• 한국건설관리학회논문집
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• 제12권1호
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• pp.13-22
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• 2011

클레임의 발생원인과 예방에 대하여 많은 연구들이 수행되어 왔으나, 개선방안 혹은 제도개선, 대응방안 등에 대한 연구가 대부분이었다. 특히, 잠재되어 있는 클레임에 대한 구체적인 내용들을 정리하고, 예방을 위한 실무적인 연구는 미흡한 실정이다. 그러므로 향후 발생할 수 있는 클레임에 대해, 그 중 설계단계에서 잠재될 가능성이 큰 원인들을 사전에 검토 및 재확인하여 클레임을 예방할 수 있는 수단이 부족하다. 본 연구에서는, 클레임이 발생되는 시기가 대부분 시공단계이지만 클레임의 원인은 설계단계에서 발생하는 점에 착안하여, 설계단계에서 잠재된 클레임 예방을 위하여 설계단계의 설계서 등을 포함한 계약문서를 중심으로 연구를 수행하였다. 클레임의 근거서류를 준비하고, 관련법규의 적용규정을 확인하면서 클레임 발생원인을 짚어볼 수 있는 체크리스트를 개발하였다.

• Journal of applied mathematics & informatics
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• 제32권3_4호
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• pp.343-357
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• 2014

In many non-life insurance applications past data are given in a form known as the run-off triangle. Smoothing such data using parametric crisp regression models has long served as the basis of estimating future claim amounts and the reserves set aside to protect the insurer from future losses. In this article a fuzzy counterpart of the Hoerl curve, a well-known claim reserving regression model, is proposed to analyze the past claim data and to determine the reserves. The fuzzy Hoerl curve is more flexible and general than the one considered in the previous fuzzy literature in that it includes a categorical variable with multiple explanatory variables, which requires the development of the fuzzy analysis of covariance, or fuzzy ANCOVA. Using an actual insurance run-off claim data we show that the suggested fuzzy Hoerl curve based on the fuzzy ANCOVA gives reasonable claim reserves without stringent assumptions needed for the traditional regression approach in claim reserving.

• 대한수학회지
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• 제50권1호
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• pp.111-125
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• 2013

In this paper, we consider a continuous time risk model involving two types of dependent claims, namely main claims and by-claims. The by-claim is induced by the main claim and the occurrence of by-claim may be delayed depending on associated main claim amount. Using Rouch$\acute{e}$'s theorem, we first derive the closed-form solution for the Laplace transform of the survival probability in the dependent risk model from an integro-differential equations system. Then, using the Laplace transform, we derive a defective renewal equation satisfied by the survival probability. For the exponential claim sizes, we present the explicit formula for the survival probability. We also illustrate the influence of the model parameters in the dependent risk model on the survival probability by numerical examples.

• Communications for Statistical Applications and Methods
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• 제23권1호
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• pp.85-91
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• 2016

Aggregate claim amounts with a large claim frequency represent a major concern to automobile insurance companies. In this paper, we show that a new hybrid method to combine the analytical saddlepoint approximation and Monte Carlo simulation can be an efficient computational method. We provide numerical comparisons between the hybrid method and the usual Monte Carlo simulation.

• 정보관리연구
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• 제31권2호
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• pp.47-65
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• 2000

KINITI에서는 효율적인 클레임업무처리를 위하여 EDI 클레임문서 전송시스템을 개발하였다. 본고에서는 EDI 표준에 관한 이론적인 내용(정의, 구조, 이점)과 실제 클레임시스템 구현사례, 문제점, 그리고 향후 시스템 개선방안을 살펴보았다.

• 한국병원경영학회지
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• 제9권3호
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• pp.71-97
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• 2004

This study conducted a comparative analysis of awareness level of review standards, continuing education, and awareness about the need for speciality and educational courses in order to improve quality of Korean health insurance review work and to present directions for policies of personnel development and continuing education to smoothly perform hospital's insurance claim work and Agency's review work. The analysis unit of the study is individuals, and survey was conducted among hospital's claim officers and Agency' review officers by distributing questionnaires. The major results of the study are as follows: First, it is found that hospital's claim officers and Agency's review officers have conflicting awareness about review standards; more Agency's review officers think that current review standards are universal and reasonable, while more hospital's claim officers believe that they need to be revised. Especially, hospital's claim officers replied that it is possible that review results can differ according to government's policies. Second, there is no significant difference between the two groups in the opinion that there are individual differences in awareness level of review standard. In particular, both groups share the opinion that review results can differ according to officer's interpretation of review standards. Third, Both review officer groups feel the need for further training and continuing education. Fourth, there is no difference between the two groups in the opinion that both groups members should be educated in review related educational institutions. However, while 81.5% of Agency's review officers the education should be offered at the Agency, only 45.2% of hospital's claim officers agreed to it. Fifth, both review personnel do not show any difference in awareness of needed experience to successfully perform review work; both groups replied that three to four years experience is necessary to smoothly perform claim work and review work. This study was tried in order to search for directions to improve Korean insurance review work in quality rather than to explore characteristics themselves of individual factors. In this sense, this study presupposed an intention that the educational subjects for further training and continuing education for the two groups should be the same in order to narrow the awareness gap between hospital's claim officers and Agency's review officers. Thus, this study suggests that it is desirable to offer beginner courses at junior colleges or in undergraduate courses and advanced courses in professional graduate school for six to twelve months. In that a comparison of awareness level of hospital's claim officers and Agency's review officers who are actually in practice should precede appropriate presentation of directions for the qualitative improvement of insurance review work in Korea, the significance of this study lies in comparatively analyzing the awareness level of hospital's claim officers and Agency's review officers and in presenting the establishment of future further training and continuing education.

