Medicare Advantage Healthcare Platform
Full-stack healthcare platform serving Medicare Advantage members — spanning a self-service Member Portal, a Care Coordination system for nurses and case managers, and a Population Health analytics platform for proactive care interventions.
Overview
Zing Health is a Medicare Advantage insurance company focused on underserved communities. I joined as a senior full-stack engineer to build and scale the technology platform serving members, care teams, and clinical operations.
I worked across three interconnected systems: the Member Portal (digital self-service for benefits and claims), the Care Coordination & Case Management platform (workflow tooling for nurses and care managers), and the Population Health platform (data pipelines and analytics for identifying high-risk members and enabling proactive care).
Problem
Medicare Advantage members — predominantly elderly and in underserved communities — had limited digital access to their own benefits, claims, and provider information. Care managers were tracking care plans in spreadsheets and disparate tools, making coordination slow and error-prone. The population health team had no systematic way to identify high-risk members before they had acute events, relying on reactive rather than preventive care.
On the technical side, the platform needed to scale as enrollment grew while maintaining reliable access to critical healthcare data — downtime or data errors in a healthcare insurance platform have direct member impact.
Solution
I built the Member Portal as a React + Node.js application, connecting to backend APIs that aggregated data from claims processing, benefits management, and provider networks. For care coordination, I designed REST APIs and task management services that gave nurses structured workflows for care plans, SDOH (social determinants of health) tracking, and member outreach.
For population health, I built Python-based data pipelines that ingested claims and clinical data, applied risk stratification logic, and surfaced high-risk member cohorts to care teams. I also focused heavily on platform reliability — query optimization, monitoring, and automated testing to keep the platform stable as enrollment grew.
Architecture
Members access benefits, claims, and providers through a React portal backed by Node.js APIs. Care teams use a coordination platform to manage care plans and social determinants. A Python analytics pipeline identifies high-risk members to drive proactive interventions.
The platform is structured as a set of domain-focused backend services behind a shared API gateway. The Member Portal is a React SPA that talks to a Node.js API layer, which aggregates data from claims, benefits, and provider services backed by PostgreSQL. The Care Coordination service manages care plans and tasks as structured data with state-machine-driven workflows. The Population Health pipeline is a Python batch system that runs risk stratification jobs on claims and clinical data, writing cohort outputs back to PostgreSQL for consumption by the care coordination UI.
Components
Member Portal
React SPA enabling members to view benefits, check claims, access EOBs, and find in-network providers; backed by Node.js API aggregating multiple data sources
Node.js API Layer
REST API services handling member authentication, benefits data, claims history, and provider directory queries; PostgreSQL-backed with query optimization for concurrent member sessions
Care Coordination Service
Backend services for care plan management, task assignment, SDOH tracking, and member outreach workflows — used by nurses and case managers daily
Population Health Pipeline
Python batch pipelines that ingest claims and clinical data, apply risk stratification models, and produce high-risk member cohorts for proactive care intervention
Analytics & Reporting
SQL-based analytics layer supporting population health dashboards, quality measure tracking, and compliance reporting for Medicare Advantage requirements
Platform Reliability
Monitoring, automated tests, and query optimization ensuring the platform stays stable and performant as member enrollment grows
Execution Flow
Execution Flow
Key Technical Decisions
Medicare Advantage members interact with benefits and claims data that varies significantly by plan and member state. A React SPA with client-side data fetching let us build a dynamic, personalized UI that could render member-specific views without full page reloads — important for the responsiveness expected by members navigating complex healthcare information.
Reliability & Scaling
Query optimization and index tuning on claims and provider data — identified and resolved slow queries before adding caching complexity
Connection pooling for PostgreSQL to handle concurrent member sessions during peak enrollment periods
Automated tests across backend services to catch regressions before deployment, especially critical for claims and benefits data accuracy
Monitoring and alerting on API latency and error rates — downtime or errors in a healthcare insurance platform have direct member impact
Idempotent data pipeline design for population health batch jobs — safe to re-run without double-counting or corrupting risk scores
Platform scaled to support growing member enrollment while maintaining reliable access to critical healthcare data
Impact
Impact Metrics
Improved digital self-service adoption by enabling members to access benefits, claims, EOBs, and providers through a modern portal
Enabled nurses and care managers to manage care plans and social determinant workflows more efficiently, reducing coordination time
Powered proactive care interventions by identifying high-risk Medicare Advantage members through population health data pipelines
Helped the platform support growing member enrollment while maintaining reliable API performance through query and infrastructure optimization
Translated complex Medicare Advantage workflows into scalable platform services by collaborating closely with clinicians and operations teams
Tech Stack
Backend
Infrastructure
Data
AI / ML