Microsoft Insurance Claims Automation, powered by AI, handles claim processing through an intelligent agent with cognitive skills to handle image, ID, and documents with the goal to reduce claims processing time and manual effort in end-to-end claims processing for better customer experience.

HIPAA compliant SaaS platform for Claims Processing, CMS 057-F CMS Regulatory FHIR APIs, EDI integration platform for healthcare payers. Process X12 transactions (270/275/277/278/837), FHIR R4 APIs, and CMS-0057-F compliance. Deploy on Azure, AWS (EKS), GCP (GKE), Digital Ocean (DOKS), Kubernetes.

End-to-end healthcare claims analytics: Synthea → DuckDB → dbt (sources/staging/intermediate/marts) → Streamlit + Plotly ops UI. Surfaces $2.6M outstanding across 14K claims with a ranked priority queue, claim-level drill-down, and explainable "why flagged" rules. Modern data stack portfolio build.

A fact-checking system that verifies user claims with evidence-backed explanations using web searches and AI, delivering clear, transparent verdicts through a simple interface.

website Drainer

healthcare-claims-pipeline

Your personalised claims assistant

Claim Drain

About PT ABB Insurance Brokers (formerly PT Artha Bina Bhayangkara)

Automatic claims parsing and submission with GPT4

Automating claims processing for the New York Workers' Compensation Board using machine learning. Features model training, optimization, and evaluation via a Kaggle competition.

AI-powered Python tool using LLMs to automate insurance form autofill from unstructured documents. Boosts efficiency for claims, underwriting, and policy processing.

Claim Drainer

Health insurance claims processing platform leveraging Augustium smart contracts for automated, transparent, and fraud-resistant claim handling. Features blockchain-based verification, ML fraud detection, and multi-signature approvals.

Automated end-to-end claims recovery system for shipping failures — classifies, drafts, files, follows up, and escalates carrier claims using a multi-agent LLM pipeline. ISB AMPBA CT2 Assignment.

The graph-native operating system for healthcare transactions. A manifesto for replacing the $300B fraud problem the industry pretends is unsolvable. 2.08µs adjudication. 63 fraud patterns in real time. Illegal states structurally impossible. The prototype era is over.

AI-Powered Intelligent Claims Adjudication Layer for HealthFlow HCX Platform — Eligibility, Medical Coding, Fraud Detection & Medical Necessity agents built on LangGraph, LiteLLM, and ChromaDB RAG

PostgreSQL 15 ETL pipeline simulating 837/834/835 EDI ingestion with a 12-rule automated data quality engine, exception logging, and financial reconciliation across 2 claim batches.

An agentic experience layer for health plan payers and providers that translates claims using deterministic mapping + RAG.

PRD templates and LLM workflow specs for claims automation systems · from 500+ daily claims in production