ClaimAudit
Bhupendra KumarAgentic AI based application using langgraph and fastapi , and reactJS ui as follows- -> dashboard homepage , have upload excel file button , on uploading that ill will save all rows in a table of sqlite db [AppData.db] to table allAuditClaims, [each row have claimID, rxClaimNumber, and questions] -> we can have more than 1 batch of claims in form of excel , so i also have a table claimsBatch , for each excelsheet at one row in claimsBatch table, -> already had a table rule , with some sot of rules with some category, -> have one claims tabel with all claims details ,(have rxclaimnumber also) display data their
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System Requirements
ClaimAudit
Introduction
The ClaimAudit project is designed to streamline the insurance claim auditing process by automating the application of rules to claims using advanced AI techniques. This document outlines the system requirements for the ClaimAudit application, which aims to enhance efficiency and accuracy in auditing insurance claims.
System Overview
ClaimAudit is an AI-based application that leverages multi-agent systems and LLMs to process and categorize insurance claims. The system is designed to handle the ingestion of Excel files containing claim details and questions, apply predefined rules to these claims, and generate human-like explanations for auditing results. The application utilizes FastAPI for backend operations, ReactJS for the user interface, and SQLite for data storage.
Functional Requirements
- As a User, I should be able to upload Excel files containing claim details and questions.
- As a System, I should store uploaded data in the SQLite database, categorizing it by batches.
- As a System, I should identify rule categories from questions using an LLM.
- As a System, I should apply appropriate rules to each claim based on identified categories, focusing solely on internal auditing processes.
- As a System, I should evaluate claims using an LLM to generate explanations for rule compliance.
- As a User, I should be able to view comprehensive reports of auditing results on the dashboard.
User Personas
- Internal Auditor: Responsible for reviewing the auditing results and ensuring compliance with internal standards, including managing Excel file imports.
- System Administrator: Manages system configurations and oversees data integrity.
Visuals Colors and Theme
- primary: #2A9D8F (Teal)
- primary_light: #A8DADC (Light Teal)
- secondary: #E76F51 (Coral)
- accent: #F4A261 (Sandy Orange)
- highlight: #E9C46A (Golden Yellow)
- bg: #F1FAEE (Off White)
- surface: rgba(233, 245, 248, 0.8)
- text: #264653 (Dark Slate)
- text_muted: #6D6875 (Muted Purple)
- border: rgba(38, 70, 83, 0.2)
Signature Design Concept
The ClaimAudit homepage will feature an interactive "Claim Galaxy" concept. Users will navigate through a 3D galaxy where each star represents a claim batch. Clicking on a star will zoom into a cluster of claims, allowing users to explore individual claims as planets. Each planet will display claim details and auditing results. The galaxy will be rendered using @react-three/fiber and @react-three/drei, providing a dynamic and engaging user experience. Hovering over stars will highlight connections between claims and their respective rules, creating an immersive exploration of the auditing process.
Interaction Model & Motion Direction
The landing page will utilize a "parallax" interaction model, creating a sense of depth as users scroll through the galaxy of claims. Decorative layers will move at different speeds, enhancing the storytelling aspect of the application. Internal pages, such as the dashboard and reports, will adopt a "static" interaction model to prioritize readability and data presentation.
Non-Functional Requirements
- The system should handle concurrent uploads and processing of multiple Excel files efficiently.
- The application must ensure data security and integrity during storage and processing.
- The user interface should be responsive and accessible across various devices and screen sizes.
Tech Stack
- Frontend: ReactJS
- Backend: FastAPI
- Database: SQLite
- AI Models: LLM for category identification and claim evaluation
- AI Tools: Langchain for LLM routing
- Local Orchestration: Docker
- Server-side Orchestration: Kubernetes
Assumptions and Constraints
- The system assumes that Excel files are formatted consistently with required claim details and questions.
- The application is constrained to operate within the capabilities of the selected AI models and tools.
- The system must comply with relevant data protection regulations and standards.
Glossary
- LLM: Large Language Model, used for natural language processing tasks.
- Multi-Agent System: A system architecture where multiple agents perform specific tasks to achieve a common goal.
- FastAPI: A modern web framework for building APIs with Python.
- ReactJS: A JavaScript library for building user interfaces.
- SQLite: A lightweight, disk-based database engine.
Intelligent Claim Auditing at Scale
Automate the application of auditing rules to insurance claims using multi-agent AI. Process thousands of claims in minutes with human-readable explanations and full compliance tracking.
Navigate the Claim Galaxy
Every claim batch becomes a star cluster in your auditing universe. Hover over each step to see the galaxy respond in real time.
Upload Claims
Import Excel files containing claim details, questions, and batch metadata directly into the system.
AI Processing
Our LLM-powered engine identifies rule categories from claim questions and routes them for analysis.
Rule Application
Predefined auditing rules are automatically applied to each claim based on identified categories.
Review Results
View comprehensive reports with human-readable explanations for every auditing decision on your dashboard.
The Claim Auditing Pipeline
From upload to insight in four streamlined stages. ClaimAudit automates rule application and generates human-readable compliance reports.
Upload Claims
Import Excel files with claim details and audit questions in bulk batches.
AI Processing
LLM agents categorize questions and identify applicable rule sets automatically.
Rule Auditing
Multi-agent system applies predefined rules and evaluates each claim for compliance.
Generate Reports
Human-readable explanations and comprehensive audit results delivered to your dashboard.
Audit Smarter with AI-Powered Intelligence
ClaimAudit automates rule application, generates human-readable explanations, and processes claim batches at scale — so your team can focus on decisions, not data entry.
AI Rule Application
Automatically identify rule categories from claim questions using advanced LLMs, then apply the appropriate auditing rules to each claim with precision.
Natural Language Explanations
Generate clear, human-readable explanations for every auditing decision. Reviewers understand exactly why each claim passed or was flagged.
Batch Processing
Upload Excel files containing hundreds of claims and questions. ClaimAudit ingests, categorizes, and processes entire batches concurrently.
Real-time Monitoring
Track processing status live on the dashboard. View comprehensive reports of auditing results as each claim moves through the evaluation pipeline.
Built for Every Auditing Role
Whether you're reviewing claims internally, partnering as an external auditor, or managing the platform, ClaimAudit adapts to your workflow.
Trusted by Audit Professionals
See how internal auditors and insurance teams use ClaimAudit to streamline compliance and cut review time by up to 90%.
Choose Your Audit Plan
Scale your insurance claim auditing with AI-powered automation. Every plan includes core LLM-driven rule evaluation and human-readable explanations.
- Up to 500 claims/month
- Basic rule engine (10 rules)
- Excel file upload & parsing
- Standard audit reports
- Email support
- Multi-agent LLM processing
- Custom rule builder
- API access & webhooks
- Dedicated account manager
- Up to 5,000 claims/month
- Advanced rule engine (unlimited)
- Excel file upload & parsing
- Comprehensive audit reports
- Priority email & chat support
- Multi-agent LLM processing
- Custom rule builder
- API access & webhooks
- Dedicated account manager
- Unlimited claims
- Advanced rule engine (unlimited)
- Bulk Excel & API ingestion
- Custom compliance reports
- 24/7 dedicated support
- Multi-agent LLM processing
- Custom rule builder
- API access & webhooks
- Dedicated account manager
All plans include a 14-day free trial. No credit card required. Compare all features →
Ready to Streamline Claim Auditing?
Join hundreds of insurance teams automating rule application, generating human-readable audit explanations, and cutting review time by up to 80%. Start with ClaimAudit today.
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