Jun 25, 2021
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Completed

Claims Management System for Evaluating Hospital Bills

$75,000+
4-6 months
United States
6-9
view project
Service categories
Service type
Custom Software Development
Web Development
Domain focus
Banking & Financial Services
Solution type
Business Software
Enterprise Software
Programming language
Python
Frameworks
Django
React.js

Challenge

The healthcare claims management system is a web app that helps medical insurance auditors making a judgment on the claims issued by the medical aid providers. It reduces the costs of claims auditing process and fraudulent risks or human mistakes with the help of machine learning algorithms.

Solution

The Medical insurance company needed a solution that would help their auditors in making correct judgments on the claims issued by the medical aid providers. The main idea behind the creation of the system is to reduce the costs of claims auditing process performed by the auditors with the help of Machine Learning algorithms, therefore illuminating the risks or human mistakes. After being sufficiently trained, the algorithm is expected to optimize the day-to-day activities of the company’s insurance auditor. While calculating the required metrics, the system relies on AI technologies and the past data rather than making decisions based on variable computational rules.

Results

The whole development process is subdivided into 4 main stages: The 1st stage which involves educating our Machine Learning algorithm. It involves training the ML algorithm to analyze the results of the auditor’s decisions based on the 6 Million claim items collected over the past 5 years. At the 2nd stage of the development process, the system should be sufficiently trained to give auditors some useful information they’ll need to make correct judgments on the particular claim. The 3rd stage should be characterized by our system being able to automatically give a correct decision on the claims received by the medical insurance company. The 4th stage will be highlighted by the system being able to optimize the day-to-day activities of the company’s Medical insurance auditors.