claims-processing

Open-source healthcare AI agent skills and life sciences agent skills. 42 skills for medical coding, risk adjustment, claims analytics, quality measures, genomics, imaging, and drug discovery across 13 HCLS domains.

A library for stance detection, claim extraction, and more

Python ETL pipeline automating healthcare claims auto-adjudication reporting — ingestion, validation, metrics, Excel reports, and email delivery across 5 business segments.

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.

Multi-modal insurance claims review agent built for HackerRank Orchestrate Hackathon June 2026

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.

Evidence-driven document intelligence for heterogeneous healthcare claim documents, turning PDF bundles into structured, traceable clinical information.

Two AI surfaces over one synthetic insurance claim: a claims-review workspace running OpenAI gpt-5.6-terra on Amazon Bedrock behind Bedrock Guardrails, and a speech-to-speech provider assistant on the OpenAI Realtime API. The model cannot settle a claim - its tool registry has no settlement entry. AWS CDK, synthetic data, MIT-0.

Works out what a health insurance claim should pay. The money maths is plain Python, a claim saves fully or not at all, and there is more test code than application code. FastAPI + PostgreSQL.

OPD health-insurance claims engine: Gemini reads the documents, deterministic code applies the policy, every decision comes with a full trace.

Production-style multi-agent insurance claims platform with LangGraph, CrewAI, FastAPI, React, HITL workflows, memory, and LLM evaluation.

Healthcare Claims Query Agent built with MCP + Groq LLM — answers eligibility, claim status, and denial reason queries in plain English.

Explainable anomaly detection for healthcare claims: hybrid rule engine + isolation forest caught 100% of 4,643 seeded anomalies in 252,750 claims with a plain-English reason on every flag. 21ms online scoring via a precomputed population context.

AI-powered research paper review with claim extraction, evidence analysis, and Neo4j knowledge graphs for discovering connections and potential research directions.

Reference architecture for governed agentic AI on AWS. Purpose-bound Cedar authorization at column level, Iceberg snapshot-pinned queries for replayable audit trails, and confidence-gated document extraction with Bedrock Data Automation and AgentCore, demonstrated on insurance claims processing with an EU AI Act mapping.

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

Pre-submission claim scrubbing and denial-risk engine for hospital revenue cycle. 11 configurable payer edits, calibrated risk scoring, expected-loss ranked review workqueues, and Power BI-ready SQL views. FastAPI, PostgreSQL, scikit-learn.

ClaimFlow — Autopilot Agent for Claims Processing | Track 4: Autopilot Agent | Global AI Hackathon with Qwen Cloud

AI agent for checking motor repair-estimate packets for clerical consistency before claims review, built with Agentic Star.

Independent, audit-ready platform for managing provider-side healthcare reimbursement disputes—from claim intake and eligibility through filing, deadlines, and payment reconciliation.