Health Insurance Claim Management and Verification System Using Blockchain and Machine Learning

Abstract

In the rapidly evolving healthcare sector, the accurate forecasting and secure management of health insurance claims are crucial for both insurance providers and their clients. This study introduces an integrated framework that merges machine learning algorithms with blockchain infrastructure to enhance fraud prevention and optimize the prediction and processing of health insurance claims. The primary objective is to accurately predict claim amounts using advanced regression modeling and to streamline the entire claims administration process via an open, transparent, and decentralized blockchain network. For the predictive component, the XGBoost Gradient Regression algorithm was implemented. To complement this forecasting capability , A blockchain-based system is proposed for managing health insurance claims. This system enables secure collaboration and data exchange among key stakeholders, including hospitals, insurance firms, laboratories, and third-party administrators. The blockchain layer ensures data integrity, transparency, and security, substantially reducing opportunities for fraud, processing delays, and administrative overhead. By uniting the predictive power of machine learning with the trust and efficiency of blockchain, this project offers a robust, intelligent, and secure solution for modern health insurance management.