金仕达卫宁(2021~NOW)

        上海金仕达卫宁软件科技有限公司(简称“金仕达卫宁”)是专业的医疗保险和商业健康险数字化风险控制解决方案与服务提供商。业务覆盖医保基金监管、医保支付方式改革、医保基金运行管理、商业健康保险智能风控、医疗机构精细化管理等,致力于通过现代化科技手段,服务于医保管理部门、商业保险公司及医疗机构等,协助客户在数字时代,打造智能化的医疗保险、商业健康险风险控制新模式,旨在成为全民“健康保障护航者”。

As one of the core developers of the National Healthcare Security Administration's Intelligent Supervision Subsystem, I was involved in the research and deployment of the system. This system leverages big data analysis of fund settlements, combined with our company's medical clinical knowledge base, to identify and warn against risks, as well as conduct subsequent supervision. After its launch, the system has annually saved billions of RMB for the National Healthcare Security Administration and local healthcare security bureaus, making significant contributions to combating medical fraud.

In the modules I was responsible for, I primarily participated in the development of the following functionalities: Suspicious Activity Identification: Using big data analysis to detect potential fraudulent activities in medical insurance. Document Review: Developing an efficient document review process to ensure the compliance of each transaction. Fund Deduction: Implementing automated fund deduction functions to enhance the efficiency of financial management. Additionally, I was involved in the deployment and delivery of the system across various provincial platforms nationwide, ensuring its smooth launch and stable operation.