The health 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.
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.
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.