I 摘要 伴随着经济发展，人民生活条件得到极大改善，车辆在社会生产、家庭生活等 各个领域中得到广泛的应用，车辆消费随之日益增长。我国汽车保险市场随着机动 车保有量的迅速增加，既显示出巨大潜力，又面临着巨大挑战。车险经营的状况关 系着财险公司的规模、利润及发展。保险理赔充分体现了保险人的社会管理职能， 同时也是评价保险公司业务质量与服务水平的关键环节。风险是财险公司的主营产 品，最重要的任务就是风险的管控。车险理赔风险的管控水平是财险公司管理制度 规范程度的体现，在提升公司综合竞争力上具有重要作用。 首先、本文在分析国内外对车险理赔风险控制的研究现状基础上，从车险理赔 理论、保险经营的风险控制理论和车险理赔风险的表现形式三个方面对车险理赔风 险控制理论进行概述。其次、在此理论的基础上，从车险理赔流程、车险理赔经营 现状和现有车险理赔风险管控机制三个方面入手对TB财险山东分公司车险理赔风 险管控现状进行分析。第三、对TB财险山东分公司车险理赔风险管控存在问题分析， 从车险理赔业务人员、公司车险理赔系统平台、车险理赔流程、车险理赔风险管控 制度四个方面进行阐述。最后、从建立车险理赔风险创新管控机制、建立符合风险 管控导向的新理赔机制、建立和完善理赔的人才机制三大方面构建TB财险山东分公 司车险理赔风险管控机制。 本文通过对TB财产保险公司山东分公司车险理赔风险管控研究，可以为公司在 汽车保险市场和行业中健康发展、提升战略竞争力提供理论指导和借鉴。在我国汽 车保险市场竞争日趋激烈的今天，该课题具有理论、实践上研究和探讨的双重意义。 关 键 词：车险理赔； 风险管控；TB财险；保险经营 ABSTRACT III ABSTRACT Along with economic development, people's living conditions have been greatly improved. Vehicles are widely used in various fields such as social production, family life and so on. Vehicle consumption is growing. With the rapid increase of motor vehicle ownership in China's auto insurance market, it not only shows great potential, but also faces great challenges. The situation of car insurance management is related to the scale, profit and development of the financial insurance company. Insurance claims fully reflect the social management function of the insurer, and it is also the key link to evaluate the business quality and service level of the insurance company. Risk is the main product of a financial company, and the most important task is to control the risk. The control level of the risk of auto insurance claims is the embodiment of the standard degree of the management system of the financial insurance company, which plays an important role in promoting the comprehensive competitiveness of the company. First, based on the analysis of the research status of vehicle insurance claims risk control at home and abroad, this paper summarizes the theory of vehicle insurance claims risk control from three aspects: vehicle insurance claim theory, insurance operation risk control theory and vehicle insurance claim risk form. Based on this theory, from the three aspects of vehicle insurance claims process, insurance claims operation status and existing vehicle insurance claims risk management and control mechanism, we analyze the current situation of vehicle insurance claims risk management in Shandong TB insurance company. The third part analyzes the existing problems of vehicle insurance claims risk management and control in Shandong branch of TB property insurance company. It elaborates from four aspects: vehicle insurance claims business personnel, vehicle insurance claims system platform, vehicle insurance claims process, vehicle insurance claims risk management and control system. Finally, from the establishment of vehicle insurance claims risk innovation control mechanism, the establishment of new claims mechanism in line with risk management and control, the establishment and improvement of the talent mechanism of claims, three aspects of building TB automobile insurance claims risk management and control mechanism of Shandong property insurance company are established. By studying the risk management and control of vehicle insurance claims in Shandong 西安电子科技大学硕士学位论文 IV branch of TB property insurance company, this