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.

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

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.

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.

Claim Drainer

Health insurance claims processing platform leveraging Augustium smart contracts for automated, transparent, and fraud-resistant claim handling. Features blockchain-based verification, ML fraud detection, and multi-signature approvals.

Healthcare Claims Query Agent built with MCP + Groq LLM — answers eligibility, claim status, and denial reason queries in plain English.

Production-style multi-agent insurance claims platform with LangGraph, CrewAI, FastAPI, React, HITL workflows, memory, and LLM evaluation.