Case 20 · Hospital Insurance Pre-Audit Agent · 30,000+/Month · Rejection Rate -30%¶

TL;DR: Hospital Insurance Pre-Audit Agent · 30,000+/Month · Rejection Rate -30%. Direction: Government/Manufacturing/Healthcare/Contract/Tender. Scale: 30000+ claims/month. Hard KPI: hospital insurance rejection rate -30%. Tech: national insurance rule library + intramural clinical norms, structured + LLM dual-match. My role: agent workflow design, rule-library engineering, audit dashboard. Client name anonymized under NDA.

• Direction: Government/Manufacturing/Healthcare/Contract/Tender
• Industry: healthcare
• Scale: 30000+ claims/month
• Hard KPI: hospital insurance rejection rate -30%

Problem¶

Hospital insurance rejection rate is high, manual pre-audit is slow and lossy, impacting cash flow and patient experience.

Solution¶

Agent pulls national insurance rules + intramural clinical norms · pre-audits before claim submission · high-risk to human review.

Tech Stack¶

national insurance rule library + intramural clinical norms, structured + LLM dual-match

Result (Hard KPIs)¶

hospital insurance rejection rate -30%

My Role¶

agent workflow design, rule-library engineering, audit dashboard

Related¶

• Full 20-case portfolio · Direction · Government/Manufacturing/Healthcare/Contract/Tender
• PDF one-pager
• 中文原页

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Client name anonymized · KPIs verified · Real client name disclosable under NDA.