ProgramsSpring 2026 Stevens Industry Capstone ProgramProjectsHealthcare AI Insurance Verification Agent

Project Title: Healthcare AI Insurance Verification Agent

Alliance Orthopedics

Details
Project Title Healthcare AI Insurance Verification Agent
Project Topics Artificial Intelligence & Machine Learning Data Management Innovation Lean Systems and Process Improvement Operational Performance and Metrics Operations Research & Development Software Design & Development Strategic Planning UX/UI & Human-Centered Design
Skills & Expertise Data Collection Python
Project Synopsis: Challenge/Opportunity
Alliance Orthopedics is a leading health care, specialized orthopedics, that focusing on patient outcomes and satisfaction. 

However, as an out of network facility, we have to call insurance companies to find out what benefits each of our patients have.  Currently, the manual process of making these calls to insurance companies is labor intensive and prone to errors. This situation creates a pressing need to use AI to streamline this process. 

All components of this AI project will be designed, developed, and deployed only to the extent permitted by applicable laws and regulations. Any features or capabilities that are restricted or prohibited by law will be excluded or implemented with appropriate safeguards to ensure full legal and ethical compliance.
Project Synopsis: Activities/Actions Required
  • Build a voice-enabled AI agent to call insurers and collect data on eligibility, deductibles, co-pays, and authorization requirements.
  • Enable human QA (quality assurance) oversight and confidence scoring to flag unclear responses.
  • Include an autonomous phone-tree mapping feature that periodically tests insurer phone lines, detects changes in dial paths or phone numbers, and dynamically updates the AI agent’s call logic to avoid failure points.
 All components of this AI project will be designed, developed, and deployed only to the extent permitted by applicable laws and regulations. Any features or capabilities that are restricted or prohibited by law will be excluded or implemented with appropriate safeguards to ensure full legal and ethical compliance. 
Project Synopsis: Expected Results
A system that will do the following:
  • Make a phone call to an insurance carrier
  • Press the sequence of buttons needed for insurance verification. This sequence is stored somewhere that the system can access. However if the sequence of buttons does not work (this usually happens when the insurance companies change the button sequence), then the system should listen to the prompts to recalculate the sequence of buttons.
  • Ask the insurance carrier about different benefits that the patient has. The sequence of questions to ask will be provided as a resource in a playbook, as the questions can change depending on what services the patient would like to get.
  • Flag any unclear responses
  • Log the answers to the questions

 All components of this AI project will be designed, developed, and deployed only to the extent permitted by applicable laws and regulations. Any features or capabilities that are restricted or prohibited by law will be excluded or implemented with appropriate safeguards to ensure full legal and ethical compliance. 

Project Timeline

Touchpoints & Assignments Date Type

Academic Calendar

 Jan 20 2026 Other

Spring 2026 Midterm Student Evaluation

 Apr 10 2026, 23:59 PM EST (UTC-05:00) Evaluation

Spring 2026 Midterm Presentations

 Apr 10 2026, 23:59 PM EST (UTC-05:00) Action Item

Spring 2026 Final Student Self Reflection

 May 22 2026, 23:59 PM EST (UTC-05:00) Evaluation

Spring 2026 Final Presentations

 May 22 2026, 23:59 PM EST (UTC-05:00) Action Item