• International conference on construction engineering and project management
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• 2017.10a
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• pp.281-290
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• 2017

As various stakeholders are involved in construction projects, disputes between the parties are more likely to occur, which is a very important issue for the participants in the projects. Claims in construction projects, however, are very complex and thus difficult to manage. In particular, as the cause of a claim in the preceding stage that has not been resolved in a timely manner has an effect on the cause of a claim in the following stage, it is difficult to find a point of compromise regarding a claim caused by the relationship between the causes that occur in the preceding and following stages. In this regard, this study sought to examine the rules for the generation of change order claims, which occur most frequently among the construction claims, and thus to select the key management targets through the analysis of the relationship between the causes of claims arising in the preceding and following stages for the efficient management of claims. It is expected that the use of rules for the generation of change order claims as well as of representative and similar cases will help the construction practitioners in judging claims, considering the relationships among the causes of the claims. Meanwhile, in this study, association analysis was conducted regarding the causes of the occurrence of change order claims in a design-build delivery method, and therefore, it is necessary to verify the effectiveness of the method when applied to other delivery methods.

• Communications for Statistical Applications and Methods
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• v.31 no.3
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• pp.323-336
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• 2024

The accurate forecasting of insurance claims is a critical component for insurers' risk management decisions. Hierarchical Bayesian parametric (BP) models can be used for health insurance claims forecasting, but they are unsatisfactory to describe the claims distribution. Therefore, Bayesian nonparametric (BNP) models can be a more suitable alternative to deal with the complex characteristics of the health insurance claims distribution, including heavy tails, skewness, and multimodality. In this study, we apply both a BP model and a BNP model to predict group health claims using simulated and real-world data for a private life insurer in Indonesia. The findings show that the BNP model outperforms the BP model in terms of claims prediction accuracy. Furthermore, our analysis highlights the flexibility and robustness of BNP models in handling diverse data structures in health insurance claims.

• Journal of the Korean Society of Clothing and Textiles
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• v.17 no.4
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• pp.550-564
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• 1993

The purpose of this study is to investigate the consumer's claims related to clothing merchandise. By th origination stage of claims, details of claims, and treatments of claims purchasing places of clothing merchandise, the consumer's claims are analyzed which were lodged to in consumer's complaint center, Seoul YWCA, in 1981-1990. To analyze these data statistically, frequency and percentile are used. The results of analysis for consumer's claims are as next : 1. Concerning the sex distinction, female complainers are more than male complainers. About the age bracket, twenties and thirties are the most numerous. The originations of claims being various. It is laundry and dry cleaning stage out of them that rank first, and total numbers of claims for clothing products continually have increased during 1981-1990. Out of the clothing items, outerwears are of the first rank and formal wear and coat are highest in rank of outerwears. For claims about purchasing places, agency ranked first and market, department store, custome-made and discount store came after in order. 2. Concerning the contents, quality of clothing product ranks first, inferior service, price, contrast, unfair transaction ranks in order. There are claims about quality of clothing product that color change ranks first and damage and form change rank in order. 3. The treatments of claims are that counsel, exchange, refund, repair and correction rank in order.

• Proceedings of the SAREK Conference
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• 2006.06a
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• pp.820-825
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• 2006

It is necessary to correspond to building users' claims rapidly as much as possible in order to satisfy user's need, because the final tarket of building maintenance service is user of building. This paper investigates the time taken for receiving users' claims and the time taken for the service organization to respond to the claims in the office building; types of claims and service responses are analysed, through which the response characteristics of the maintenance management organization are evaluated with respect to users' claims. Throughout extensive simulation analysis, important performance measures such as mean time to repair and utilization of maintenance personnels have been investigated.

