Published on: April 2026
AI-BASED INSURANCE CLAIM PROCESSING AND VERIFICATION SYSTEM
Jayashri Kharat
Prof. Kanifnath S Satav
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Abstract
Health insurance claim processing is one of the most important activities in the insurance industry, as it directly affects both insurance companies and policyholders. In the traditional claim processing system, claim verification, document checking, policy validation, and fraud investigation are mostly done manually. This process takes a lot of time, increases operational costs, and may lead to human errors. In addition, the increasing number of fraudulent claims has become a major challenge for insurance companies, resulting in financial losses and delays in genuine claim settlements. Therefore, there is a growing need for an intelligent and automated system that can improve the efficiency, accuracy, and security of health insurance claim processing.
How to Cite this Paper
Kharat, J. (2026). AI-Based Insurance Claim Processing and Verification System. International Journal of Creative and Open Research in Engineering and Management, <i>02</i>(04). https://doi.org/10.55041/ijcope.v2i4.927
Kharat, Jayashri. "AI-Based Insurance Claim Processing and Verification System." International Journal of Creative and Open Research in Engineering and Management, vol. 02, no. 04, 2026, pp. . doi:https://doi.org/10.55041/ijcope.v2i4.927.
Kharat, Jayashri. "AI-Based Insurance Claim Processing and Verification System." International Journal of Creative and Open Research in Engineering and Management 02, no. 04 (2026). https://doi.org/https://doi.org/10.55041/ijcope.v2i4.927.
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References
- AI-Powered Claims Processing Research Journal
- IEEE Research Papers on Fraud
- Tom Mitchell (1997). Machine Learning. McGraw-Hill Education.
- Ian Goodfellow, Yoshua Bengio, and Aaron Courville (2016). Deep Learning. MIT Press.
- Research on AI-based Insurance Fraud Detection and Claim Automation.
- Springer Nature. Studies on Predictive Analytics in Health
- AI-Based Claims Automation Solutions.
- Fraud Detection in Healthcare Insurance Claims Using Machine Learning (2023), published in MDPI Risks Journal.
- Fraud Detection in Healthcare Claims Using Machine Learning: A Systematic Review (2025), published in Artificial Intelligence in Medicine.
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- •Peer Review Type: Double-Blind Peer Review
- •Published on: Apr 30 2026
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