Healthcare Systems Architecture

• Payer business architecture
• Payer data models
• Claims processing
• Payment integrity
• Healthcare integrations

1. Nov 2, 202612 min read

   Healthcare payer business architecture: the five core entities

   Part 1 of 6. Carrier, sponsor, policy, plan, and benefit. The same words point to different organizations in commercial coverage, Medicare, and Medicaid.

2. Sep 7, 20268 min read

   Beyond pay-and-chase: a closed-loop payment integrity architecture

   Pre-pay and post-pay only work together—fast inline scoring for adjudication, deeper retrospective analytics as the feedback loop that keeps the rules honest.

3. Aug 12, 20266 min read

   Where payment integrity architectures usually break

   Post-pay recovery fails less from missing rules and more from latency, brittle vendor seams, and claims data that no longer matches adjudication reality.

4. Jun 3, 20265 min read

   Notes from moving claims ETL off SSIS onto AWS Glue

   A practical look at replacing brittle on-prem SSIS packages with Glue jobs without losing operational control of claims extracts.

5. Mar 18, 20264 min read

   Using TOGAF without drowning a delivery team

   How enterprise architecture ceremonies stay useful when the real work is still C#, SQL Server, and production claims traffic.

All writing · Data Science & Engineering