I 摘要 我国机动车辆保险获得了较大发展，但目前车险市场的成熟度还不能满足消费 者日益多样化的需求，车险“理赔难”问题日渐突出。此问题具体表现在理赔效率低 和服务质量差。理赔效率不仅关系到公司的经营状况和市场竞争力，也关系到公司 的信誉和效益。因此，提高车险理赔效率的研究对保持 X 财险石家庄分公司健康良 好地发展具有非常重要的意义。 梳理相关文献，借鉴当前提高车险理赔效率的研究成果。搜集并整理研究对象 近三年的理赔数据，分析数据变化，找到了车险理赔效率存在的问题，如：理赔周 期偏长、赔付率较高、车险追偿减损降低、投诉增多、理赔满意度不高、诉讼案件 占比增多等。根据找到的问题分析出产生问题的原因，原因可分为两部分，来自外 部环境的原因和来自内部环境的原因。外部原因包括：客户原因、行业监管原因、 媒体宣传报道原因、车辆修理厂原因、人伤案件纠纷原因、保险代理人原因；内部 原因包括：公司组织架构原因、理赔流程原因、工作人员业务技能原因、人伤案件 缺乏管控原因。深入剖析这些问题，再根据研究对象的实际运营现状，最后提出了 可行的提升车险理赔效率的具体对策。如：建立在线理赔岗位、建立反欺诈岗位、 建立协赔岗位、控制承保风险、优化理赔流程、加强与外单位合作、推行案件快速 处理政策等。 本文结合公司运营现状，提出了提高公司车险理赔效率的具体对策，从而促进 整个公司更加健康稳定地经营发展。 关键词 机动车辆保险；理赔效率；理赔时效；理赔质量；提升对策Abstract III Abstract China's motor vehicle insurance has achieved great development, but the maturity of the current vehicle insurance market can not meet the increasingly diversified needs of consumers, and the problem of "difficult to settle claims" is becoming increasingly prominent. This problem is manifested in the low efficiency of claim settlement and poor service quality. The efficiency of claim settlement is not only related to the company's business situation and market competitiveness, but also related to the company's reputation and efficiency. Therefore, the research on improving the efficiency of automobile insurance claims is of great significance to the healthy development of Shijiazhuang branch of X property insurance. Combing the relevant documents, draw lessons from the current research results of improving the efficiency of car insurance claims. Collecting and organizing the research object in nearly three years claims data, analyze data, find the problems existing in the efficiency of car insurance claims, For example, the claim cycle is longer, the loss rate is higher, the impairment of car insurance recovery is reduced, the number of complaints is increased, the satisfaction of claims is not high, the proportion of lawsuits is increased, etc. According to the analysis of the problems, the reasons can be divided into two parts, the reasons from the external environment and the reasons from the internal environment. The external causes include: customers, industry regulatory reasons, media publicity, vehicle repair shop reasons, injury compensation disputes, insurance agent reasons. The internal reasons include the reasons for the company's organizational structure, the claims process, the staff's business skills, and the lack of management and control of human injury cases. In-depth analysis of these problems, and then according to the actual operation status quo of the research object, finally puts forward the feasible concrete countermeasures to promote efficiency of car insurance claims. Such as: establishing online claims, to set up the anti-fraud job, establishing the association of post, control the underwriting risk, optimizing the claims process, strengthening the cooperation with other units, to implement case rapid policy, etc. This paper combined with the current situation of the company's operation, put forward specific countermeasures to improve the efficiency of the company's car insurance claims, so as to promote the whole company more healthy and stable business河北科技大学硕士学位论文 IV development. Key words Motor vehicle insurance；Claim settlement efficiency；Limitation of claims； Claim quality；Improve countermeasures目 录 V 目 录 摘要........I Abstract... III 第 1 章 绪 论......................1 1.1 研究背景与研究意义.1 1.1.1 研究背景..............1 1.1.2 研究意义..............1 1.2 国内外研究现状.........2 1.2.1 国内研究现状......2 1.2.2 国外研究现状......2 1.2.3 国内外研究述评..3 1.3 研究内容与研究方法.3 1.3.1 研究内容..............3 1.3.2 研究方法..............4 1.3.3 技术路线图..........4 第 2 章 基本理论..................5 2.1 机动车辆保险概述.....5 2.1.1 车辆保险的险种及作用.....................5 2.1.2 车辆保险的特点..5 2.1.3 车辆保险理赔介绍.............................6 2.2 车险理赔效率.............6 2.2.1 车险理赔效率的概念.........................6 2.2.2 车险理赔效率的体现指标.................6 2.3 本章小结.....................7 第 3 章 X 财险石家庄分公司车险理赔现状分析............................9 3.1 公司概况.....................9 3.2 公司理赔部组织架构及审核流程............9 3.3 公司车险理赔流程...11 3.3.1 接报案及调度....11 3.3.2 查勘....................11 3.3.3 立案....................12河北科技大学硕士学位论文 VI 3.3.4 定损....................12 3.3.5 核价....................12 3.3.6 核损....................13 3.3.7 理算....................13 3.3.8 人伤跟踪............13 3.3.9 医疗审核............13 3.3.10 核赔..................13 3.3.11 追偿..................14 3.4 车险理赔效率存在的问题......................14 3.4.1 理赔周期偏长....14 3.4.2 赔付率较高........16 3.4.3 客户满意度不高17 3.4.4 引导客户快速处理效果差...............18 3.4.5 结案率降低........19 3.5 问题产生的原因.......19 3.5.1 外部环境............19 3.5.2 内部环境............21 3.6 本章小结...................22 第 4 章 提升公司车险理赔效率的对策...........23 4.1 改善理赔组织架构...23 4.1.1 建立在线理赔岗位...........................24 4.1.2 建立反欺诈岗位24 4.1.3 建立协赔岗位....24 4.1.4 简化理赔流程....25 4.2 控制承保风险...........25 4.2.1 规范承保行为....26 4.2.2 加强核保管控....26 4.2.3 加强风险控制....26 4.3 优化人力资源配置...27 4.3.1 推动理赔专业化27 4.3.2 更新服务理念....27 4.3.3 健全理赔考核制度...........................27 4.4 优化理赔流程...........28 4.4.1 加强理赔标准化28目 录 VII 4.4.2 简化理赔手续....28 4.5 加强与外单位合作...28 4.5.1 与保险公估机构合作.......................28 4.5.2 与交警队合作....28 4.5.3 与修理厂或 4S 店合作.....................29 4.6 推行案件快速处理政策..........................29 4.6.1 小额人伤案件快速处理办法...........29 4.6.2 小额案件自动核赔方案...................30 4.6.3 人伤疑难案件会商处理方案...........31 4.6.4 万元以下案件单证简化工作方案...31 4.6.5 理赔无纸化方案32 4.7 本章小结...................33 结 论.....35 附 录.....37