paper can provide theoretical guidance and reference for company's healthy development and strategic competitiveness in the automobile insurance market and industry. With the increasingly fierce competition in the automobile insurance market in China, the subject has both theoretical and practical research and discussion. Keywords: Car insurance claims, Risk control, TB financial insurance, Insurance business 插图索引 V 插图索引 图2.1 理赔流程图................9 图2.2 风险管理过程...........11 图2.3 COSO内部控制五要素框架图..............12 图2.4 车险各环节理赔风险表现形式.............18 图3.1 理赔全流程图..........20 图3.2 简易案件处理流程图.............................21 图3.3 定损流程图..............22 图3.4 查勘端提调流程图..29 图3.5 审计流程图..............30 图4.1 TB财险山东分公司理赔业务流程图....35 表格索引 VII 表格索引 表3.1 2017年业务大类分析表........................ 26 表3.2 2016保单和2017保单出险频度对比表..............................26 表3.3 2017年车辆种类分析表.........................27 表3.4 2017年分车价分析对比表.....................27 表3.5 2017年分使用年限分析对比表.............28 表3.6 2017年分险别分析对比表.....................28 目录 IX 目录 摘要 I ABSTRACT ................ III 插图索引 ..................... V 表格索引 ................... VII 第一章 绪论 ................ 1 1.1研究背景及意义 ............................ 1 1.1.1 研究背景 ............................ 1 1.1.2 研究意义 ............................ 1 1.2 国内外研究综述 ........................... 1 1.2.1 国外研究现状 .................... 1 1.2.2 国内研究现状 .................... 2 1.2.3 简要评述 ............................ 3 1.3研究设计......... 3 1.3.1 研究思路 ............................ 3 1.3.2 研究方法 ............................ 4 1.3.3 框架结构 ............................ 4 第二章 相关理论基础 . 5 2.1 车辆保险概念及内涵 ................... 5 2.1.1 车辆保险的定义 ................ 5 2.1.2 国内外车辆保险的发展 .... 5 2.1.3 车辆保险的相关概念 ........ 6 2.1.4 车辆保险的分类 ................ 6 2.2 车险理赔概念及内涵 ................... 7 2.2.1车险理赔的含义 ................. 7 2.2.2车险理赔的意义 ................. 8 2.2.3车险理赔的原则 ................. 8 2.2.4车险理赔的特点 ................. 8 2.2.5车险理赔的流程 ................. 9 2.3 风险管控理论 9 2.3.1风险的定义 ......................... 9 2.3.2风险的特性 ....................... 10 2.3.3风险管理 ........................... 10 西安电子科技大学硕士学位论文 X 2.3.4风险控制 ........................... 11 2.4 保险公司内部控制理论 ............. 11 2.4.1COSO内部控制框架 ........ 11 2.4.2保险公司内部控制基本准则 .......................... 12 2.5 车险理赔风险表现形式 ............. 13 2.5.1接报案及调度的理赔风险 .............................. 13 2.5.2查勘调查的理赔风险 ....... 13 2.5.3估损、定损和核损的理赔风险 ...................... 14 2.5.4机动车损的理赔风险 ....... 14 2.5.5人伤损失的理赔风险 ....... 15 2.5.6赔案理算的理赔风险 ....... 16 2.5.7核赔的理赔风险 ............... 16 2.5.8结案的理赔风险 ............... 16 第三章 TB财险山东分公司车险理赔风险管控现状分析 ... 19 3.1公司简介 ....... 19 3.2公司车险理赔流程 ...................... 19 3.2.1车险理赔流程图示 ........... 19 3.2.2事故现场的查勘 ............... 22 3.2.3 非现场定损 ...................... 23 3.2.4 理赔权限设置 .................. 24 3.3TB财险山东分公司车险理赔经营现状 .................... 24 3.3.1公司总体经营情况 ........... 24 3.3.2TB财险山东分公司业务结构分析 ................. 25 3.4公司现有车险理赔风险管控机制 ............................. 29 3.4.1查勘定损端提起调查 ....... 29 3.4.2部门内部定期审计 ........... 29 3.4.3后援中心案件集中审核 ... 30 第四章TB财险山东分公司车险理赔风险管控存在问题分析 ........................... 33 4.1公司车险理赔业务人员存在的问题 ......................... 33 4.1.1查勘定损岗位 ................... 33 4.1.2电话中心坐席岗位 ........... 33 4.1.3收单初核岗位 ................... 34 4.1.4核价核损岗位 ................... 34 4.2公司车险理赔系统平台存在的问题 ......................... 34 目录 XI 4.3公司车险理赔流程存在