Author ORCID Identifier
Document Type
Conference Proceeding
Publication Date
8-7-2025
Publication Title
New Trends in Disruptive Technologies, Tech Ethics and Artificial Intelligence
Volume
DiTTET 2025
DOI
https://doi.org/10.1007/978-3-031-99474-6_34
Abstract
This paper addresses how Generative AI-mediated policy framing influences insurance outcomes and the broader adjudication ecosystem. We explore a hybrid decision-making framework that combines an XGBoost model for initial claim likelihood prediction and OpenAI’s GPT-4 for policy application. This approach is tested using two distinct policies: a contextual risk-benefit assessment (CRBA) and an equal needs and fairness evaluation (ENFE). The study specifically analyzes how GenAI’s interpretation and application under these different policy framings impact claim approval rates and associated financial liabilities. Furthermore, we examine the broader implications of integrating this AI-driven framework for multiple stakeholders involved in the adjudication process, including ethical considerations.
Recommended Citation
Osamau, E., Tsai, CH. (2025). Generative AI in Policy-Informed Insurance Adjudication: A Comparative Analysis. In: de la Iglesia, D.H., de Paz Santana, J.F., López Rivero, A.J. (eds) New Trends in Disruptive Technologies, Tech Ethics and Artificial Intelligence. DiTTET 2025. Advances in Intelligent Systems and Computing, vol 1465. Springer, Cham. https://doi.org/10.1007/978-3-031-99474-6_34
Comments
This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/978-3-031-99474-6_34
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