Insurance Claim Data Analysis – A Medical Claim Overpayment Recovery Company

Industry: Business Services (B2B); Insurance; Healthcare
Solution: Insurance Claim Data Analysis
Technologies: SQL Server
Solution Type: Business Process Automation; Dashboard and Analytics

medical claims overpayment logo
The Claim Overpayment Recovery Company specializes in recovering the overpayment of health insurance claims. The company provides its clients with a custom yet scientific approach to finding claim overpayments. The company based out of Chicago’s western suburbs has been revolutionizing medical claim overpayment recovery since 2003.

Challenge Challenge - Mountain without Flag

There were multiple situations the company needed assistance with:
Situation 1 – Data Analysis
The company receives massive amounts of claim data from their clients. One of their major clients was providing claim data in multiple files. The client did not provide any explanation on how the data between the multiple files was related. The part that made the situation even more difficult was that there were over 500 million claims records between these files to review. Seasoned database professionals were needed to guide the company on how to organize and process the data efficiently.
Situation 2 – Evolving Business Process
The company developed their own home grown IT systems in FoxPro to process claim data. The importing of claim data into their FoxPro data mining systems needed to be updated. The company’s work load was growing and business process evolving. The company wanted to speed up the importing of claim data along with wanting to keep more of a history of claims. Any improvements that could be made would routinely save the company several hours in that they were regularly importing and processing millions of records.

Solution Solution - Mountain with Flag

alligatortek went to the company’s offices and worked with the operations staff to streamline and automate multiple business processes.
A certified Microsoft database administrator and a seasoned programmer went onsite to the company’s offices to work with their staff. Using the company’s knowledge of claim overpayment and alligatortek’s knowledge of databases, big improvements were made. The multiple files of claim data were analyzed, organized, and merged together. Consolidating the claim data made it much easier to analyze and recognize claim overpayments. Processes then were setup and optimized to analyze the millions of records to automate the finding of claim overpayments.
Situation 2 – Evolving Business Process
Their claim processing was updated to keep a history of the claim data imported. The history of claim data now enables more comprehensive analysis of claim overpayment. More information means better decision making and claim overpayment recovery.
Most of the programming code in FoxPro was migrated to SQL Server stored procedures. This means that data processing is now done using the power of SQL Server, rather than the outdated FoxPro platform. After the work was done, the company was left with a system that imports and processes data faster along with finding more claim overpayment records. They are now exceeding previous expectations and doing it in a shorter amount of time and without increasing operating costs.

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