Leading benefits consulting firm leverages our custom-designed business rules engine to process data in a fraction of the time

Caserta partnered with a leading benefits and human resources consulting firm headquartered in New York City. The firm provides a full range of employee benefits and human resources consulting services for multiemployer benefit funds, public sector organizations, and private sector companies.

The firm serves as a broker between municipalities and insurance carriers and provides analytics on medical and prescription claims to all of the members of their clients. They help their clients with financial management, benefit design and network management of health plans. In addition, they provide consultative guidance on general health trends, health risks, and chronic conditions of plan members.

The consulting firm receives a massive and growing volume of medical, pharmacy and enrollment claims data each month from all of the involved insurance organizations. Their existing data analysis pipeline could not keep up with the increased load and grew beyond the capacity of their existing data warehouse. The ETL data ingestion process and subsequent reporting were also not running optimally. As a result, their ability to onboard new clients and grow the business were restricted.

Caserta was engaged to assess the overall ETL challenges, make recommendations to remove bottlenecks and drastically improve performance and scalability of the firm’s data analytics platform.

Caserta’s solution for the benefits and human resources consulting firm consisted of three deliverables designed to position the firm’s data analytics program for success.

First, Caserta designed and developed a custom data-driven business rules engine (BRE) to evaluate incoming medical, prescription and enrollment claims.  The BRE was utilized in determining if a claim line met a rule based on diagnosis codes, procedure codes, location, gender, or combination of different attributes in order to identify diseases, care gaps, and hospital admissions. In addition, Caserta collaborated with internal staff to introduce improvements to the existing load of the data warehouse that would increase efficiency and reporting performance.

Finally, Tableau was introduced as a reporting and analysis tool to increase flexibility and to reduce the time to introduce new reports and analyses by the business users. Tableau provided quick and easy access to all data along with self-service capabilities to empower end users to join legacy data warehouse structures along with the redesigned new rules and disease diagnosis structures.

The combination of Caserta’s custom data-driven BRE along with the enhancements made in the data ingestion and database platform areas improved processing performance dramatically. Monthly data processing for a typical client dropped from hours to minutes. This improved analytics platform is scalable and has enabled Segal to onboard new clients and continue to grow its business.