claims-processing

Agent skills for healthcare and life sciences: genomics, imaging, claims, drug discovery, and more. Works with Amazon Quick, Kiro, Amazon AgentCore, AWS Strands SDK, Claude Code, Codex, and any Agent Skills-compatible platform.

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.

website Drainer

healthcare-claims-pipeline

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

Your personalised claims assistant

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.

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.

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

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.

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.

Automatic claims parsing and submission with GPT4

About PT ABB Insurance Brokers (formerly PT Artha Bina Bhayangkara)