REM: A microservice for health insurance expert systems

Date

2023-9

Author

Ağın, Tahir Murat

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The health insurance area has entered into a digitalized process and started to put various software systems into operation. Protein is a software that provides end-to- end service for insurance companies that do not have health insurance infrastructure, with which all insurance activities can be carried out. One of the main and perhaps the most important functions of Protein is the claim assessment. This is the determination of how much will be invoiced to insurance company or insured by evaluating the health service received from the hospital by the insured who has purchased a health insurance policy, depending on the purchased policy terms and the contract of the insurance company with the hospital. Since it is a financial decision process, result is very important for both insurance company and insured. In addition, completion time of result directly affects customer satisfaction as it determines hospitalization time of insured. This study aims to develop an additional module by using a rule-based microservice architecture within the scope of claim assessment processes to the Protein. With developed microservice, it is aimed to improve the service quality in health insurance sector by improving claim assessment processes, to reduce the costs, to minimize the margin of error and to enable individuals and institutions in the health services sector to experience more efficient and faster processes. REM (Rule Engine Microservice) is designed in a structure that can be easily integrated into the systems of other insurance companies, apart from being integrated with Protein.

Subject Keywords

Rule-based Expert Systems, Health Insurance, Claim Assessment, Microsoft RulesEngine

URI

https://hdl.handle.net/11511/105451

Collections

Graduate School of Natural and Applied Sciences, Thesis