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name: postgres-schema-expert description: Instructions for managing the PostgreSQL schema, writing SQL queries, and maintaining data integrity for the insurance analytics project.

PostgreSQL Schema Expert Skill

This skill covers the database layer of the insurance analytics project: the insurance schema, table definitions, indexes, SQL patterns, and data-integrity rules.

Schema overview

All tables live in the insurance schema inside the insurdb database.

insurance
├── member      – one row per enrolled health-plan member
├── provider    – one row per healthcare provider
└── claim       – one row per insurance claim (child of member + provider)

The DDL lives in src/sql/ddl_create_tables.sql and is applied with:

# DATABASE_URL uses the SQLAlchemy format (postgresql+psycopg2://...).
# psql requires a driver-free URL — strip the +psycopg2 prefix:
PSQL_URL="${DATABASE_URL/+psycopg2/}"
psql "$PSQL_URL" -f src/sql/ddl_create_tables.sql
# or use the Makefile shortcut (handles the URL conversion for you):
make db-init

Table definitions

insurance.member

Column	Type	Notes
member_id	BIGSERIAL PRIMARY KEY	Auto-incrementing surrogate key
person_id	BIGINT	External identifier
dob	DATE	Date of birth — used to derive age in Python
gender	VARCHAR(10)	'male' / 'female' / 'U' — Kaggle datasets map the source sex column to gender; 'U' is the default when gender is absent
region	VARCHAR(50)	Geographic region (e.g. 'Northeast')
effective_date	DATE	Coverage start date
termination_date	DATE	Coverage end date (NULL = still active)

insurance.provider

Column	Type	Notes
provider_id	BIGSERIAL PRIMARY KEY	Auto-incrementing surrogate key
specialty	VARCHAR(80)	Medical specialty (e.g. 'Cardiology')
in_network	BOOLEAN	TRUE = in-network, FALSE = out-of-network
region	VARCHAR(50)	Geographic region of the provider

insurance.claim

Column	Type	Notes
claim_id	BIGSERIAL PRIMARY KEY	Auto-incrementing surrogate key
member_id	BIGINT FK → member	Required — every claim belongs to a member
provider_id	BIGINT FK → provider	Required — every claim belongs to a provider
service_date	DATE	Date the service was rendered
diagnosis_code	VARCHAR(8)	ICD-10 code (e.g. 'Z00.00')
procedure_code	VARCHAR(8)	CPT code (e.g. '99213')
billed_amount	NUMERIC(12,2)	Amount the provider billed
allowed_amount	NUMERIC(12,2)	Maximum amount the plan will pay
paid_amount	NUMERIC(12,2)	Amount actually paid by the plan
place_of_service	VARCHAR(20)	E.g. 'Office', 'Hospital'

Indexes

-- Speeds up joins from claim → member
CREATE INDEX IF NOT EXISTS idx_claim_member      ON insurance.claim(member_id);
-- Speeds up date-range queries on claims
CREATE INDEX IF NOT EXISTS idx_claim_service_date ON insurance.claim(service_date);

Add new indexes only when a slow query is identified. Over-indexing slows down INSERT/UPDATE.

Common SQL query patterns

Monthly paid totals by region

SELECT
    DATE_TRUNC('month', c.service_date) AS month,
    m.region,
    COUNT(*)                            AS claim_count,
    SUM(c.paid_amount)                  AS paid_total
FROM insurance.claim c
JOIN insurance.member m ON c.member_id = m.member_id
GROUP BY 1, 2
ORDER BY 1, 2;

In-network vs out-of-network comparison

SELECT
    p.in_network,
    COUNT(*)           AS claims,
    AVG(c.paid_amount) AS avg_paid,
    SUM(c.paid_amount) AS total_paid
FROM insurance.claim c
JOIN insurance.provider p ON c.provider_id = p.provider_id
GROUP BY p.in_network;

Claims for currently active members only

SELECT c.*
FROM insurance.claim c
JOIN insurance.member m ON c.member_id = m.member_id
WHERE m.termination_date IS NULL
   OR m.termination_date > CURRENT_DATE;

Top 10 providers by paid amount

SELECT
    c.provider_id,
    p.specialty,
    SUM(c.paid_amount) AS paid_total
FROM insurance.claim c
JOIN insurance.provider p ON c.provider_id = p.provider_id
GROUP BY 1, 2
ORDER BY paid_total DESC
LIMIT 10;

Resetting and re-initialising the database

# Drop and recreate the schema, then re-apply DDL
make db-reset

# Equivalent raw SQL (strip the +psycopg2 driver prefix for psql compatibility)
PSQL_URL="${DATABASE_URL/+psycopg2/}"
psql "$PSQL_URL" -c "DROP SCHEMA IF EXISTS insurance CASCADE;"
psql "$PSQL_URL" -c "CREATE SCHEMA insurance;"
psql "$PSQL_URL" -f src/sql/ddl_create_tables.sql

Load behaviour and idempotency

src/load.py uses a truncate-then-load strategy so repeated runs are safe:

-- Runs inside a single transaction
TRUNCATE insurance.claim, insurance.provider, insurance.member CASCADE;

This means every make kaggle-load call replaces all data. Do not run it on a production database with live data unless you intend to replace everything.

Data-integrity rules

1. Foreign keys – Every claim must reference an existing member and provider. PostgreSQL enforces this automatically.
2. Numeric scale – NUMERIC(12,2) stores up to 10 digits before the decimal and exactly 2 after. Never store amounts as FLOAT — floating-point rounding causes accounting errors.
3. Date columns – Always store dates as DATE, never as VARCHAR. This enables range comparisons and DATE_TRUNC without casting.
4. Schema isolation – All objects live in the insurance schema, not public. This keeps the database clean if other schemas are added later.

Environment variable

The application connects using the DATABASE_URL environment variable:

DATABASE_URL=postgresql+psycopg2://postgres:postgres@localhost:5432/insurdb

The psql CLI accepts a slightly different format (no driver prefix):

psql "postgresql://postgres:postgres@localhost:5432/insurdb"