• The Journal of the Korean life insurance medical association
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• v.26
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• pp.31-39
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• 2007

Background and main issue: In the Korean insurance market, an outstanding issue is the decrease of margin of risk ratio. This affects the solvency and profitability of insurance companies. Insurance medicine, which has been developed in Western countries, is so-called medical risk selection or medical underwriting. Medical risk selection is based on clinical follow-up study and mortality analysis methodology. Unfortunately, there have been few clinical follow-up studies, and no intercompany disease analysis system is available in the Korean insurance market. In practice, we use underwriting guidelines, which were developed by some global reinsurance companies. However, these guidelines were developed under clinical follow-up studies performed abroad. So, we cannot rule out underestimation of excess mortality factors such as mortality ratio, excess death rate, and life expectancy. It is necessary to perform medical assessment in claims administration. Comparing the insured's statement by medical records with products' benefit according to this procedure, we can make sound claim decisions and participate in the role of sound underwriting. We can call this scientific procedure as the verification of medical claims review. Another area of medical claims review is medical counsel for claims staff. Result: There is another insurance medicine in addition to medical risk selection. Independent medical assessment by medical records of insured is medical claims review. Medical claims review is composed of verification and counsel.

• Journal of Internet of Things and Convergence
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• v.8 no.2
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• pp.13-24
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• 2022

In order to explore the context of fraudulent claims and the measures for preventing them targeting the long-term care institutions for the elderly, which is increasing every year in Korea, this study conducted the text mining analysis using the media report articles. The media report articles were collected from the news big data analysis system called 'BIG KINDS' for about 15 years from July 2008 when the Long-Term Care Insurance for the Elderly took effect, to February 28^th 2022. During this period of time, total 2,627 articles were collected under keywords like 'elderly care+fraudulent claims' and 'long-term care+fraudulent claims', and among them, total 946 articles were selected after excluding overlapped articles. In the results of the text mining analysis in this study, first, the top 10 keywords mentioned in the highest frequency in every section(July 1^st 2008-February 28^th 2022) were shown in the order of long-term care institution for the elderly, fraudulent claims, National Health Insurance Service, Long-Term Care Insurance for the Elderly, long-term care benefits(expenses), elderly care facilities, The Ministry of Health & Welfare, the elderly, report, and reward(payment). Second, in the results of the N-gram analysis, they were shown in the order of long-term care benefits(expenses) and fraudulent claims, fraudulent claims and long-care institution for the elderly, falsehood and fraudulent claims, report and reward(payment), and long-term care institution for the elderly and report. Third, the analysis of TF-IDF was similar to the results of the frequency analysis while the rankings of report, reward(payment), and increase moved up. Based on such results of the analysis above, this study presented the future direction for the prevention of fraudulent claims of long-term care institutions for the elderly.

• Journal of Korea Trade
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• v.23 no.6
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• pp.14-32
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• 2019

Purpose - This study is designed to provide new insights on trade claim management by typifying trade claims from a relational perspective, which defines trade as an organic combination that exchanges relationships based on a mutual goal instead of conflicts between obligations and rights of the contracting parties. Design/methodology - This is a phenomenological study that aims to typify trade claims based on a relational perspective and extract implications for trade claim management. The research procedures of this study are as follows. First, international commercial dispute cases applying the CISG are collected. Second, the cases collected are quantified through content analysis. The variables for quantification are developed based on a relationship perspective. Third, cluster analysis is conducted on coded data to typify cases. And finally, this study compares the characteristics of each type using analysis of variance and suggests implications for the strategic management of trade claims from a relational perspective. Findings - Results show that trade claims are divided into four clusters, depending on whether flexibility is accepted or not and which party violates mutuality. There is also a difference between the claimant and the cause of the claim, according to the cluster. Based on the results, this study suggests that the buyer and the seller should employ different strategies depending on the type of trade claim and presents proposals for strategic claim management. Originality/value - Firstly, this study extends the theoretical discussion on trade claims by applying relational contract theory. Prior studies on trade claims have been primarily based on traditional contract theory. The second is to analyze trade claims quantitatively. Prior case studies on trade claims have mainly relied on qualitative research. Finally, the study contributes to international commercial practice by typifying trade claims and presenting options for strategic management.

