The digitalization of insurance operations and the transformation of claims scope review
保险运营数字化对理赔范围审核的变革

摘要

保险行业的服务质量与可持续发展，很大程度上取决于理赔范围审核这一核心环节的运作效能，在数字技术深度融入社会经济各领域的当下，保险运营模式的转型已成必然趋势，理赔范围审核也随之迎来深刻变革。本文围绕保险运营数字化转型趋势，详细探讨大数据、人工智能等技术在优化理赔审核流程、强化风险管控方面的应用，探索构建契合数字时代的理赔审核新模式，为保险行业提升服务效率、增强风险防控能力提供可行路径，助力行业实现高质量发展。

Abstract

The service quality and sustainable development of the insurance industry largely depend on the operational efficiency of the core link of claims scope review. With the deep integration of digital technology into various fields of social economy, the transformation of insurance operation mode has become an inevitable trend, and claims scope review has also undergone profound changes. This article focuses on the trend of digital transformation in insurance operations, and explores in detail the application of technologies such as big data and artificial intelligence in optimizing claims review processes and strengthening risk management. It explores the construction of a new claims review model that fits the digital age, providing a feasible path for the insurance industry to improve service efficiency and enhance risk prevention and control capabilities, and helping the industry achieve high-quality development.