Healthcare documents · 27 of 31 · Evidence · 2 minutes
Healthcare products. From problem to production.
Annual review
Claims automation, provider matching and a legacy claims integration replaced — explored through the documents and decisions.
01
Annual review: capability and outcome attribution
What the claims work delivered, with each outcome attributed to the work that produced it.
Product decision
Report what changed without manufacturing a shared program.
- Document type
- Annual review
- Lifecycle stage
- Operate & learn · 25 / Operate & learn
- Contents
- 3 sections · 1 table · about 1 min
- Status
- Sample format · headline results from my healthcare claims work
- Product decision
- Report what changed without manufacturing a shared program.
Portfolio sample from my healthcare product experience. Requirements, thresholds and review records are illustrative; they are not employer documents or historical sign-offs.
Capability record
Paper-to-EDI conversion, a new daily reconciliation audit, provider identity on the enterprise master, and a replaced claims engine. They were separate workstreams; this review keeps them separate.
- Paper-to-EDI conversion
- a new daily reconciliation audit
- provider identity on the enterprise master
- a replaced claims engine
They were separate workstreams; this review keeps them separate.
Outcome attribution
| Workstream | Outcome | Basis |
|---|---|---|
| Mailroom digitization | 400,000+ claims converted; 80-person team redeployed; about $1M a year | Program outcome |
| Reconciliation | 300,000 missing claims and about $10M found; daily audit | 20-million-claim analysis |
| Provider identity | 99% match against the master; legacy matching retired | Proof of concept |
| EDI shredding replacement | Homegrown EDI shredding into a normalized datamart before adjudication; 50% shorter enhancement turnaround. | Post-replacement measures |