关键词 AI核保、智能服务、健康险数字化、保险科技生态、普惠保障 水滴公司于2025年以AI技术为核心驱动力，推动健康险服务实现从"人工依赖"到"智能决策"的关键转 型。其上线的AI核保专家"KEYI.AI"，依托自研"水滴水守大模型"与千万级核保知识库，实现复杂健康 险核保平均处理时间缩短80%、响应速度提升260倍、准确率达99.8%的突破，并将AI能力延伸至客服、 销售辅助、理赔协同等全流程，同时通过开放技术能力赋能行业，联合险企构建普惠生态，为保险行业 智能化转型提供实践样本。 案例正文： 在健康险市场，"投保难、核保慢"长期是用户与行业的双重痛点。调研数据显示，48%的受访者认为保 险产品"过于专业"，传统人工核保面对非结构化的医疗记录、健康问卷时，不仅平均处理周期长达数 天，还易因审核人员经验差异产生误判；带病人群、老年人群等"非标体"群体，更常因健康告知门槛陷 入"想买却难买"的困境。2025年，水滴公司通过聚焦核保环节的技术革新，将AI能力贯穿保险服务全链 条，重新定义健康险的效率与覆盖边界。 作为国内较早布局AI大模型应用的保险科技平台，水滴公司以"用互联网科技助推广大人民群众有保可 医，保 ...

Core Insights - The article discusses the transformative impact of AI on the underwriting process in health insurance, highlighting the shift from traditional manual methods to AI-driven intelligent decision-making [1][2][5]. Group 1: AI Underwriting Transformation - AI underwriting systems can now understand and analyze medical texts, health questionnaires, and insurance terms, moving from "process assistance" to "intelligent decision-making" [1][2]. - The use of algorithms replaces manual judgment in non-structured segments, significantly improving efficiency and accuracy in health risk identification and underwriting recommendations [2][3]. Group 2: Case Study - Waterdrop's AI Underwriting Expert "KEYI.AI" - Waterdrop's AI underwriting expert "KEYI.AI" has achieved an 80% reduction in average processing time and a 260-fold increase in response speed, with an accuracy rate of 99.8% [3]. - The system also enhances customer experience by matching rejected clients with suitable products six times more effectively and offers 24/7 "second-level response" capabilities [3]. Group 3: Industry Trends and International Expansion - Several insurance technology companies are initiating international expansion plans, with Waterdrop establishing a licensed insurance brokerage in Hong Kong and aiming to leverage its domestic success in international markets [4]. - The industry is witnessing a shift towards "smart insurance," where AI not only enhances underwriting but also improves overall service quality and customer understanding [5][7]. Group 4: Governance and Regulatory Considerations - The rise of AI underwriting introduces new governance challenges, including the need for algorithm transparency, data security, and fairness in risk assessment [8][9]. - The industry must balance the scientific efficiency of AI with the necessity for regulatory frameworks that protect public interests [9]. Group 5: Future Outlook - The essence of AI underwriting is to enhance human capabilities rather than replace them, focusing on scientific risk identification and understanding customer needs [10]. - Future competition in the insurance sector will hinge on algorithm precision, data sensitivity, and service philosophy, marking a significant shift towards an "intelligent decision-making era" [10].

Core Insights - The insurance industry is transitioning towards an intelligent decision-making era with the rise of AI underwriting, significantly improving efficiency and user experience [1][10] Group 1: AI Underwriting Transformation - Traditional underwriting processes are often slow and inefficient, leading to poor user experiences due to complex terms and information asymmetry [1] - AI underwriting systems can now analyze medical texts, health questionnaires, and insurance terms, moving from process assistance to intelligent decision-making [2][3] - Waterdrop's AI underwriting expert "KEYI.AI" has demonstrated an 80% reduction in average processing time and a response speed increase of hundreds of times, achieving an accuracy rate of 99.8% [2][3] Group 2: Industry Trends and Innovations - AI underwriting is automating tasks such as health risk identification, terms matching, and underwriting recommendations, replacing manual judgment in non-structured segments [2] - Waterdrop's "KEYI" system has improved the matching of rejected clients to suitable products by six times and offers 24/7 instant response capabilities [3] - The introduction of AI in underwriting is not just about efficiency but also about enhancing the entire insurance value chain, leading to smarter risk assessments and better customer interactions [5][6] Group 3: International Expansion and Collaboration - Several insurance technology companies, including Waterdrop, are planning international expansions, with Waterdrop establishing a licensed insurance brokerage in Hong Kong [4] - Waterdrop aims to leverage its domestic success in product and operational innovation to explore applications of technology in international insurance markets [4] Group 4: Governance and Ethical Considerations - The rise of AI underwriting raises new governance issues, including the need for algorithm transparency, data security, and fairness in risk selection [8] - The industry must balance the scientific efficiency of AI with the need for regulatory frameworks that protect public interests [8] Group 5: Future Outlook - The essence of AI underwriting is to enhance human capabilities rather than replace them, focusing on scientific risk identification and understanding customer needs [9][10] - Future competition in the insurance sector will hinge on algorithm precision, data sensitivity, and service philosophy, marking a significant shift in the industry's landscape [10]