Bogadhi S

Ai Ml Engineer @Cigna Healthcare

TX, US

Built the core agentic AI platform using LangGraph and GPT-4/Claude 3 (Azure OpenAI), orchestrating autonomous agents across prior authorization, care management, and claims workflows end-to-end, reducing manual effort compared to the previous human-review workflow. •Developed the prior authorization agent integrating multiple internal systems including claims history, drug formulary, clinical guidelines, and eligibility with Retrieval Augmented Generation(RAG) pipelines featuring hybrid retrieval and reranking over Pinecone-indexed clinical documents, delivering approval decisions with full citations significantly faster than the manual process. •Implemented RLAIF feedback pipelines with weekly clinical staff review cycles, automatically folding corrections into model retraining to continuously improve decision accuracy on safety-critical prior authorization decisions. •Deployed care coordination agents monitoring high-risk members through real-time Kafka streams across claims, pharmacy refills, lab results, and ER visits, triggering automated SMS alerts and nurse callbacks on detected risk signals. •Connected agentic workflows into member-facing products (Clearity app, myCigna, virtual assistant) using FastAPI and FHIR APIs, enabling real-time coverage and cost answers and improving member satisfaction post-rollout. •Built claims review agents for the vCision revenue cycle platform (CitiusTech partnership) that flag risky claims, auto-correct billing codes, and chase missing documentation pre-submission, reducing denial rates and recovering previously contested claims. •Optimized the platform on Kubernetes (AKS) with request batching, model output caching, and complexity-based routing between GPT-4 and smaller models, sustaining high concurrent sessions during open enrollment with no outages.