The healthcare claim management system is a web-based application that was created to help auditors make a correct judgment on the invoices 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 eliminating 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 past data rather than making decisions based on variable computational rules.
Our development team acts as a contractor to our customers and is responsible for creating the actual system.
The work is organized using the Agile development model and the Scrum framework. We have split the development into bi-weekly sprints with new features and product demos coming at the end of each stage. The client communicates with the team via Slack and Skype. We also use Git as a code repository.
The whole development process is subdivided into 4 main stages:
The system consists of the following UI elements:
Comments UI. The later is useful for Machine Learning engineer when there is a deviation between the auditor’s claim’ judgment and the one made by our system.