理賠裁決引擎
保險理賠案件的全自動化裁決管線 — 資格驗證、條款比對、金額計算和合規檢查由系統自動執行，例外案件路由至人工處理。
eventsystemdbapi
為什麼需要 OSOP
理賠裁決的自動化能大幅提升處理速度。OSOP 定義每個裁決步驟的邏輯和例外條件，確保自動裁決的一致性和準確性，並完整記錄決策依據以備監管查核。
Workflow Steps (6)
1
Claim Submission Event
event2
Policy Lookup
db3
Coverage Rules Engine
system4
Benefit Calculation
system5
Payment System
api6
EOB Notification
apiConnections (5)
Claim Submission Event→Policy Lookupsequential
Policy Lookup→Coverage Rules Enginesequential
Coverage Rules Engine→Benefit Calculationconditionalclaim.eligible == true
Benefit Calculation→Payment Systemsequential
Payment System→EOB Notificationsequential
6
Steps
5
Connections
4
Node Types