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.