2024年蚂蚁保平台健康险理赔92亿元，“人民调解员”成保司与用户间桥梁

Core Viewpoint - Ant Insurance has demonstrated significant advancements in health insurance claims processing, showcasing the effectiveness of its "Anxin Pei" service in enhancing user experience and resolving disputes [1][3][7]. Group 1: Claims Data - In 2024, Ant Insurance's platform facilitated health insurance claims totaling 9.2 billion yuan, serving 7.25 million claimants [1]. - The average claim amount for critical illness insurance on the platform was 77,920 yuan, with the highest single payout reaching 1.6 million yuan [1]. - The average claim amount for hospitalization medical insurance was 6,586 yuan, primarily due to conditions like breast cancer, lung cancer, and pneumonia [1]. Group 2: Anxin Pei Service - The "Anxin Pei" service has been upgraded since 2022, covering 85 products from 11 insurance companies, providing comprehensive support throughout the claims process [3][4]. - The service includes AI interpretation of claims conclusions, one-on-one expert assistance, and mediation by trained personnel, enhancing communication between users and insurance companies [3][4]. Group 3: Dispute Resolution - In 2024, 162,000 health insurance claim users utilized the AI interpretation service, achieving a self-resolution rate of 96% [4]. - For complex claims disputes, the Ant Mediation Studio successfully mediated 955 cases, assisting users in recovering 4.97 million yuan [2][4]. - The mediation process has a high resolution rate, with over 98% of disputes resolved through AI interpretation and expert assistance, leaving less than 2% of cases requiring mediation [8]. Group 4: Industry Impact - The introduction of a neutral third-party platform like Ant Insurance enhances communication between insurers and users, providing a new model for resolving claims disputes [7][8]. - The focus on improving claims services aligns with the industry's goal of protecting consumer rights and enhancing user satisfaction [7][8].