Claims validation system fuzzy approach
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CitationKumar, S. ve Pathak, P. (2009). Claims validation system fuzzy approach. Maltepe Üniversitesi. s. 361.
The markets are dynamically changing with changing consumer behavior. End users in all sectors, be it product or service find themselves empowered with wide range of options available to them. And therefore in today’s world nothing exists like monopoly. Insurance today is not what it used to be decade ago. It has evolved now, where consumers are more concerned about the quality, customer handling, transparent and easy process and proactive value added customer service. Insurance claim settlement process tops the priority list of all policy holders. From insurance company perspective, it is one of the most tedious business processes which directly impacts profit margins, policy holder satisfaction and business growth in turn. In order to reduce turnaround time of claim settlements besides settling the claim, claims needs to be verified and validated. Till now it is ensured by human adjusters and this process makes claim settlement vulnerable to subjective judgment and the use of discretion while finalizing a claim. Trends show adjusters get biased to claimants and settle claims in their favor and impact monetary gains of insurers, to counter this growing trend and limiting cost on human expertise, companies are in need of reliable expert systems that can help them in validating or authenticating processed claims. This work presents a model (of Claims Validation System) which is designed by using fuzzy mathematics and expert system. This model will provide indicative result on the authenticity of claim in process and the result from this system will also help Auditors during settlement process. The methodology is also supported with the help of an example.
SourceInternational Conference of Mathematical Sciences
- Makale Koleksiyonu 
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