Client Health Claims Benchmarking Report
Aug
2020
Problem / Purpose
Larger clients wanted insights on employee wellness trends and healthcare usage to support initiatives like flu shots and chronic condition management. The company lacked a scalable, data-driven product to provide value in this space.
Solution
Independently initiated and built a reporting solution based on the Health Care Cost Institute’s (HCCI) public methodology. Used raw claims data to replicate HCCI metrics and benchmark client-level performance against national data. Created custom reports for large clients showing chronic condition prevalence, utilization rates, prescription share, claim spend, and more. Designed the reports to support future integration with nurse or physician advisory services for tailored wellness recommendations.
Key Achievements / Impact
Produced an innovative, HIPAA-compliant client reporting concept aimed at increasing client satisfaction and creating a unique product offering. Although the product didn’t launch due to a role transition, the framework remains a potential foundation for future white-glove client programs.
Key Technologies / Tools Used
SQL, Excel, Word, Data Analysis, Healthcare Analytics, HIPAA Compliance, Claims Data Analysis, Health Insurance, Insurance Analytics
Role
Manager, Insurance and Profitability (self-initiated)
ProService Hawaii