English

Claim Automation using Large Language Model

Computation and Language 2026-02-20 v1

Abstract

While Large Language Models (LLMs) have achieved strong performance on general-purpose language tasks, their deployment in regulated and data-sensitive domains, including insurance, remains limited. Leveraging millions of historical warranty claims, we propose a locally deployed governance-aware language modeling component that generates structured corrective-action recommendations from unstructured claim narratives. We fine-tune pretrained LLMs using Low-Rank Adaptation (LoRA), scoping the model to an initial decision module within the claim processing pipeline to speed up claim adjusters' decisions. We assess this module using a multi-dimensional evaluation framework that combines automated semantic similarity metrics with human evaluation, enabling a rigorous examination of both practical utility and predictive accuracy. Our results show that domain-specific fine-tuning substantially outperforms commercial general-purpose and prompt-based LLMs, with approximately 80% of the evaluated cases achieving near-identical matches to ground-truth corrective actions. Overall, this study provides both theoretical and empirical evidence to prove that domain-adaptive fine-tuning can align model output distributions more closely with real-world operational data, demonstrating its promise as a reliable and governable building block for insurance applications.

Keywords

Cite

@article{arxiv.2602.16836,
  title  = {Claim Automation using Large Language Model},
  author = {Zhengda Mo and Zhiyu Quan and Eli O'Donohue and Kaiwen Zhong},
  journal= {arXiv preprint arXiv:2602.16836},
  year   = {2026}
}

Comments

46 pages, 12 figures. Code and data processing pipeline described

R2 v1 2026-07-01T10:42:02.537Z