Session 01 is in production
The recording for this session is being produced now. The outline below is final — subscribe on YouTube and you will get it the day it releases.
What this session covers
How a health plan really works — who it covers, who funds it and how a claim gets paid. The nine-stage payer journey, the systems and EDI transactions behind it, and what QA must test.
- What a payer is — and the four main types
- The nine-stage payer journey
- Who funds the plan — follow the money
- The systems and X12 transactions behind a payer
- Claim adjudication, compliance and the QA view
Terms introduced in this session
- Member
- 834
- 837
- 835
- Adjudication
Where Session 01 sits in the framework
Every BDC track runs through the same nine layers in the same order. Session 01 is the Domain layer.
Where are we?
The industry, its segments, the players and the regulators that shape it.
A one-page domain map
A reusable artefact you can take into your own project, not just notes.
Healthcare — Payer
Health plans, insurers and government programmes — how members are enrolled, care is authorised and claims are adjudicated and paid. See all 10 sessions →
Materials for this session
Slide decks and summary notes that go with Session 01. Free materials download straight away; the rest unlock when you enrol for the Healthcare — Payer certification.
Healthcare — Payer at a Glance — slide deck
Healthcare - Payer at a Glance.pptx
Healthcare — Payer at a Glance — Summary Notes
Healthcare - Payer at a Glance - Summary Notes.pdf
Healthcare — Payer at a Glance — slide deck (తెలుగు)
Healthcare - Payer at a Glance (Telugu).pptx
Healthcare — Payer at a Glance — Summary Notes (తెలుగు)
Healthcare - Payer at a Glance - Summary Notes (Telugu).pdf
Common questions
Is "Healthcare — Payer at a Glance" free to watch?
Yes. Session 01 of every domain track is free for everyone, in English and with a separate Telugu explanation video. The remaining sessions unlock when you enrol for the Healthcare — Payer certification.
Do I need a background in this industry to follow it?
No. The session starts from the business — what the industry does and how it makes money — and only then gets to systems, data and integrations. It is built for QA engineers, business analysts, developers and delivery managers moving onto a healthcare — payer project.
What comes after this session?
The rest of the Healthcare — Payer track follows the nine-layer framework through to the certification assessment. New sessions are published weekly on the YouTube channel.
Keep your progress across the track
A free account saves where you are, unlocks the free downloads, and tells you when the next session in this track goes live.