Human–AI Collaboration in Insurance Fraud Detection: Ethical Cloud-Native Architectures for Fair and Transparent Decision Support

Abstract

Claims fraud detection systems are confronted with pressing issues regarding balancing efficiency with ethical due diligence as more organizations migrate towards cloud-native architectures and AI-driven autonomous decision-making. The merging of computing models with ML capabilities facilitates concurrent data processing from varied sources, thereby raising pressing dilemmas on fairness, explainability, and accountability for claim assessment. Cloud-native architectures and designs offer structured blueprints for developing fraud detection systems with human diligence, explainability tools, and bias removal tools incorporated at junctures for critical decisions. Microservices designs, event-processing architectures, and containerized designs offer flexible architectures amenable for building systems with independent components for ethical safeguarding and prediction analytics seamlessly. Distributed data processing platforms enable stable and equal data access with audit trail capabilities vital for regulatory functions. Auto-scaling infrastructures optimize system efficiency without degraded performance under fluctuating usage demands, preventing hasty decisions with an influx of claims. Human-readable descriptions from AI with explainable components make feasible domain-expert interpretations on fraud detection. Process mining tools analyze workflow patterns, identifying opportunities for collective improvements on system efficiency and fairness. Social implications for these technologies and planning considerations include trust and fairness in financial service accessibility and service enablement among policyholders and wholesale challenges on algorithmic and AI-driven legitimacies.