Legacy Insurance Adjudication Rescue

A health insurance provider relied on an AS400 adjudication system that was, in their own words, "lipstick on a pig." Green-screen input, function-key mazes, and PDF printouts were the only interface. There was zero documentation, no API, and no way to produce modern or financial reports. Forecasting was impossible, auditors were frustrated, and external providers routinely overbilled because the organization could not reconcile claims against payments.

Reverse-engineered the entire system from raw data extracts. Rebuilt the relational logic from scratch, constructed SQL views, and deployed a data warehouse. Delivered dashboards with drill-down capability, Excel pivot-based analysis layers, and directly auditable financial reports. Added fraud-detection patterning and provider-specific reporting so stakeholders could defend every dollar.

Full visibility where there had been none. A provider accustomed to requesting supplemental payments was presented with a precise reconciliation of claims against remittances. The request was not pursued further. The organization gained forecasting capability, satisfied its auditor general, and gave government funders the transparency they required.