Jiayi S

Solution Designer: Health Insurance Settlement & Prescription Routing

Changzhou Healthcare Security Bureau

Mar 2026 - Present • 7 mos

Own the settlement and prescription-routing engine for a municipal platform that connects public health insurance, commercial insurers, hospitals and pharmacies. It is the core logic the platform's business modules depend on, and it is designed as a template other cities can reuse. - Found a gap in the approved settlement flow: a refused delivery or partial return would have left funds stranded with two independent payers. Specified the reversal flow across insurer, public-fund and pharmacy ledgers, with partial-return proration and reconciliation alerts. - Specified integration contracts with national and provincial insurance platforms, the prescription-routing regulator, hospital record systems, pharmacy ERPs and insurer APIs. A tiered model (standard API, adapter, spreadsheet import) keeps the slowest counterparty from blocking rollout. - Negotiated the data-sharing boundary between public and commercial insurers under China's Level-3 protection standard and personal-data law: purpose limitation to claims, diagnosis scoped to the claim, pseudonymized IDs instead of national ID, and prescriber identity withheld from insurers entirely.

Applied AI Engineer (Forward-Deployed): Clinical Documentation & Patient Navigation

Grifols Healthcare Solutions

Jun 2025 - Jun 2026 • 1 yr

Led scoping and architecture for two LLM systems running in live clinical workflow. - Patient navigation assistant over the hospital's own documents (department directory, floor plans, exam-preparation rules). Every answer cites its source document. When retrieval finds nothing, it says it doesn't know and hands off to staff. Red-flag symptoms are routed straight to emergency instructions before the AI runs. - Dictation-to-record system for physicians. Output is checked by a deterministic validator against the national record-writing standard, and any record that fails is regenerated. A physician-correction loop grew the labeled set from 200+ to 3,000+ records. - Deployed entirely inside the hospital network, with de-identified training data and per-record audit logging. Outcome: in production across 12 departments with 60 physicians. 70% of records are accepted with zero edits in internal medicine and OB/GYN. Navigation handles about 1,000 questions a day and reduced front-desk inquiries by 30% at rollout, rising to about 50% as coverage expanded.

Product Manager: Food Safety & Label Compliance

Noble Bean

Jan 2025 - Aug 2025 • 7 mos

Owned the tempeh product line at a fermented-food manufacturer. - Built the Preventive Control Plan required under CFIA's Safe Food for Canadians Regulations: HACCP-based hazard analysis, label compliance and supplier verification. - Managed 10 suppliers end to end, from qualification review and specification negotiation to scheduled re-evaluation. - Kept labels compliant under federal bilingual rules and Quebec's French-language requirements (Bill 96). - Turned sales demand into production schedules, preventing 3 stockouts. When raw material ran short, qualified a substitute and carried the label change through to compliant packaging.