insurance-claim-document-processing

Extract fields from insurance claim images and PDFs with confidence scoring.

580|66|Updated Apr 21, 2025
One-click install
npx skills add https://github.com/aliyun/qwen-dianjin --skill insurance-claim-document-processing
Or copy as Structured Prompt for Agent
Please help me install this Agent Skill.
Skill: insurance-claim-document-processing
Source: https://github.com/aliyun/qwen-dianjin/tree/main/DianJin-SKILLS/claim-expert/claim-document-processing
Command: npx skills add https://github.com/aliyun/qwen-dianjin --skill insurance-claim-document-processing

SYSTEM DOCUMENTATION & REQUIREMENTS

💡 This Skill requires agentscope, dashscope, and includes scripts (resource) and references (resource) and assets (resource) components.

What problem does it solve?

This Skill helps insurance claims teams convert uploaded claim documents (medical invoices, medical records, appraisal reports, and expense lists) into structured, audit-friendly outputs by performing OCR-based extraction, standardized categorization, completeness checks, cross-document consistency validation, and medical timeline summarization—while enforcing strict grounding to avoid guessing missing data.

Core Features & Use Cases

  • 全链路理赔材料解析:对理赔图片/PDF进行一次性多模态分析,输出统一结构化结果(目录、摘要、审计信息)。
  • 材料分类与合规校验:自动归入标准类别(医疗发票、病历资料、鉴定报告、鉴定费用、费用清单、其他),并进行完整性/一致性/交叉验证风险标注。
  • 病程时间线梳理:从医疗类文档提取诊疗关键节点,按时间线输出病程摘要与关键信息用于审核跟进。
  • 合规与审计能力:每项结论必须标注数据来源与置信度,异常触发预警并要求人工确认,生成审计日志(JSONL 追加)。

Quick Start

Run the skill on your local materials folder by providing the insurance claim input directory and your DashScope API key, then choose the execution scope (e.g., 全部 or 分类/完整性/一致性/交叉验证/病程时间线) to obtain standardized audit reports.

Frequently Asked Questions about insurance-claim-document-processing

High-intent search queries and answers about installing and using this skill.

FAQPage Schema
How do I extract key fields and validate consistency across insurance claim documents?

To extract key fields and validate consistency across insurance claim documents, perform OCR-based end-to-end analysis on images and PDFs. This process categorizes documents into standardized claim categories, checks completeness, and cross-verifies identity, time, and amount fields with confidence scoring.

How does cross-document consistency validation work for medical invoices and expense lists?

Cross-document consistency validation for medical invoices and expense lists works by applying OCR to extract structured data, then cross-verifying invoice expenses against billed amounts. It flags discrepancies and generates risk warnings with confidence scores and audit logs without guessing missing data.

Can I use DashScope to generate a medical timeline summary from claim PDFs?

Yes, you can use DashScope to generate a medical timeline summary from claim PDFs. The Skill uses a front-load multi-modal parsing step via the DashScope API to extract key treatment nodes from medical records and outputs a chronological disease course summary.

What is the best way to detect missing pages or document types in uploaded claim materials?

The best way to detect missing pages or document types in uploaded claim materials is through automated completeness checks. The system categorizes documents into standard types like medical invoices and appraisal reports, then flags absent required pages and outputs risk warnings.

Do I need to configure a DashScope API key to perform OCR on insurance claim images?

Yes, you need to configure a DashScope API key to perform OCR on insurance claim images. The Skill requires this key to execute its front-load multi-modal parsing step, which generates reusable structured outputs and audit logs for your banking, insurance, or medical claims.

Why does the claim document parser output risk warnings for unreadable fields instead of guessing?

The claim document parser outputs risk warnings for unreadable fields instead of guessing to enforce strict grounding and compliance. It ensures audit-level accuracy by requiring human confirmation for anomalies and appending every conclusion with data sources and confidence scores to a JSONL audit log.