...............................................................................................................................I Abstract.......................................................................................................................II 第 1 章 绪论.............................................................................................................. 1 1.1 研究背景和意义................................................................................................1 1.1.1 选题背景..................................................................................................1 1.1.2 研究意义..................................................................................................4 1.2 国内外研究现状................................................................................................4 1.3 主要内容.............................................................................................................8 1.4 研究方法及技术路线图.................................................................................. 9 第 2 章 理论基础................................................................................................... 11 2.1 相关概念界定..................................................................................................11 2.1.1 机动车辆保险......................................................................................11 2.1.2 车险理赔成本......................................................................................11 2.1.3 保险欺诈.............................................................................................. 12 2.2 理论基础...........................................................................................................13 2.2.1 成本控制理论......................................................................................13 2.2.2 信息不对称理论——道德风险.......................................................14 2.2.3 归因理论.............................................................................................. 14 2.3 车险经营成本构成模型分析........................................................................ 15 2.3.1 车险经营成本构成要素.....................................................................15 2.3.2 车险理赔成本颗粒化分析理论...................................................... 17 第 3 章 天安财险苏州分公司车险理赔成本控制现状及存在的问题......20 3.1 天安财险苏州分公司简介............................................................................20 3.2 天安财险苏州分公司车险理赔流程..........................................................21 3.3 天安财险苏州分公司车险理赔成本分析.................................................22 3.4 天安财险苏州分公司车险理赔成本控制调查........................................26 3.4.1 问卷调查对象、范围与内容的确定............................................. 26 3.4.2 调查问卷的设计与实施....................................................................26 3.4.3 调查问卷分析过程.............................................................................26 3.5 存在的问题........................................................................................................30 3.6 存在问题的原因...............................................................................................32 3.6.1 外部原因.............................................................................................. 323.6.2 内部原因.............................................................................................. 33 第 4 章 天安财险苏州分公司车险理赔成本控制的优化对策...................35 4.1 指导思想...........................................................................................................35 4.2 基本原则...........................................................................................................35 4.3 车险理赔成本控制的优化思路....................................................................36 4.3.1 理赔流程优化.......................................................................................36 4.3.2 明确车险理赔成本控制优化的主要难点......................................38 4.4 天安财险苏州分公司车险理赔成本控制的优化措施............................39 4.4.1 全面做好事先控制——理赔渗漏控制...........................................39 4.4.2 优化事中控制——理赔欺诈控制.................................................. 40 4.4.3 构建渗漏风险模型，利用规则防控渗漏风险.............................41 4.4.4 构建全方位、多维度的理赔控制体系..........................................44 4.4.5 建立专门针对欺诈、虚假案件的防范体系................................46 4.4.6 先进信息技术工具、手段在理赔风险防范中的应用............... 47 第 5 章 车险理赔成本控制优化的保障条件..................................................49 5.1 人员保障...........................................................................................................49 5.1.1 提升理赔人员专业能力....................................................................49 5.1.2 优化理赔人员配置.............................................................................49 5.2 组织保障...........................................................................................................50 5.2.1 改善组织架构......................................................................................50 5.2.2 优化作业模式......................................................................................51 5.3 制度保障...........................................................................................................52 5.4 技术保障...........................................................................................................53 5.4.1 构建信息支持机构.............................................................................53 5.4.2 构建车险理赔风险识别系统...........................................................53 5.4.3 借鉴远端视频系统对事故进行定损...............................................54 结论............................................................................................................................55 参考文献...................................................................................................................57 致谢............................................................................................................................60 附录............................................................................................................................61I 摘要 近年来随着我国保险业的发展，国内财产保险公司机动车辆保险保费 收入增长迅速。机动车保险业务快速发展的同时，居高不下的理赔成本已 成为制约产险公司健康发展的重要因素。 本文以天安财险苏州分公司为研究对象，主要是从避免车险欺诈方面 进行理赔成本控制研究。文中在对车险欺诈和风险识别国内外研究的基础 上，针对天安财险苏州分公司车险赔付现状，通过问卷调查的方式，阐述 了公司车险理赔工作存在人员专业程度不够、组织架构不健全等问题，同 时分析了导致问题存在的诸多内外部原因。文中提出了天安财险苏州分公 司车险理赔成本控制关键是车险欺诈案件的防范和识别，并从构建渗漏风 险模型、构建全方位、多维度的理赔控制体系、运用先进信息技术等方面， 提出了车险理赔成本控制的优化措施。最后，从人员、组织、制度、技术 四个方面总结出车险理赔成本控制优化的保障条件。 期望本文的研究能对有效降低天安财险苏州分公司车险欺诈风险，控 制车险赔付成本起到有益的借鉴作用；同时对于同业中其他保险公司具有 一定的参考价值。 关 键 词：天安苏州分公司；车险理赔；成本控制；优化研究II Abstract In recent years, with the development of my country's insurance industry, domestic property insurance companies' motor vehicle insurance premium income has increased rapidly. With the rapid development of motor vehicle insurance business, high claims costs have become an important factor restricting the healthy development of property insurance companies. This article takes Tianan Property & Casualty Insurance Suzhou Branch as the research object, and focuses on the research of claim cost control from the aspect of avoiding auto insurance fraud. On the basis of domestic and foreign research on auto insurance fraud and risk knowledge, this article focuses on the current status of auto insurance claims of Tianan Property & Casualty Insurance Suzhou Branch through a questionnaire survey, expounds the company's auto insurance claims work with insufficient professionalism and unsound organizational structure. At the same time, many internal and external reasons leading to the problem are analyzed. The article proposes that the key to the cost control of auto insurance claims of Tianan Property & Casualty Insurance Suzhou Branch is the prevention and identification of auto insurance fraud cases, and proposes from the aspects of building a leakage risk model, building a comprehensive and multi-dimensional claims control system, and using advanced information technology. Optimized measures for cost control of auto insurance claims, and summarized the guarantee conditions for optimization of auto insurance claims cost control from four aspects: personnel, organization, system, and technology. This study can effectively reduce the risk of auto insurance fraud by Tianan Property & Casualty Insurance Suzhou Branch, control the cost of auto insurance claims, and provide specific reference value for other insurance companies in the industry.