Abstract

The insurance sector has difficulties in processing claims effectively while keeping things clear, precise, and friendly for clients. A key part of this process is creating denial letters that outline the reasons a claim was rejected, often due to complicated policy terms and claim specifics. This study examines how Artificial Intelligence (AI) and Machine Learning (ML) can help automate the creation of denial letters for insurance claims. The aim is to boost efficiency, ensure rule compliance, and keep a caring tone to help retain customers. The document introduces an AI-based framework using Natural Language Processing (NLP), machine learning for making decisions, and automatic text creation to generate denial letters that are precise, legally valid, and considerate.