Internal Tool — Plum Health Insurance

AI-Powered
Claim Adjudication

Intelligent OPD claim processing with explainable decisions, fraud detection, and a 9-step deterministic rule engine.

Submit New ClaimView Dashboard

9-Step Rule Engine

Deterministic eligibility, coverage, and limit checks run before any AI involvement — ensuring transparent, auditable decisions.

AI-Powered Analysis

LLM-driven medical necessity validation and fraud detection working alongside traditional rules for comprehensive claim assessment.

Explainable Decisions

3-layer rejection reasoning: what rule was triggered, why it applies to this claim, and actionable steps the claimant can take next.

10Test Cases
95%Accuracy
<3sProcessing

Plum OPD Adjudicator — Built for internal use