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.

Source-available, FHIR-native core administration platform for health plans

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.

Consent-aware, multi-tenant care-coordination & claims platform: per-request authorization (tenant · role · relationship · consent · field-masking), tamper-evident audit & explainable adjudication.

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

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.

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

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.

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.