Healthcare infrastructure in Singapore consists of a government-run universal healthcare system with a significant private healthcare sector. For its citizens, financing of healthcare costs is done through a mixture of direct government subsidies, compulsory savings, national healthcare insurance, and cost sharing. For the most part the government does not directly regulate the costs of private medical care. These costs are largely subject to market forces, and vary enormously within the private sector, depending on the medical specialty and service provided. Medical advances also increase cost, especially when Singapore is often where such newer solutions are introduced. To tackle the costs, many Singaporeans and Singapore Permanent Residents also have supplemental private health insurance for services not covered by the government's programmes. Part of having a health insurance is going through the claim process and waiting for the claims to get settled.
ABC Insurance Limited is a newly established insurance company in Singapore. Its range of products includes health insurance, among many things. It’s health insurance plans cover hospitalization expenses, day care procedures, domiciliary expenses besides many others.
At present, the majority of hospitalisation claims are processed through e-filing, however the pre and post hospitalisation claims process remain as manual. Claims are submitted by customers, then these claims go through a round of verification. The claims approval process involves adhering to the business rules or policies set for the company and this can take many man hours. The company assigns the incoming claims to its staff for a first round of investigation. If the case needs further investigation, it will be assigned to a case manager based on a predefined set of rules.
The company finds that many of the claims are straightforward and the process can be improved by building a system to automate this, so as to boost productivity and achieve scalability.
Using intelligent reasoning system principles, this project aims to build a knowledge driven system powered by business rule engine to help streamline claims classification process, chatbot and document recognition as cognitive frameworks for better customer experience and a claim distributor system using constraint satisfaction tools to optimise staff productivity.
| Official Full Name | Student ID | Work Items |
|---|---|---|
| Bhavya Rema Devi | A0213538H | Data preprocessing, Knowledge Representation, Classifier implementation with clips programming, testing, documentation |
| Elisa Tjhin | A0213518L | Chatbot, data model, knowledge/business rule, testing, documentation |
| Francis Low Kok Ann | A0213550U | System architecture, systems integration, overall Docker setup, supporting systems (Object Repository, Administrative Dashboard, Chatbot Frontend), testing, documentation |
| Sindhuja Kumaran | A0213537J | Database modelling, Search Optimization, testing, documentation |
Refer to the installation guide here
Refer to the user guide here
Refer to project report at Github Folder: ProjectReport