Business-rule OSHC insurance claim decision model using GoRules/JDM decision tables and a Python reference simulator.
Multi-factor denial risk scoring and queue assignment engine for healthcare RCM operations. Routes 1,200+ claims across 5 operational queues using a 7-factor weighted model.
Two-tier Python matching engine parsing raw 837/835 EDI files, auto-classifying payments into 6 categories and surfacing $430K+ revenue at risk across 1,200+ claims.
AI-powered Insurance Claims Processing Platform backend built with Java 21, Spring Boot microservices, PostgreSQL, Docker, JWT authentication, AI document processing, and enterprise-grade architecture.
Enterprise-grade AI-assisted securities claim processing system with FIFO calculation, audit trails, explainable AI, and financial workflow automation.
An end-to-end ML system to automate Revenue Cycle Management (RCM) by predicting claim denials, analyzing root causes, and optimizing resolution workflows.
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