Medicolegal claims
ALPHV builds AI medicolegal claims processing for a leading healthcare group
ALPHV builds AI claims processing for a leading Malaysian healthcare group, taking medicolegal insurance claims from intake and extraction to assessment and adjudication for insurers and regulators.
Client
A leading healthcare group, Malaysia
Industry
Healthcare
Stack
Qwen · Claude · Document AI
The situation
Every medicolegal insurance claim arrives as a set of documents that has to be read, extracted, assessed and written up before an insurer can decide on it. Done by hand, that work takes up clinicians’ time. A leading Malaysian healthcare group appointed ALPHV to build an AI claims processing capability for its insurer end users and the regulators who oversee them.
What ALPHV built
One AI flow across the medicolegal claims pipeline, from intake to adjudication. An intelligent engine assesses each case and drafts the report, so clinicians review a draft instead of writing from scratch.
Claims intake that brings each case and its documents into one file
Document AI that extracts the details each assessment needs
Case assessment with a drafted medicolegal report for clinicians to review
Adjudication support for insurer end users and regulators
How it runs
Qwen and Claude models read the claim documents and assess each case, then the engine drafts the report for a clinician to review. Every claim moves through the same four stages, from intake to adjudication.
Stack: Qwen, Claude and document AI
Review: clinicians review every drafted report
Users: insurer end users and regulators across the claims lifecycle
Outcome
The capability brings intake, extraction, assessment and adjudication into one flow, so clinicians review a drafted report instead of writing each one from scratch.
In numbers
4
Claim stages in one flow: intake, extraction, assessment and adjudication
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Industry
Healthcare
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Service
AI engineering
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