Predicting Risks in Healthcare Claims Using Advanced Data Processing and Machine Learning Techniques

Predicting Risks in Healthcare Claims Using Advanced Data Processing and Machine Learning Techniques

Venkata Senareddy Katreddy

Computer Science Engineering, VIT-AP University.

Umesh Chandra Makkena

Computer Science Engineering, VIT-AP University.

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Abstract: Healthcare providers and insurers face significant challenges in managing claims, particularly in detecting fraudulent activities and predicting high-cost claims. This paper proposes a methodology for predicting risks in healthcare claims using data analysis and machine learning techniques. By processing large-scale claims data, analyzing patterns, and building predictive models, this approach aims to improve risk management, operational efficiency, and cost savings.

Keywords: Healthcare Claims, Risk Prediction, Data Analysis, Predictive Modeling