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.

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.

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.

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.

Sample multi-agent AI system for life insurance claims processing using Amazon Bedrock AgentCore. Six specialist agents orchestrate identity verification, document extraction, policy validation, fraud detection, and adjudication with human-in-the-loop governance.

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

Public lite version of a personal multi-disciplinary ontology spanning forensic accounting, integrated data science, and valuation. Licensed under CC BY-NC-SA 4.0

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.

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

This is an API that takes messy old claims data,checks it for errors,and spits out a summary. This project was made using C#/ASP.NET Core Minimal APIs.

OperaAI Claims Intelligence - A research-grade, open-source reference implementation of an agentic workflow system for regulated insurance operations. Built on multi-persona queue routing, Human-in-the-Loop AI Copilot, and deterministic compliance boundaries.

Model Context Protocol server for Claude. Live payer intelligence, denial detection, and claim risk scoring across healthcare specialties.

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.

Automatic claims parsing and submission with GPT4

X12 EDI Claims Pipeline — 270/271 eligibility, 837P professional claims, 835 remittance advice with revenue cycle analytics. Built with Synthea FHIR R4 synthetic data.

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.