• Journal of Information Technology Services
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• v.8 no.4
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• pp.175-185
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• 2009

Objectifying claims filed during the warranty period, analyzing the current circumstances and improving on the problem in question is an activity worth doing that could reduce the likelihood of claims to occur, cut down on the costs, and enhance the corporate image of the manufacturer. Existing analyses of claims are confronted with two problems. First, you can't precisely assess the risks of claims involved by means of the value of claims per 100 products alone. Second, even in a normal state, the existing approach fails to capture the probabilistic conflicts that escape the upper control limit of claims, thus leading to wrong control activities. To solve the first problem, this paper proposed that a time series detection concept where the claim rate is monitored based on the date when problems are processed and a hazard function for expression of the claim rate be utilized. For the second problem, this paper designed a model whereby to define a normal state by making use of PID (Proportion, Integral, Differential) and infer by way of a fuzzy concept. This paper confirmed the validity and applicability of the proposed approach by applying methods suggested in the actual past data of warranty claims of a large-scaled automotive firm, unlike hypothetical simulation data, in order to apply them directly in industrial job sites, as well as making theoretical suggestions for analysis of claims.

• International Journal of Human Ecology
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• v.14 no.1
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• pp.13-27
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• 2013

Consumer perception of the meaning of 'green' and 'green products' as well as how they use green claims (including terms, certifications, and marks) should be examined to help consumers pursue green behavior in everyday life. This study investigates what type of green claims prevail in the Korean consumer market and how consumers perceive the meaning of 'green' and green claims. For these purposes, media analysis, in-context research (shop visit) and a survey were conducted to collect green claims (including green terms and certified/noncertified green marks). Green claims in the consumer market were first summarized and analyzed; subsequently, the most frequently used 7 green marks and 15 green terms were selected to construct a consumer survey questionnaire on consumer perceptions of green claims. An online survey was performed via Embrain and the survey respondents consisted of 500 adult consumers over the age of 20. The field research results showed frequent green claims in the Korean consumer market. However, certified (and hence trustworthy green product information labels) were uncommon in the market. The only green claim widely known and used by consumers was the energy consumption efficiency label. Consumers were interested in the green information label not because it affected their utility cost nor because it was important for environment protection.

• Health Policy and Management
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• v.16 no.2
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• pp.49-76
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• 2006

The aim of this study was to explore the effects of a computerized review program which was introduced in August 1, 2003, using claims data for acute respiratory infection related diseases. National Health Insurance (NHI) claims data on respiratory infection related diseases before and after the introduction, with six month intervals respectively, were used for the analysis. Clinic was the unit of observation, and clinics with only one physician whose specialty was internal medicine, pediatrics, otorhinolaryngology and family medicine and clinics with a general practitioner were selected. The final sample had 7,637 clinics in total. Indices used to measure practice pattern was prescription rates of antibiotics, prescription rates of injection drug per visit, treatment costs per claim, and total costs per claim. Changes in the number of claims for major disease categories and upcoding index for disease categories were used to measure claiming behavior. Data were analysed using descriptive analysis, t-test for indices changes before and after the introduction, analysis of variance (ANOVA) for practice pattern change for major disease categories, and multiple regression analysis to identify whether new system influenced on provider' practice patterns or not. Prescription of antibiotics, prescription rates of injection drug, treatment costs per claim, and total costs per claim decreased significantly. Results from multiple regression analysis showed that a computerized review system had effects on all the indices measuring behavior. Introduction of the new system had the spillover effects on the provider's behavior in the related disease categories in addition to the effects in the target diseases, but the magnitude of the effects were bigger among the target diseases. Rates of claims for computerized review over total claims for respiratory diseases significantly decreased after the introduction of a computerized review system and rates of claims for non target diseases increased, which was also statistically significant. Distribution of the number of claims by disease categories after the introduction of a computerized review system changed so as to increase the costs per claims. Analysis of upcoding index showed index for 'other acute lower respiratory infection (J20-22)', which was included in the review target, decreased and 'otitis media (H65, H66)', which was not included in the review target, increase. Factors affecting provider's practice patterns should be taken into consideration when policies on claims review method and behavior changes. It is critical to include strategies to decrease the variations among providers.