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Join Claims and Providers
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Join Claims and Providers

EasySQL · PostgreSQL

Problem

Business Context

Highmark Health's Business Analytics team needs a provider-specialty view of paid medical claims for active members.

Task

Write a PostgreSQL query that joins members, claims, and providers and returns the number of qualifying claims for each provider specialty.

Requirements

  1. Include only claims with claim_status = 'PAID' and a service_date in calendar year 2025.
  2. Include claims only when the related member has member_status = 'ACTIVE'.
  3. Group results by provider specialty, labeling a missing specialty as Unknown.
  4. Return provider_specialty and claim_count, ordered alphabetically by specialty.

Schema

members
ColumnTypeDescription
member_idPKINTUnique member identifier
member_nameVARCHAR(100)Member display name
member_statusVARCHAR(20)Current membership status
claims
ColumnTypeDescription
claim_idPKINTUnique claim identifier
member_idINTMember associated with the claim
provider_idINTProvider associated with the claim
service_dateDATEDate on which care was provided
claim_statusVARCHAR(20)Claim processing status
providers
ColumnTypeDescription
provider_idPKINTUnique provider identifier
provider_nameVARCHAR(100)Provider or practice name
specialtyVARCHAR(80)Provider clinical specialty
Tablesmembersclaimsproviders
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