Leveraging LLMs for Unstructured Claims Data Analysis
利用大语言模型进行非结构化索赔数据分析
Robert D. Lieberthal, Richard Tran, Vietbao Phan, Jawand Singh, Elizabeth Sottung
AI总结 提出一个两阶段处理框架,利用大语言模型从非结构化索赔数据中提取结构化精算变量,并通过链梯法准备金验证其实际价值。
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- 41 pages, 6 figures, 3 tables. Code available at https://github.com/mdsight/llm-claims-analysis . Technical Specification Requirement included as Appendix D. Funded by the Casualty Actuarial Society Artificial Intelligence Working Group
精算师主要依赖结构化数值数据进行准备金和费率制定,而非结构化文本(包括医疗记录、理赔员笔记和通话记录)中包含的有价值预测信息大多未被使用。手动处理这些文档耗时、跨审查员不一致且不可扩展。我们提出了一个概念验证框架,使用大语言模型(LLMs)从非结构化索赔数据中提取结构化精算变量。我们实现了一个两阶段处理架构,将文档级提取(阶段1)与索赔级综合(阶段2)分开。一个模块化的四脚本Python管道处理基于FHIR的合成索赔数据和真实索赔文档,提取了涵盖准备金、费率制定和索赔管理类别的36个精算变量。我们使用两名独立临床专家审查员对20个合成索赔进行五点Likert评分,验证了14个核心变量,平均得分超过4.0,加权kappa为0.53。与链梯法准备金的集成展示了实际精算价值:严重程度分段分析将准备金估计误差从6.5%降低到4.0%。开源实现包括审计轨迹和置信度评分,为财产险中基于LLM的精算变量提取提供了可复现的基础。
Actuaries rely primarily on structured numerical data for reserving and ratemaking, while valuable predictive information in unstructured text including medical records, adjuster notes, and call transcripts remains largely unused. Manual processing of these documents is time-consuming, inconsistent across reviewers, and unscalable. We present a proof-of-concept framework using large language models (LLMs) to extract structured actuarial variables from unstructured claims data. We implement a two-stage processing architecture separating document-level extraction (Stage 1) from claim-level synthesis (Stage 2). A modular four-script Python pipeline processes synthetic FHIR-based claims data and real claims documents, extracting 36 actuarial variables across reserving, ratemaking, and claims management categories. We validate 14 core variables using two independent clinical expert reviewers scoring 20 synthetic claims on a five-point Likert rubric, achieving mean scores above 4.0 and a weighted kappa of 0.53. Integration with chain ladder reserving demonstrates practical actuarial value: severity-segmented analysis reduced reserve estimation error from 6.5% to 4.0%. The open-source implementation includes audit trails and confidence scoring, providing a replicable foundation for LLM-based actuarial variable extraction in property-casualty insurance.