International Journal For Multidisciplinary Research

E-ISSN: 2582-2160   •   Impact Factor: 9.24

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Integrating Hybrid AI and PL SQL Architectures for Automated Disability Claims Adjudication

Author(s) Pavan Kumar Veerapally
Country United States
Abstract The processing of disability claims is one of the most difficult bottlenecks in the value chain of insurers, due to the fact that medical records are multi-dimensional in nature and because regulatory requirements are strict. As a result, traditional workflows involving manual intervention as well as pure-rule-based systems have become insufficient in managing the increasing complexities of claimant profiles as well as sophisticated forms of insurance fraud. This paper proposes a new hybrid High-Performance Architecture using Artificial Intelligence (AI) and PL/SQL to autonomously manage the entire cycle of the life of the claimants for disability claims. In order to obtain the best possible balance between the ability to predict future behavior and data integrity through the combination of ML Intelligence (non-linear pattern recognition) for fraud detection and risk score determination of claimants and a deterministic, database-centric PL/SQL Engine for statutory logic, this architecture integrates both technologies. The proposed Framework also reduces IO latency by transferring all time-consuming features from the intelligence layer to the database tier. Thus, it creates a scalable and audit-ready blueprint for the automation of complex Adjudication Processes and can substantially increase throughput and consistency of decisions in high-volume insurance environments.
Keywords Disability Claims Adjudication, Hybrid AI Architecture, Oracle PL/SQL, Logic-Vector Fusion (LVF), Fraud Detection, Explainable AI (XAI), Automated Decision-Making, Insurance Technology (InsurTech), Database-Resident Feature Engineering.
Field Engineering
Published In Volume 5, Issue 1, January-February 2023
Published On 2023-02-03
DOI https://doi.org/10.36948/ijfmr.2023.v05i01.75736
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E-ISSN 2582-2160
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