An AI-powered healthcare claims investigation platform built to analyze claim risks, detect fraud indicators, identify revenue leakage, and provide investigation recommendations.
This project combines Healthcare Analytics, Power BI Dashboarding, Python Automation, and Generative AI to simulate a real-world claims investigation workflow.
Healthcare organizations process thousands of claims daily. Manual review can be time-consuming and may miss:
- Fraud patterns
- Coding issues
- Duplicate claims
- Denial risks
- Revenue leakage opportunities
This solution helps investigators prioritize high-risk claims using AI-driven analysis.
- Overall claims monitoring dashboard
- Claim volume analysis
- Paid vs billed amount tracking
- Denial monitoring
- Payer performance analysis
- High-risk claim identification
- Fraud indicators analysis
- Investigation prioritization
- Risk scoring
- Claim-level investigation support
- AI-generated investigation summaries
- Risk explanation
- Recommended actions
- Billed vs paid comparison
- Leakage identification
- Financial impact analysis
- Reconciliation insights
- Generative AI powered claim investigation
- Automated issue detection
- Investigation recommendations
- AI explanations
- Power BI
- DAX
- Power Query
- Excel
- Python
- Visual Studio Code
- OpenAI API
- Generative AI
- Prompt Engineering
- Healthcare Claims Analytics
Claims Data
↓
Python Processing
↓
OpenAI Generative AI Analysis
↓
Structured Investigation Output
↓
Power BI Visualization
↓
Investigation Insights
- Healthcare Revenue Cycle Analytics
- Claims Data Analysis
- Business Intelligence Reporting
- AI Automation
- Data Transformation
- Dashboard Design
- Risk Analytics