Training and Onboarding > Claims Reporting

Claims Reporting

Claims Reporting extracts and organizes Claim and Inventory information from source systems such as Diamond, Quest, Workflow and Siebel. Creates and manages dashboards and reports that provide actionable insights and drive business results.

High Level Process

  • Extract Source Data
    Daily, an automated job runs to extract data from Oracle, DB2 database and Active Directory for staging and transformation.
  • Create Reports
    Data is staged and transformed in a Datamart in a format easily retrievable for use on the front end user Interface. PHI and Data masking is performed as part of this process.
  • Associate Inventory Owners
    During the data load in the staging tables, inventory owners are assigned to individual records. Associated hierarchy is also assigned during this process.
  • Display Dashboard Visualizations
    Data is displayed using Power BI for Inventory reports and React User Interface for historical Claims reporting.
  • Email Exceptions
    Notifications on exceptions are sent to the applicable teams for resolution.

Team Members (Org Chart)

  • Bryan Chalker

    Principal UX Designer
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  • Patrick Kilcoyne

    Director
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Training Manuals and Documents

Applications

    Claims Reporting

    URLs:

    Who is this for?

    To allow Business and IT users to interact with Claim data more easily, using a web (rather than legacy) interface.

    Why was this app developed?

    Provide business users with a report that allows for customizable cards and metrics, showing high level summaries and/or detailed analysis of claims data.

    Primary Team Members:

    • John Smith

      Product Owner

    • Jill Smith

      BSA

    • Joe Smith

      UX Designer

    • Jim Smith

      QA Tester

  • We are the main area for procession claims.
  • We receive enrollment, opl, member and provider data.
  • We reports out claim exceptions.
  • We support over 15 business areas.
  • We have designed 7 user interfaces for business users.