---
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