Object Oriented Fuzzy Decision Model for Insurance Claim

The insurance industry faces a significant challenge concerning insurance claims, particularly due to the prevalence of fraudulent insurance claims. To address this issue, one potential solution is the implementation of a computer-based decision model. This research presents a fuzzy decision model based on object-oriented method development. The study involves seven stages (i.e. case analyzing, parameter analyzing, objects-parameters linking, detail object relation constructing, parameter exchange analyzing, OOFDM constructing, and model verifying and validating), with an object-oriented approach serving as the foundational method for constructing the model, and fuzzy logic as the primary method for assessing claim risks in proposing the best decision. The model has the capability to simulate insurance claims and offers objective decisions based on 19,611 claims data, categorizing them into two decision categories: acceptance and pending.