Introduction This nonprofit healthcare payer is a key player in multiple states along the East coast. With more than 30 years in the business, the payer employs 1,500 people and serves more than 700,000 members, offering a variety of plans including HMO, PPO, FSA, HSA, HRS and Medicare. The organization is also a leading provider of ASO (Administrative Services Only) contracts, providing third party administration services while assuming no risk for claims payments. Similar to many other organizations of its kind, this healthcare payer had a very complex and disparate flow for processing and adjudicating claims. As shown in Fig. 1, claims entering the organization landed in a staging area, and then fed into a claims database where they were sent for adjudication. During thi

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