Project Description
Our claims team needs a web-based tool that will scan hospital paperwork, policy wording and every cost line associated with a claim, then flag where money can be saved across administrative, medical and operational spend.
Health Insurance Companies have agreements with hospitals. Treatment Payment Agreement, Health Insurance Plan Analysis while settling the claim. Suppose, at the time of raising a claim, hospital send an estimated bill to insurance company for approval, our tool should analyze that any particular amount can be approved as per agreement with hospital or according to policy plan.
The emphasis is on deep cost saving analysis; any verification or claims workflows you add are a bonus, but the heart of the build must isolate avoidable expenses and quantify how much each recommendation would reduce the overall payout.
Core flow I have in mind
1. Secure upload or API pull of PDFs, billing statements and policy documents.
2. Automated text extraction and normalisation.
3. Rule- and model-driven analytics that benchmark charges, spot duplicate services, reveal policy exclusions and surface patterns of waste.
4. Interactive dashboard that shows potential savings broken down by administrative, medical and operational categories, with drill-downs to the source page in the document.
5. Exportable report (PDF/Excel) so adjusters can attach findings to the claim file.
Tech stack is open, though browser-based delivery is essential and anything that speeds up OCR, NLP or visualisation—Python, Node, React, FastAPI, TensorFlow, spaCy, D3, Power BI, etc.—is welcome.
I value proven experience over long proposals, so share links or brief summaries of previous insurance, healthcare or document-analytics projects that demonstrate you can move quickly from ingestion to insight.