Agentic AI-Powered Claims Management for MCOs

We delivered an AI-powered, end-to-end claims management platform for a leading Managed Care Organization (MCO), built on Microsoft Azure with a secure .NET backend, SQL Server, and a ReactJS experience. The solution automates the full claims lifecycle—intake, eligibility checks, clinical validation, routing, and auto-adjudication—using autonomous AI agents powered by OpenAI GPT-4 Turbo, significantly improving accuracy and reducing manual effort. FHIR-compliant integrations enable seamless interoperability with HIEs, while Mirth Connect supports providers outside those networks. Real-time tracking, predictive analytics, and intuitive dashboards help the MCO identify bottlenecks early, reduce denials, and improve payment accuracy. The platform strengthens compliance, enhances operational efficiency, and elevates stakeholder experience across the claims ecosystem.