Provider performance scoring using supervised and unsupervised learning

A non-transitory computer-readable medium comprising computer program instructions that, when executed by a computer processor, cause the processor to perform operations, the instructions comprising instructions to:

• receive data associated with a claim involving the provider;
• input the data associated with the claim into a supervised machine learning model and receiving predicted performance of the claim as output;
• select a first unsupervised machine learning model from a plurality of unsupervised machine learning models based on a stage in claim processing that the claim belongs to, one or more of the plurality of unsupervised machine learning models associated with a different stage of a plurality of stages in claim processing;
• input the data associated with the claim into the selected first unsupervised machine learning model and receiving as output from the selected first unsupervised machine learning model an identification of a cluster of candidate claims to which the claim belongs;
• generate a score corresponding to a predicted performance of the provider based on the predicted performance of the claim and the identification of the cluster of candidate claims;
• and
• provide, for display at a client device, the generated score of the provider.

A system comprising:

• a processor;
• and
• a non-transitory computer-readable medium comprising computer program instructions that, when executed by a computer processor, cause the processor to perform operations comprising:
• receiving data associated with a claim involving the provider;
• inputting the data associated with the claim into a supervised machine learning model and receiving predicted performance of the claim as output;
• selecting a first unsupervised machine learning model from a plurality of unsupervised machine learning models based on a stage in claim processing that the claim belongs to, one or more of the plurality of unsupervised machine learning models associated with a different stage of a plurality of stages in claim processing;
• inputting the data associated with the claim into the selected unsupervised machine learning model and receiving as output from the selected first unsupervised machine learning model an identification of a cluster of candidate claims to which the claim belongs;
• generating a score corresponding to a predicted performance of the provider based on the predicted performance of the claim and the identification of the cluster of candidate claims;
• and
• providing, for display at a client device, the generated score of the provider.