《保险研究》20200907-《图数据库在识别重大疾病保险团伙式欺诈中的应用研究》（周晓楠、黄磊、王飞跃、储明、黄涛）

［摘   要］随着中国经济的快速发展和保险市场的日益成熟,重大疾病保险已逐步成为国民选择的热门保险产品。然而重大疾病保险相关的保险欺诈问题却屡见不鲜,并且呈现团伙化、专业化的趋势,传统方法已经无法有效识别重大疾病保险的团伙式欺诈行为。本文运用图数据库方法,针对某大型寿险公司近10年的赔付信息进行分析,探索并验证图数据库技术在识别重大疾病保险团伙式欺诈中的应用可行性。分析表明,图数据库技术可以有效识别重大疾病保险相关的团伙式保险欺诈行为。建议在图数据库技术的应用过程中,严格把控数据质量,建立数据共享机制,以保证图数据库识别工具的有效运行,加强公司保险欺诈风险防控能力。

［关键词］重大疾病保险；保险欺诈识别；图数据库

［作者简介］周晓楠,中国太平洋人寿保险股份有限公司副总经理,合规负责人,首席风险官；黄磊,中国太平洋人寿保险股份有限公司法律合规部总经理；王飞跃,中国太平洋人寿保险股份有限公司法律合规部合规监测经理；储明,中国太平洋人寿保险股份有限公司法律合规部资深经理；黄涛,中国太平洋人寿保险股份有限公司法律合规部资深经理。

On the Application of Graph Database on Identifying Critical Illness Insurance Group Fraud

ZHOU Xiao-nan,HUANG Lei,WANG Fei-yue,CHU Ming,HUANG Tao

Abstract：With the rapid economic development and growing sophistication of the insurance market in China,the critical illness insurance has become one of the most popular insurance products.However,critical illness insurance-related frauds keep increasing and show a trend of being group-organized and specialization.The traditional tools are unable to fully detect these group frauds.By introducing the graph database method,this paper conducted an empirical analysis on application of graph database on identifying group frauds of critical illness insurance,based on the latest ten years claim information of a major life insurer.It also verified the feasibility of graph database in detecting critical illness insurance group frauds.The empirical analysis shows that graph database can effectively identify group-type critical illness insurance frauds.It recommends that the insurer should strictly control data quality and establish a data sharing mechanism to ensure the effectiveness of the graph database tool.

Key words：critical illness insurance;identification of insurance fraud;graph database