ClaimsXplorer: Claims & 30-Day Readmission Analytics

The payer needed to understand claims patterns and 30-day readmissions to manage cost and quality — but the raw claims data was not shaped for executive decision-making.

A claims analytics layer on Snowflake feeding Power BI, with readmission logic, utilization measures, and a semantic model aligned to payer reporting conventions.

Built the analytics as part of the broader cohort program, validating outputs against source-of-truth tables and packaging results into CEO-ready decks.

• Encoding correct readmission and utilization logic.
• Aligning metric definitions to payer conventions.
• Maintaining trust through reconciliation.

Delivered claims and 30-day readmission analytics with executive-grade presentation, contributing to the enterprise reporting suite alongside the Nest Cohort and Prospective Opportunity views.

• Decision-ready readmission and utilization intelligence.
• Outputs reconciled to source-of-truth Snowflake data.
• Executive decks adopted for enterprise reporting.

Claims analytics live or die on definitional precision. The value is in the logic, not the visuals.

Predictive readmission risk scoring and integration with care-gap and outreach workflows.