Systems and methods for machine learning-based routing of adverse digital claims

Abstract

A system, method, and computer-program product includes obtaining, from a computer database, claim data associated with a digital claim that has an adverse decision, extracting, using one or more feature extractors, one or more corpora of feature vectors from the claim data associated with the digital claim, computing, using a claim assessment machine learning model, a claim assessment inference that includes a likelihood of the adverse decision being reversed for the digital claim based on the claim assessment machine learning model receiving the one or more corpora of feature vectors, and automatically routing the digital claim to a target claim handling queue of a plurality of distinct claim handling queues based on the likelihood of the adverse decision being reversed for the digital claim.