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Re:Ask HN: Machine Learning Engineers, what do you do at work? by apwheele on Sunday June 09, 2024 @12:01PM (#40625356)
The scale of health insurance claims is incredible, my company has a process that simply identifies when car insurance should pay the bill instead of medicaid/medicare post traffic accident (subrogation). Seems a minor thing right? We process right at 1 billion a year in related claims (and I don't know our US market share, maybe like 10-20%).

I am guessing every datascientist that works for a BlueCross BlueShield at individual states deals with processes that touch multiple-million dollars of claims.

We even now have various dueling systems -- one company has a model to tack on more diagnoses to push up the bill, another has a process to identify that upcoding. One company has models to auto accept/deny claims, another has an automatic prior authorization process to try to usurp that later denial stage, etc.

Re:Ask HN: Machine Learning Engineers, what do you do at work? by DontchaKnowit on Monday June 10, 2024 @01:00PM (#40635609)
Man, respectfully, sounds like you are doing the dirty immoral work of insurabce companies. AI algos for adding diagnoses to rack up the bill? That is completely disgusting. Wholly unnacceptable and if I ever find out ive been the target of such a scam I will raise holy hell.
Re:Ask HN: Machine Learning Engineers, what do you do at work? by apwheele on Tuesday June 11, 2024 @06:54AM (#40644748)
I am speaking more generally of the industry. You can look at my profile and follow the bread-trail to see whom I work for. It is not insurance, we are a client of state systems, and I work to do the opposite of what you suggest (identify fraud/waste/abuse in insurance claims).

I do not know the chances that any individual provider uses a system to identify what codes to tack onto your bill.