Health Insurance Multi-Agent System
Claims Processing Automation
Challenge
A large health insurance provider needed to dramatically accelerate their claims processing pipeline. Manual reading, translation, and ICD/CPT code mapping was a bottleneck creating delays and errors at scale.
Solution
Built a multi-agent system where specialised agents handled distinct stages of the pipeline: document ingestion and OCR, medical terminology translation across languages, diagnostic code extraction, and claims mapping against policy rules. Agents coordinated via a lightweight orchestration layer, enabling parallel processing of thousands of claims.
Key Outcomes
- ✓ End-to-end claims pipeline reduced from days to minutes
- ✓ Multi-language support handled natively within the pipeline
- ✓ Audit trail and explainability built in at each agent step
- ✓ Designed for compliance with healthcare data regulations