Payer Claims & Appeals Analytics Path · Mission 9 of 25Medium

Member denial-rate cohort by region

Two-table JOIN with conditional aggregation per group. Practice routing claims through dim_members to reach a member attribute, then computing a per-region denial rate with the same SUM(CASE) / COUNT pattern from M6 — applied across a different grouping dimension.

The Brief

Aisha CarterPopulation Health Analystslack-dm

Pop health is investigating whether denials concentrate geographically. From fact_claims joined to dim_members, give me a per-region denial rate — region, total_claims, denied_claims, and denial_rate_pct (100.0 * denied / total, rounded to 1 decimal). Five regions in the membership: Northeast, Southeast, Midwest, Southwest, West. Sort by denial_rate_pct DESC so the highest-friction region reads first. If one region is materially above the others, that's a network-adequacy or member-education hypothesis we'll route to the regional health plan team.

You'll practice

Conditional aggregationCohort cross-tabPer-region rate

Tables & columns available

fact_claimsfact11 columns
ColumnTypeKey
claim_idINTPK
member_idINTFK → dim_members
provider_idINTFK → dim_providers_payer
plan_idINTFK → dim_plans
service_dateTEXT
cpt_codeTEXT
place_of_serviceTEXT
billed_amtREAL
allowed_amtREAL
paid_amtREAL
statusTEXT
dim_membersdim7 columns
ColumnTypeKey
member_idINTPK
plan_idINTFK → dim_plans
age_bandTEXT
sexTEXT
regionTEXT
enrollment_startTEXT
enrollment_endTEXT

Hints (3)

Each hint you reveal reduces the XP you can earn. Try the query first.

Hint 1

Two-table aggregate: claims joined to members on member_id, grouped by the region attribute on the member side. No plan or provider info needed — the question lives entirely on the member dimension.

Hint 2

Same denial-rate pattern as M6 — conditional aggregation for the numerator (a CASE-summing pattern that counts only the denied rows) over the row count for the denominator. The grouping dimension shifts from CPT to region. Float-promote the percentage so integer division doesn't zero out the small rates.

Hint 3

Four output columns. Whether a HAVING gate belongs here is a judgment call — think about whether any region in the membership has so few claims that a noise-floor filter would matter, or whether the volumes are uniformly large enough that the rate is already defensible.