Systems, methods, and platforms for automated quality management and identification of errors, omissions and/or deviations in coordinating services and/or payments responsive to requests for coverage under a policy

A system for identifying a likelihood of claim leakage in an open insurance claim, the system comprising:

• processing circuitry;
• a non-transitory database storage region configured to store at least one vulnerability detection data model, each associated with an insurance provider, wherein
• each of the at least one vulnerability detection data model is trained with a feature vector of claim metrics from a plurality of insurance claims associated with the insurance provider;
• and
• a non-transitory computer readable memory coupled to the processing circuitry, the memory configured to store machine-executable instructions, wherein the machine-executable instructions, when executed by the processing circuitry, cause the processing circuitry to:
• identify, for vulnerability detection processing, at least a first open insurance claim of a plurality of open insurance claims associated with the insurance provider;
• extract, from data files associated with the first open insurance claim, vulnerability detection features for the first open insurance claim;
• detect, using the at least one vulnerability detection data model stored in the non-transitory database storage region, one or more claim handling vulnerabilities among the extracted vulnerability detection features of the first open insurance claim, wherein
• each model of the at least one vulnerability detection data model is trained with a respective feature vector customized to the insurance provider such that the respective feature vector includes claims handling metrics reflecting rules, policies and/or procedures of the insurance provider,
• and detecting the one or more claim handling vulnerabilities includes identifying one or more vulnerability metrics within the vulnerability detection features that fail to meet the claims handling metrics;
• and
• responsive to identifying the one or more vulnerability metrics that fail to meet the claims handling metrics, provide notification, within a user interface screen at a remote computing device of a user, of the detected one or more claim handling vulnerabilities in the first open insurance claim, wherein the first open insurance claim is assigned to the user for handling.