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Author: search.filters.author.Nawarathne, MSubject: search.filters.subject.explainable AI

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    A Reinforcement Learning Approach with Human in the Loop to Explainable Insurance Risk Scoring and Intelligent Policy Portfolio Optimization
    (Institute of Electrical and Electronics Engineers, 2026-05-29) Gamage, C; Kasthuriarachchi, T; Denuwan, C; Mallawaarachchi, P; Abeywardhana, L; Nawarathne, M
    Assessing individual risk accurately and optimizing insurance portfolios in real time remain major challenges due to static actuarial tables, opaque models, and fragmented analytical pipelines. This paper proposes a two-part Explainable AI (XAI) framework addressing both issues. The first component, Artificial Intelligence-driven risk scoring with human-in-the-loop (HIL) weight adjustment, uses a Proximal Policy Optimization (PPO) agent to suggest feature-based changes to an insurer's risk-equation weights. Shapley Additive Explanations(SHAP) attributions and Generative AI reasoning make these changes interpretable, allowing human reviewers to approve modifications that are immediately applied to future customers, creating a self-improving loop. The second component, AI-driven policy optimization, leverages a PPO supported by an XGBoost expense regressor, SHAP/LIME explainability, PPO agent and a Retrieval-Augmented Generation (RAG) layer for rider assignment. Both components share a data backbone of 100,000 anonymized insurance records stored in MongoDB, enabling incremental updates without reprocessing. Experiments show the XGBoost regressor achieves Root Mean Square Error (RMSE) 0.4406 and Mean Absolute Error (MAE) 0.3600, the HIL guided agent increases average episodic reward by 10.3%, and the RAG layer reaches 91.7% rider-assignment accuracy. The framework significantly enhances predictive accuracy, interpretability, regulatory traceability, and portfolio adaptability compared to traditional actuarial and black-box approaches.