• Journal of Preventive Medicine and Public Health
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• 제33권4호
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• pp.393-401
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• 2000

Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

• 한국의류산업학회지
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• 제19권2호
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• pp.166-179
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• 2017

Fashion industry have been emphasizing on eco-friendly business to enhance their public image. Due to the lack of consumers' awareness and experience of eco fashion advertising, this have resulted in adverse outcomes. Therefore, it is required to develop eco fashion advertisement that meets the public interest of Koreans. This study aims to obtain practical implications which can be applied to further eco fashion advertising. The study examines the public opinion towards eco fashion using Twitter as big data analysis and the protracted implication was provided to consumers as consumer vocabulary to see the advertising effect of consumer vocabulary. In addition, this study focuses on the environmental claim types to identify the most effective advertisement in eco fashion. The results are as follow. Associative claim types had a more positive influence on advertising attitude than substantive claim types. Substantive claim types had a more positive influence on brand cognition than associative claim types. In addition, the moderating effects of consumer vocabulary on advertising attitude and brand cognition were supported in substantive claim types. Advertisement attitude shows positive effects to both brand cognition and brand attitude. It has been proved that brand cognition leads to positive influence towards brand attitude and brand attitude eventually increases consumers' urge to buy products. This study has implication when providing a guideline for eco fashion advertisements.

• 무역상무연구
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• 제55권
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• pp.155-181
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• 2012

This study considered as precautions in light of practical affairs related to a claim for damages focusing on CISG (1980) and PICC (2004). Given summarizing contents of this study, those are as follows. First, when exercising a claim for damages, proving the damages may be difficult and hard. Thus, there is necessity for stating the liquidated damages clause in contract given conclusion of contract. Second, as for the application of interest rate given a claim for interest, CISG is not covered interest rate. PICC is covered interest rate. However, there is possibility that PICC will not be applied as general principles. Thus, to remove this insecurity and uncertainty, there is necessity for stating this in contract by deciding on the detailed standard stipulation after fully discussing about interest payment with the counterpart given sale contract. Third, when a seller delivered non-conformity of the goods for contract, a buyer is desirable to exercise by discreetly judging the exercise method or limitation element on a problem of selecting and exercising remedy favorable to oneself out of a claim for damages and a right to reduce the price. Finally, There was suggestion that the contract parties are desirable to utilize by modifying and supplementing properly this in line with own business-based necessity and situation based on the ICC Model International Sale Contract, and to state CISG and PICC the governing law clause, in preparing contract. This study is expected to possibly become guideline in which the damaged party exercises a claim for damages or aims to cope with the counterpart's exercising a claim for damages.

• 한국건설관리학회논문집
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• 제18권3호
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• pp.22-32
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• 2017

과거 사례로 볼 때 건설시공사는 클레임 시스템이 없이 발주자에게 클레임을 제기하여 미 승인 또는 감액 등을 받아 손실을 입는 경우가 종종 발생하고 있어 기존의 클레임 프로세스 개선이 필요하다. 이를 개선하기 위하여 건설시공사는 클레임 프로세스 개선을 위하여 조직구성의 강화, 클레임 담당자에 대한 정확한 업무부여, 담당자에 대한 주기적 클레임 교육실시, 공기관리 및 공정관리 기법 개선과 철저한 문서관리가 필요하다. 또한 정기적인 클레임 회의가 필요하다. 본 연구에서는 발주자 잘못으로 인한 관급자재 조달의 지연, 구두 작업지시, 작업진행상 필요한 정보지연 및 과다 설계변경 등이 발생한 'A' 프로젝트에 대하여 개선된 프로세스를 적용하여 초기 공사기간 62개월에서 34개월의 공기연장을 받아 96개월에 완공하여 이를 입증하였다. 개선된 클레임 프로세스 시스템이 대규모 건설사업장은 물론 소규모 건설사업장에도 적용하여 도움이 될 것으로 기대한다.