claims-analytics

Modelisation MySQL dune mutuelle sante - contrats, sinistres, plafonds de remboursement, loss ratio par formule, 18 tests automatises

ClaimScope is a vehicle insurance claims portfolio intelligence platform that identifies warranty concentration, geographic imbalance, and anomalous claims using explainable analytics. Built on DuckDB and IsolationForest, it turns raw claims data into actionable triage signals — no actuarial black boxes, no LLM fabrication.

Executive-grade Power BI insurance claims analytics portfolio featuring PBIP, TMDL, DAX, Power Query, SQL, synthetic data quality, financial exposure and risk-based review prioritization.

Healthcare Claims & Patient Analytics Dashboard Built in Tableau Public

Healthcare claims intelligence platform for PMPM, readmissions, HCC/RAF-style risk, FWA review, ML scoring, custom data ingestion, and GitHub Pages deployment.

Medicare Claims Utilization, Payment & Quality Analytics on CMS DE-SynPUF synthetic data: DuckDB star schema, dbt, governed KPIs, Excel, Tableau workbook

Production-style healthcare interoperability and claims analytics engineering portfolio using CMS Blue Button synthetic FHIR data, PostgreSQL, data governance, and Power BI PBIR.

Power BI analytics over 1,000 healthcare claims — finds that two status-tracking fields disagree on 43.5% of claims, and quantifies which denial reason drives the most revenue loss.

End-to-end healthcare claims analytics — SQL Server, Azure Data Factory, Microsoft Fabric, Power BI, SSIS

Interactive Power BI dashboard analyzing healthcare claims operations, analyst and team performance, response times, workload, and satisfaction trends.

Explainable healthcare claims risk and FWA analytics with Python, SQL, machine learning and a Streamlit investigation dashboard

Synthetic healthcare claims, provider, enrollment, contract, data quality, and audit-ready reporting analytics portfolio.

End-to-end maternity episode cost analysis and risk prediction model simulating real-world payer strategy — $15.7M spend, 2K episodes, $2.3M savings opportunity identified.

Monthly Excel report pack automation kit built twice from one spec: VBA + Power Query for the desktop reality, a pytest-covered Python twin for CI. Synthetic claims data, schema-drift repair, row quarantine with reasons, styled multi-sheet output. 500k rows to an 8-sheet pack in 9.5 s; 97% coverage. Simulation only.

Which claims get denied, what denials cost, and what a billing team should do: DuckDB SQL + pandas + Streamlit

Managed Care Contracting Analytics report analyzing payer reimbursement performance using DAX time intelligence, Reimbursement Index, and Variance from Benchmark to support managed care contract negotiation strategy

Garner Health — independent third-party profile of a public API surface, by API Evangelist. Garner Health is a healthcare technology company that helps members find high-quality, in-network doctors and helps employers, benefits advisors, health plans, and providers improve care quality while lowering healthcare costs.

Turns insurance claims data into answers: loss ratios, fraud flags, adjudicator performance and regional trends, delivered as an Excel report.

Garner — independent third-party profile of a public API surface, by API Evangelist. Garner Health is a healthcare technology company that helps members find high-quality, in-network doctors while helping employers, advisors, health plans, and providers improve care quality and lower costs.