From Claim Denials to Smart Decisions: My Experience Using AI in Healthcare Claims Processing

Introduction I’ve spent a good part of my career working on healthcare claims systems, and if there’s one thing I can say—it’s never as simple as it looks. On paper, a claim is just data moving from one system to another. In reality, it goes through multiple validations—eligibility checks, provider verification, coding rules, pricing logic, compliance… and every step has its own complexity. In one of the projects I worked on, we were processing a huge volume of claims daily. Even with strong...