Optimizing Insurance Claims Processing with Agile-LEAN Hybrid Models and Machine Learning Algorithms

Authors

  • Thirunavukkarasu Pichaimani Molina Healthcare Inc, USA Author
  • Sarita Gahlot KPMG, USA Author
  • Anil Kumar Ratnala Albertsons Companies, USA Author

Keywords:

Agile-LEAN hybrid, machine learning, insurance claims processing, predictive analytics

Abstract

A transformative model for optimise insurance claim is processing utilises the integrated model of Agile methodologies, LEAN principles, and machine learning (ML) algorithms. The aim of this research paper is to investigate the efficiency of the Agile-LEAN hybrid framework added to predictive analytics techniques which includes Random Forest and Gradient Boosting helps in streamlining claim evaluation, routing, and approval workflows.

Downloads

Download data is not yet available.

References

M. B. Arya, P. K. Shukla, and S. P. Gupta, "A survey on machine learning techniques for automation in insurance claims processing," Journal of Computational Science, vol. 12, no. 3, pp. 135-144, 2021.

S. T. Wang and J. G. Lee, "Agile methodologies in financial services: A comparative analysis," International Journal of Financial Technology, vol. 8, no. 2, pp. 52-60, 2020.

J. H. Tien, "Lean principles in financial services: A framework for operational efficiency," Journal of Business Process Management, vol. 20, no. 4, pp. 263-278, 2020.

S. W. Lee and A. P. Tan, "Machine learning applications in fraud detection in insurance claims," Artificial Intelligence and Insurance, vol. 6, no. 1, pp. 11-20, 2019.

A. K. Gupta and R. S. Rawat, "A comprehensive review of machine learning techniques in insurance fraud detection," International Journal of Machine Learning and Cybernetics, vol. 10, no. 5, pp. 983-1000, 2021.

M. S. Khan and A. M. Zubair, "Hybrid Agile-LEAN framework for continuous improvement in insurance claims processing," Journal of Software Engineering and Technology, vol. 22, no. 3, pp. 247-261, 2020.

A. L. Harris, "Predictive analytics in claims management: A machine learning approach," International Journal of Predictive Modeling, vol. 29, no. 4, pp. 47-59, 2021.

M. G. Green and B. H. Thomas, "Automating insurance claims processing using predictive analytics," Proceedings of the International Conference on Machine Learning Applications, pp. 85-92, 2020.

R. J. Smith, "The application of deep learning in claims processing automation," Deep Learning in Financial Services, vol. 5, pp. 100-112, 2021.

T. M. Liu and S. P. Lee, "A review on the role of AI in automating claims management systems," International Journal of Artificial Intelligence and Data Science, vol. 4, no. 2, pp. 213-225, 2021.

C. Y. Park and K. D. Choi, "Integrating machine learning with Agile-LEAN for insurance claims automation," Proceedings of the International Conference on Artificial Intelligence, pp. 58-67, 2020.

K. C. Lee, "Using machine learning for fraud detection in insurance claims: A systematic review," Journal of Financial Technology, vol. 3, no. 2, pp. 45-58, 2021.

N. S. Patel, "Optimizing insurance claims processing through Agile-LEAN and machine learning," Insurance Technology Review, vol. 15, no. 7, pp. 130-142, 2021.

M. D. Adams and S. P. Shah, "Applying Agile and LEAN principles for operational efficiency in insurance claims," International Journal of Lean Six Sigma, vol. 16, no. 1, pp. 89-105, 2021.

L. A. Jennings and K. M. Singh, "AI-driven automation in insurance claims: Implications for compliance and operational efficiency," Journal of Insurance Regulatory Affairs, vol. 9, no. 3, pp. 15-24, 2021.

M. D. West, "Scalable models in insurance fraud detection and claims automation," Machine Learning in Finance Journal, vol. 7, no. 4, pp. 67-78, 2020.

P. B. Haskell and C. L. Pearson, "Challenges in integrating machine learning into insurance claims workflows," Journal of Risk Management and Automation, vol. 8, pp. 198-205, 2020.

J. W. Stewart and A. T. Turner, "Future of AI in the insurance industry: Automation in claims processing," AI and Financial Services Review, vol. 10, no. 2, pp. 35-50, 2021.

H. K. Zeng and S. X. Liu, "Deep learning for automation of claims processing in insurance: A comparative study," Deep Learning for Business, vol. 3, pp. 201-211, 2021.

L. R. Moser and V. H. Mathews, "Agile-LEAN hybrid frameworks for operational efficiency: Applications in financial sectors," International Journal of Business Process Engineering, vol. 12, no. 6, pp. 120-134, 2020.

Downloads

Published

20-04-2022

How to Cite

[1]
Thirunavukkarasu Pichaimani, Sarita Gahlot, and Anil Kumar Ratnala, “Optimizing Insurance Claims Processing with Agile-LEAN Hybrid Models and Machine Learning Algorithms ”, American J Auton Syst Robot Eng, vol. 2, pp. 73–109, Apr. 2022, Accessed: Dec. 12, 2025. [Online]. Available: https://ajasre.org/index.php/publication/article/view/32