摘要
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论文题目：中银保险车险欺诈风险管理研究
学科名称：工商管理
学员姓名：曲振涛
签名：
指导教师：张博
副教授
签名：
摘要
随着国民收入的不断提高，我国汽车保有量逐年上升，机动车保险行业也随之得到
快速发展，机动车保险已经逐渐成为与国民生活密不可分的险种。中银保险公司是一家主
要经营车险业务的财产保险公司，虽然近几年来车险保费收入和公司规模保持着快速增长
的趋势，但是公司的经营效益和利润却呈现了负增长的态势。车险费率的改革导致车险车
损险费率下降明显，同时保险公司住处的赔付成本却在不断上升，使中银保险公司的车险
业务的利润受到双重挤压。2015年末中银保险车险的综合成本率达到了103.25% ，较去
年上升了1.62个百分点，车险业务持续连年亏损走势。根据中银保险历年的数据分析来
看导致中银保险连年亏损局面的因素除了车险费率改革、承保手续费上升、进口车辆赔付
成本上升、车险业务结构不合理和国家死亡伤残标准提高外，车险欺诈案件的持续增多也
是个主要原因。中银保险公司也已经开始认识到车险欺诈的危害性，并针对车险欺诈采取
了一系列的管控措施，但受制于公司规模、人员素质、重视程度等多重因素并没有建立起
一套完整和行之有效的车险欺诈案件的管控机制，车险反欺诈工作结果并不理想

本为旨在结合欧美、日韩等车险行业起步较早的发达国家的机动车保险欺诈的风险管
理方法和研究，总结出一套适合中银保险公司的机动车保险欺诈风险管理方案。首先论述
了机动车保险欺诈的相关研究理论及学说，并分析了车险欺诈的形成原因、表现方式和危
害。其次阐述了目前中银保险车险业务经营现状及针对车险欺诈采取的一系列的管控措
施，并分析了中银保险车险欺诈管理中存在的问题和不足。再次，从完善公司架构、建立
欺诈识别模型、构建车险欺诈预警系统、总结打击车险欺诈方法四个方面设计了一套适合
中银保险公司的车险欺诈风险管理方案。最后，针对车险欺诈管理方案总结了一系列的保
障措施和手段以保证管理方案的顺利实施

车险欺诈的猖獗不仅扰乱了保险公司正常的车险经营，同时也侵害了其他合法投保人
的正当利益，对我国车险行业的健康稳定发展产生了严重的阻碍。车险业务在中银保险的
业务占比中占有绝对的份额，所以建立一套行之有效的适合中银保险公司的机动车保险欺
诈风险管理方案对降低中银保险的赔付率、综合成本率进而实现车险业务经营利润意义重
大

关键词：机动车辆保险 欺诈风险管理 保险反欺诈
abstract
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Title: Research on the risk management of automobile insurance
fraud for tie Bank of China Insurance
Major: Business Administration
Student: Qu zhentao Signature:
Supervisor:Prof.Zhangbo Signature:
Abstract
With the continuous improvement of national income, China's car ownership has increased
year by year, the motor vehicle insurance industry has also been rapid development. Bank of
China Insurance Company is a major property insurance companies operating in the insurance
business, although in recent years the insurance premium income and the size of the company
maintained a rapid growth trend, but the company's operating efficiency and profits but showed
a negative growth trend. Motor vehicle insurance rates led to the reform of motor vehicle
damage insurance rates decreased significantly, while the cost of insurance company
accommodation costs are rising, so that the profits of the insurance company's insurance
business in the Bank of Korea by double squeeze. At the end of 2015, the comprehensive cost
of insurance and insurance companies in China reached 103.25%, compared with last year, an
increase of up to 1.62 percentage points, auto insurance business continued losses in recent
years. According to the analysis of the data over the factors that lead to the Bank of China
Insurance Bank of China insurance losses situation in addition to the reform of auto insurance
rates, underwriting fees rise, rising costs, payment of imported vehicle insurance business
structure unreasonable and the National Death disability standards, auto insurance fraud case is
a major cause of increasing. Bank of China Insurance Company has also begun to realize the
harm of insurance fraud, and adopted a series of control measures for auto insurance fraud, but
subject to the size of the company, the quality of personnel, the degree of attention of multiple
factors and did not establish a complete and effective management mechanism of insurance
fraud, insurance anti fraud work results is not ideal.
This is aimed at combining risk method and study of the management of the insurance
industry in Europe and the United States, Japan and South Korea and other developed countries
started earlier in the automobile insurance fraud, summed up a set of suitable for the Bank of
China Insurance Company auto insurance fraud risk management plan. First of all, this paper
discusses the theory and theory of motor vehicle insurance fraud, and analyzes the causes,
manifestations and harm of auto insurance fraud. Secondly, this paper expounds the current
西安理工大学工商管理硕士专业学位论文
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situation of the insurance business of the insurance business in China and a series of control
measures taken against the auto insurance fraud. Again, from the improvement of company
structure, the establishment of fraud identification model, construction of auto insurance fraud
warning system, a set of bank insurance company auto insurance fraud risk management
scheme design summary against auto insurance fraud four aspects. Finally, a series of safeguard
measures and methods are put forward to ensure the smooth implementation of the management
plan.
The rampant auto insurance fraud not only disturbs the normal auto insurance business of
insurance companies, but also infringes the legitimate interests of other legal persons. The auto
insurance business accounted for an absolute share in the Bank of China insurance business,
establish a set of effective for Bank of China Insurance Company auto insurance fraud risk
management scheme so to reduce the BOC insurance payment rate, comprehensive cost rate
and realize the auto insurance business operating profit is significant.
Key words
: automobile insurance; fraud risk management； insurance against frauds。
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