Collective Health, Inc.

Raphael N'Gouan

Asif Khalak

Henning Chiv

Sergio Martinez-Ortuno

Andrew Chang

Chetan Ithal

Yulia Eskin

Erica Leigh Horowitz

John George O'Leary

Xiaowen Ye

Heather Grates

Nicholas Halpern-Manners

Irene Victoria Tollinger

Izac Benjamin Milstein Ross

Thomas Bedingten

Thomas Bedington

A claim adjudication system including an automatic adjudication pipeline that uses pipeline rules to automatically adjudicate a claim associated with a benefit plan at one or more stages. The automatic adjudication pipeline can redirect the claim to a user interface for manual review when a pipeline rule associated with a manual review condition is triggered. The user interface can present information about the claim relevant to the manual review condition in an integrated format, including highlighting the reasons for the manual review. A user can evaluate the claim in the user interface and provide user input that addresses the manual review condition, and the claim can be routed back to the automatic adjudication pipeline. The user input can also be used as training data for machine learning to adjust pipeline rules that are used to automatically process claims and to redirect future claims for manual review.

Routing claims from automatic adjudication system to user interface

Growing community of inventors

Belmont, CA, United States of America

Raphael N'Gouan