README.md

metadata

title: Claim Adjudication Engine
emoji: 🏥
colorFrom: blue
colorTo: green
sdk: docker
app_port: 7860

OPD Claims Adjudication API

FastAPI backend running on Hugging Face Spaces.

Plum AI Automation Engineer - Intern Assignment Package

📋 Overview

Welcome! This package contains everything you need to complete the OPD Claim Adjudication Tool assignment for the AI Automation Engineer intern position at Plum.

📁 Package Contents

assignment_package/

│

├── README.md # This file

├── plum_intern_assignment.md # Main assignment document with requirements

├── policy_terms.json # Insurance policy configuration

├── adjudication_rules.md # Business logic for claim decisions

├── test_cases.json # Test scenarios with expected outputs

└── sample_documents_guide.md # Guide for creating test documents

🎯 Your Mission

Build an AI-powered web application that automates the adjudication (approval/rejection) of OPD insurance claims by:

1. Processing medical documents (bills, prescriptions)
2. Extracting relevant information using AI/LLMs
3. Validating against policy terms
4. Making intelligent approval/rejection decisions

🚀 Getting Started

Step 1: Read the Assignment

Start with plum_intern_assignment.md to understand the full requirements and evaluation criteria.

Step 2: Understand the Business Logic

• Review policy_terms.json to understand coverage limits and exclusions
• Study adjudication_rules.md to learn the decision-making process
• Examine test_cases.json to see expected behavior

Step 3: Set Up Your Development Environment

# Clone this assignment package

# Set up your preferred tech stack (React/Next.js + Node/Python)

# Get API keys for LLM services (OpenAI, Claude, or open-source)

Step 4: Create Test Documents

Use sample_documents_guide.md to understand medical document formats and create mock documents for testing.

Step 5: Build Your Solution

Focus on:

• Document upload and processing
• AI-powered data extraction
• Rule engine implementation
• Clean, intuitive UI
• Comprehensive testing

💡 Pro Tips

1. Start Simple: Build a basic working version first, then add advanced features
2. Use AI Tools: We encourage using Cursor, Copilot, or other AI coding assistants
3. Document Everything: Clear documentation shows your thinking process
4. Test Thoroughly: Use all provided test cases and create additional ones
5. Ask Early: If something is unclear, ask within the first 24 hours

📊 Evaluation Focus Areas

• Core Functionality (40%): Does it work correctly?
• AI Integration (25%): How effectively do you use LLMs?
• Code Quality (20%): Is the code clean and maintainable?
• User Experience (15%): Is it easy to use?

⏰ Timeline

• Total Duration: 2-3 days from receipt

intern-assignment