A Hybrid Architecture for Multi-Stage Claim Document Understanding: Combining Vision-Language Models and Machine Learning for Real-Time Processing
Claims documents are fundamental to healthcare and insurance operations, serving as the basis for reimbursement, auditing, and compliance. However, these documents are typically not born digital; they often exist as scanned PDFs or photographs captured under uncontrolled conditions. Consequently, they exhibit significant content heterogeneity, ranging from typed invoices to handwritten medical reports, as well as linguistic diversity. This challenge is exemplified by operations at Fullerton Health, which handles tens of millions of claims annually across nine markets, including Singapore, the Philippines, Indonesia, Malaysia, Mainland China, Hong Kong, Vietnam, Papua New Guinea, and Cambodia. Such variability, coupled with inconsistent image quality and diverse layouts, poses a significant obstacle to automated parsing and structured information extraction. This paper presents a robust multi-stage pipeline that integrates the multilingual optical character recognition (OCR) engine PaddleOCR, a traditional Logistic Regression classifier, and a compact Vision-Language Model (VLM), Qwen 2.5-VL-7B, to achieve efficient and accurate field extraction from large-scale claims data. The proposed system achieves a document-type classification accuracy of over 95 percent and a field-level extraction accuracy of approximately 87 percent, while maintaining an average processing latency of under 2 seconds per document. Compared to manual processing, which typically requires around 10 minutes per claim, our system delivers a 300x improvement in efficiency. These results demonstrate that combining traditional machine learning models with modern VLMs enables production-grade accuracy and speed for real-world automation. The solution has been successfully deployed in our mobile application and is currently processing tens of thousands of claims weekly from Vietnam and Singapore.