Shuangjiang He

AnExplainable AI Engineering Framework for Claims-Only First-Stage Provider Audit Triage Using SHAP-Guided Hybrid Retrieval-Augmented Generation

This study proposes an explainable artificial intelligence (XAI) engineering workflow for provider-level healthcare claim audit prioritization using SHAP-guided hybrid retrieval-augmented generation (RAG). The framework integrates provider-level claim aggregation, tree-based risk...