交换标准和网络安全策略，实现软件体系结构、网络体系结构的统一和一体化的征收管理程序的应用，保护现有网络和数据资源，提升跨部门业务的应用。应用实践证明，该系统能有效实现信息资源共享，实现社保基金征收管理手段的现代化，降低有形和无形的成本，提高政府职能部门为民服务质量。     

基于Vue.js的车险报价系统的设计与实现

随着近些年来随着WEB应用的迅速扩展,涌现了多种前端框架,Vue.js就是其中一款轻量且高效的前端框架,其核心是一个响应的数据绑定系统,适合开发单页应用(SPA)。单页应用在浏览器使用期间不会重新加载页面,它可以看作一种从Web服务器加载的富客户端。当下的车险市场发展前景良好,将传统的投保流程与互联网结合形成线上投保将是未来的一种发展趋势,设计的Web车险报价系统能够在浏览器端进行线上车险购买,不仅能够缩减传统投保流程中成本,更能加快车险的落地周期。而线上投保流程强调的是实时与高效,加上前后端分离开发,使得这一系统可以被量身定做为一款单页应用程序。结合车险出单系统,从业务场景、技术介绍、工程设计实现3个层面,全面分析在Vue.js框架下如何开发设计一款独立的单页应用。     

On the Continuous Dependence of Non-Ruin Probability on Claim Distribution Function in the Classical Risk Model

The Cramer–Lundberg model is considered as a model of insurance company. Since it is impossible to obtain an explicit solution for the non-ruin probability function of insurance company for an arbitrary distribution of the values of insurance claims, the authors consider the problem of estimating the convergence of the original non-ruin probability to one that would be obtained by approximating the values of claim distribution function.     

Towards the improved treatment of generalization of knowledge claims in IS research: drawing general conclusions from samples

This paper presents a framework for justifying generalization in information systems (IS) research. First, using evidence from an analysis of two leading IS journals, we show that the treatment of generalization in many empirical papers in leading IS research journals is unsatisfactory. Many quantitative studies need clearer definition of populations and more discussion of the extent to which ‘significant’ statistics and use of non-probability sampling affect support for their knowledge claims. Many qualitative studies need more discussion of boundary conditions for their sample-based general knowledge claims. Second, the proposed new framework is presented. It defines eight alternative logical pathways for justifying generalizations in IS research. Three key concepts underpinning the framework are the need for researcher judgment when making any claim about the likely truth of sample-based knowledge claims in other settings; the importance of sample representativeness and its assessment in terms of the knowledge claim of interest; and the desirability of integrating a study's general knowledge claims with those from prior research. Finally, we show how the framework may be applied by researchers and reviewers. Observing the pathways in the framework has potential to improve both research rigour and practical relevance for IS research.     

Mixed method for solving the general convex programming problem

Conclusion Let us return to the claim that we made at the beginning: given the existing level of computers, computational mathematics must not ignore new opportunities for finding results that have been impossible until very recently. In our view, the proposed mixed method is consistent with technological progress: all known problems have been solved in acceptable time, and not in a single case has the method failed to produce a solution. Although we can always dispute claims of the kind made above, our calculations nevertheless convince that the algorithms proposed in this article may be used to solve a fairly broad class of problems, and in particular semidefinite programming problems [7, 17]. Translated from Kibernetika i Sistemnyi Analiz, No. 4, pp. 121–134, July–August, 1998.     

On the applicability of capability models for small software organizations: does the use of standard processes lead to a better achievement of business goals?

The ISO/IEC 15504 standard implies that the use of its level-based capability model for software process development leads to a better business performance. At capability level 3, this would mean that there is not only a positive correlation but also a causal relation from the use of standard processes to better achievement of business goals. In this paper, we make this claim explicit and challenge it with a counterargument in the context of small software organizations. We argue that in most part, the way the software is designed is what determines the business success in software development, and when application domains are complex socio-technical systems, relying on a standard process instead of human expertise not only fails to answer the promise of process stability but also presents business risks related to poor design, a loss of diversity, and reduced adaptability. With reasons to believe that the standard’s claim is weak in this context, we come up with alternative explanations for why some small software organizations nevertheless use standard processes. Through these hypotheses, we argue that the reasons are not necessarily process-related. In closing, we suggest further studies on how the standard’s notion of process capability and business goals relate to each other when the application domain is not just complicated but complex.     

基于Web Service的医疗保险系统的设计与实现

医疗保险是社会保障体系的一个重要环节,医疗保险系统是贯彻相关政策的直接载体.如何与社会保障系统中的其他系统以及社会保障系统外的其他系统相互集成和数据共享成为医疗保险系统应用的一大挑战.本文利用Web服务的体系结构和它的关键技术,设计了基于Web服务的医疗保险应用系统,解决了医疗保险应用系统与其他系统的相互集成问题和系统间数据共享问题.     

Time prediction based on process mining

Process mining allows for the automated discovery of process models from event logs. These models provide insights and enable various types of model-based analysis. This paper demonstrates that the discovered process models can be extended with information to predict the completion time of running instances. There are many scenarios where it is useful to have reliable time predictions. For example, when a customer phones her insurance company for information about her insurance claim, she can be given an estimate for the remaining processing time. In order to do this, we provide a configurable approach to construct a process model, augment this model with time information learned from earlier instances, and use this to predict e.g., the completion time. To provide meaningful time predictions we use a configurable set of abstractions that allow for a good balance between “overfitting” and “underfitting”. The approach has been implemented in ProM and through several experiments using real-life event logs we demonstrate its applicability.     

基于 Petri 网的保险索赔工作流模型

Petri网是一种有效的形式化建模工具,能自然地描述并发、冲突、同步等系统特性。给出基于Petri网的保险索赔工作流模型,将Petri网三要素以对象的形式描述出来,并对此工作流模型的正确性定义和验证进行了说明。