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Predicting Insurance Claim Rejections

Client / Partner
California-based HealthTech Platform
Problem Overview

Manual insurance claim processes were inefficient and prone to denials, causing cash flow delays and increasing administrative costs.

Solution Implemented
Built a predictive ML engine capable of forecasting claim rejections and suggesting alternate coding strategies to improve claim acceptance rates.
Key Features / Components
  • Claim Rejection Prediction Engine
  • Rule Definition & Automation Module
  • Devalidator Module (to remove outdated rules)
  • Agile Delivery with Healthcare SMEs
  • Custom Dashboards for RCM Teams
Impact & Outcomes
  • 60% increase in successful claim reimbursements
  • Reduced claims processing cycle time
  • Enhanced decision-making with intelligent claim suggestions

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