How shivatejabadugu/healthcare-claims-analytics works
Healthcare Claims Analytics is a local dbt/DuckDB warehouse that turns payer eligibility, roster, medical-claim, and pharmacy-claim files into validated, versioned, dimensional data and plan-facing metrics. The workflow runs from synthetic data generation through staging, intermediate cleanup, core dimensions and facts, then analytics marts; rejected records form a data-quality branch. The README documents these layer relationships and major marts, but most SQL was not sampled, so the graph uses documented layer-level links rather than asserting unverified model-level calls.
Main entry points: fct_claim_lines.sql Medical claim fact · staging Typed staging · int_medical_claim_lines__validated.sql Validated claims · int_medical_claims__final_version.sql Final claim versions
Components 18
Data generation
- Synthetic data generator
generator/generate.py - Payer landing files
Claims transformation
- Typed staging
models/staging - Eligibility spans
models/intermediate/int_eligibility__merged_spans.sql - Validated claims
models/intermediate/int_medical_claim_lines__validated.sql - Final claim versions
models/intermediate/int_medical_claims__final_version.sql - Member months
models/intermediate/int_member_months.sql
Core warehouse
- Member and provider dimensions
models/marts/core/dim_member.sql - Medical claim fact
models/marts/core/fct_claim_lines.sql - Inpatient stays
models/marts/core/fct_inpatient_stays.sql - Pharmacy claims fact
models/marts/core/fct_pharmacy_claims.sql
Analytics and quality
- PMPM mart
models/marts/analytics/mart_pmpm.sql - Readmissions marts
models/marts/analytics/mart_readmissions.sql - Medication adherence
models/marts/analytics/mart_medication_adherence.sql - Member analytics
models/marts/analytics/mart_member_profile.sql - Plan quality scorecard
models/marts/analytics/mart_plan_quality_scorecard.sql - Rejected-record reporting
models/marts/data_quality/dq_rejected_records.sql - Ad hoc analyses
analyses
Connections 21
- Synthetic data generator → Payer landing files: writes extracts
README.md - Payer landing files → Typed staging: loads and types
README.md - Typed staging → Eligibility spans: cleans spans
README.md - Typed staging → Validated claims: validates claims
README.md - Validated claims → Final claim versions: resolves versions
README.md - Eligibility spans → Member months: derives months
README.md - Final claim versions → Medical claim fact: loads fact
README.md - Typed staging → Member and provider dimensions: models dimensions
README.md - Medical claim fact → Inpatient stays: merges stays
README.md - Final claim versions → Pharmacy claims fact: models fills
README.md - Medical claim fact → PMPM mart: feeds metrics
README.md - Member months → PMPM mart: feeds metrics
README.md - Inpatient stays → Readmissions marts: feeds stays
README.md - Pharmacy claims fact → Medication adherence: feeds fills
README.md - Member and provider dimensions → Member analytics: feeds profiles
README.md - Medical claim fact → Member analytics: feeds costs
README.md - PMPM mart → Plan quality scorecard: summarizes measures
- Readmissions marts → Plan quality scorecard: summarizes measures
- Medication adherence → Plan quality scorecard: summarizes measures
- Validated claims → Rejected-record reporting: routes rejects
README.md - Medical claim fact → Ad hoc analyses: supports analysis