Building Comcare’s Claims Data Architecture

Better understanding and documenting data to support improvement initiatives

Learn how Comcare needed to document their Claims Data Architecture and how it would provide foundational capabilities to improve their understanding of their claims data.

Overview

Comcare is the national Work Health and Safety and Worker’s Compensation Authority. They are a government regulator, workers’ compensation insurer, claims manager and scheme administrator.

Comcare works with employees and other workers, employers, service providers and other organisations to:

  • Minimise the impact of harm in the workplace
  • Improve recovery at work and return to work
  • Promote the health benefits of good work

Comcare collaborates and partners with other schemes and organisations on research and innovative projects that improve outcomes.

Expenditure Forecasting

Challenge

The Claims Management Group needed to better understand and document its data to support its improvement initiatives.

The claims data architecture includes the definition of data attributes within Comcare’s core claims management system and the documentation of data integration between the core system and other Comcare systems such as finance and the data warehouse.

The need to document the Claims Data Architecture was to provide foundational capabilities to improve Comcare’s understanding of its claims data.

This supports the organisation’s Data Strategy, future projects and other operational needs.

Expenditure Forecasting

Solution

The engagement was to document the claims data architecture aligning to the ISO-11179 metadata standard. Data Agility had extensive experience using this standard and understood the detail and complexities of ISO-11179 and how best to apply to it.

1. Metadata definition

  • Creation of a standardised template based on ISO 11179 for the capture of definitions
  • Capture of claims metadata with a focus on the representation layer from the ISO 11179 standard which includes business definitions, usage context, data quality statements and mapping between the claims management system front end and database
  • Stakeholder consultations with each area of claims management to understand the claims data and associated definitions
  • Approval by relevant business and technical SMEs, Directors, and Project Sponsor

2. Dataflow mapping

  • Creation of standardised dataflow mapping template
  • Consultation with various groups of business and technical stakeholders to understand data flows and system integration
  • Data mappings developed for the data flows between the core claims management system and twelve other business systems, both upstream and downstream to the core claims management system
  • Approval by relevant business and technical SME’s, Directors, and Project Sponsor

3. Governance and training

  • Development of relevant governance processes to maintain the claims data architecture
  • Development of ‘how to guidelines’ to use, maintain and apply the claims data architecture
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Results

The claims data architecture developed by Data Agility provides Comcare:

  • Improved understanding of what data attributes are within the core claims management system with a clear and agreed set of attribute definitions
  • Improved understanding of how the data flows to and from the core claims management system and applied transformations
  • Increased awareness and understanding of the importance of data, data quality and data governance within the Claims Management Group

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