Industry: Healthcare administration, insurance services, employee benefits

Focus: Vendor data integration, claims data centralization, data quality management, automated reporting

Technologies: Azure Cloud Services, Azure SQL, Angular, .Net, MS Fabric Lakehouse, Power BI dashboards, ETL scripting and data mapping, various API/EDI integrations, validation workflows, HIPAA standardization

Duration: 12-week build for first production-ready deployment, with ongoing enhancements and additional data integrations

The Challenge

Disparate vendor feeds slowing operations and obscuring cost drivers

A healthcare administration team needed to consolidate medical claims data from multiple third-party administrators and vendor partners. Each vendor provided reports in different formats, quality and on different schedules, making it hard to:

• Errors propagating into billing, audits, and client reporting

• Limited ability to detect outlier claims, cost drivers, or billing anomalies

• Difficulties onboarding new vendors quickly

• Delays in requested reports from vendors delaying business processes (e.g., underwriting, billing)

 

The team needed a robust, centralized, and flexible approach to integrate external data, enforce quality standards, and enable accurate, timely reporting.

Our Solution

A scalable data integration and quality management platform.

We designed and delivered a modular system to ingest, validate, and standardize claims data from multiple vendors, providing a reliable foundation for all downstream processes.

Key capabilities include:

• Automated data ingestion supporting diverse file formats and data feeds
• Rule-based validation engine to ensure data quality and business compliance
• Exception flagging and workflow tools for human review of anomalies
• Centralized, reconciled claims database as a single source of truth
• Dashboards to monitor data quality and track vendor feed health

The platform was designed to scale with new vendor integrations and support evolving business rules without requiring extensive manual rework. The client’s data is now fully prepared for in-depth analysis and AI-driven enhancements.

Business Impact

Streamlined operations, improved accuracy, and enhanced cost management insights

• Enhanced visibility into high-cost claims, anomalies, duplicates, and billing errors, driving cost savings of more than $1.5M
• Reduced time to implement point solutions relying on vendor data from 12+ months to less than 1-2 months
• Enabled downstream automations of operational work, including portfolio reporting, client reporting, and billing
• Freed up staff time to focus on supporting clients with proactive solutions to help manage healthcare costs and improve insured outcomes

By centralizing and standardizing data from multiple vendors, the team transformed a fragmented, error-prone process into a streamlined, scalable operation. This foundation not only reduced operational costs but also positioned the organization to deliver better insights and value to clients.