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Claim Automation using Large Language Model

About

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.

Zhengda Mo, Zhiyu Quan, Eli O'Donohue, Kaiwen Zhong• 2026

Related benchmarks

TaskDatasetResultRank
Semantic Similarity EvaluationInsurance Tasks N=1500 (test)
Mean BERT Cosine Similarity0.869
6
Text SimilarityInsurance tasks HQ subset N = 1334
Mean Score89.9
6
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