The client is one of the leading providers of employee benefits to members of the agri-business community. The company works with organizations ranging from small family farms to larger corporate agricultural businesses to provide comprehensive healthcare solutions tailored to each business’s needs. The client offers a full range of services, from acute and episodic care to disease management and prevention.
Business Challenges
The client faced critical discrepancies in data quality between the Oracle Source database, staging repository, and DataMart. Additionally, the lack of processes to validate claim eligibility prior to settlement resulted in increased claim settlement costs and a significant waste of resources. Finally, limited to basic report functionality with SSRS and Power BI, they lacked the necessary insights into key metrics. The challenges were:
- Data quality issues across databases
- No claim eligibility process in place
- Limited insights and basic reports
Benefits
- Significant savings in claim settlement
- More accurate reports
- Improved report usability
- High-quality data
- In-depth insights
PreludeSys Solution
PreludeSys streamlined the reporting process by crafting new features to improve both SSRS and Power BI reports readability. We also resolved data quality problems within DataMart. Additionally, we established an efficient resolution procedure for non-compliant claims submissions and provided an end-to-end system validation that ultimately identified members who didn’t meet the eligibility criteria for submitting claims. The solution included:
- Addressed data quality issues
- Set up the claims submissions process
- Designed new reporting features