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Navigating a path forward in the new normal

On-demand webcast

Explore what’s required for success in the future of Australian private health insurance and Oracle’s experiences in healthcare innovation.

Building future-ready insurance ecosystems

Australian Health Insurance Essentials

To succeed in the coming decade and beyond, executives and technologists must embrace emerging technologies that enable faster speed to market, regulatory agility, and new data interoperability standards to build interconnected healthcare systems driven by data, preventive health, service effectiveness, and cost efficiency.

Transform and simplify your customers' health insurance journeys today

Oracle Health Insurance solutions are now SOC2 Type 2 certified

Oracle Health Insurance Solutions for Claims and Policy Administration (OHI) has proudly achieved their SOC2 type 2 Certification Compliance for Security and Data Confidentiality.

Customer Video – Defence Health

Defence Health leverages the flexibility of Oracle Health Insurance to bring products to market more quickly.

Harvard Pilgrim Health Care improves customer satisfaction with Oracle

Harvard Pilgrim Health Care rapidly and accurately process approximately 1 million claims transactions each month by running Oracle Health Insurance applications on Oracle Exadata Database Machine.

Developing the foundation for achieving claims excellence

Health insurance claims and benefits management is a frontier ripe for innovation. Estimates of loss to claims leakage equates to more than $300M. Learn more about the importance of effective health insurance claims and benefits management, and how to reap the cost savings.

Developing the foundation for achieving claims excellence

Onboard to a uniquely Australian, future-ready health insurance platform

Oracle Health Insurance offers Australian private health insurers a readily available, localised core platform that maximizes benefits of turnkey product while offering maintainability for individual insurers.

A flexible, layered model

Oracle has developed a layered model that allows for Oracle to build and maintain localisation features and yet have customers extend these to create their own IP, and maximise brand differentiation.

Oracle health insurance core product

Provides Australian market capabilities such as age based discounts, LHC, and Medicare rebate. Plus core capabilities of membership, provider contracts, claims pricing and adjudication. Delivered as a SaaS service, maintained by Oracle.

OHI configuration layer

The majority of market specific features includes data attributes commonly used in Australia, as a cohesive model to ensure speedy compliance with market changes. These include things such as rate and rebate tables, market specific claim rules, and integrations and extracts to external service providers, or agencies like the ATO.

Customer specific configurations

Includes a variety of information such as custom codes, product & benefit designs, premium schedules, claims processing rules, fraud waste and abuse rules and more. This is client retained IP and is never contained within our core product.

Localisation artifacts

Oracle’s investment in Australian market localizations is extensive. As a result, the Oracle Health Insurance solution provides all required functionality as pre-built configuration.

Common configuration

Based on publicly available specifications or requirements and will be documented and supported by standard product support mechanisms. Localisation’s will be delivered as core product functionality. An Example is ‘Date Paid to’.

Interpreted configuration

Localisation with reliance on 3rd party end points/data sets or a mixture of industry and fund specific business rules. This is documented as a configuration set, and an implementation asset for use in customer onboarding and support. An example is claims processing rules for eclipse hospital claims.

Active customer advisory board

Oracle works closely with customers in support of innovation. Our CAB extends beyond advancement of the OHI application and Oracle technology, into partnerships that provide customers access to insight and innovation that only Oracle can provide via global industry relationships.

Harness true innovation

Maximise brand differentiation and harness capability to innovate and deliver at speed, with not only the configurability and flexibility of the OHI platform, but through integration of additional technologies and value propositions.

Plug and play added value

Oracle supports readily available value add solutions covering a whole host of industry specific areas. Such as Health and Wellness, quantification of health, blockchain, telehealth, AI driven claims excellence, OCR, HL7 FHIR and much more.

Componentized, comprehensive, administrative capabilities

As a modular PHI solution specifically for health payers, Oracle’s ‘Insurer in a box’ furthers the concept by bundling additional functional modules commonly required to confidently migrate from legacy. E.g. CRM, CCM, IFRS17, Analytics and more. Take one, some, or all, progressively, depending on requirements.

Maximise data interoperability

With a comprehensive RESTful API layer, 150+ industry specific integration points and the powerful Oracle Insurance Gateway, OHI’s integration and data interoperability capability ensures data gets to where it’s needed, when it’s needed.

Manage change at speed

Configurability is what has allowed OHI to localise for the Australian market, but is also what gives insurers confidence to manage change, at speed moving forward. Tackle market and regulatory change in your stride, and not at the expense of growth.

True insurance cloud services

Complete and comprehensive PHI administrative capability, on Australian based cloud, as a service. Designed for Australian Health Insurers, with 3 upgrades a year on highly available single tenant environments. Let Oracle keep the lights on while you deliver for members.

Insights

Read about the latest industry trends and thought leadership from Oracle Health Insurance

Healthcare Technology

Embracing the transformation to digital healthcare technology

For insurers, applying a digital façade to the front end is not going to be enough if one is to stay ahead. The only sustainable way to deliver improved services at a lower cost is to be digital at the core.

  • What does the transformation to digital entail for the modern insurer
  • Embracing the transformation to digital
  • Defence Health partnership with Oracle Health Insurance
Read the article (PDF)

Health insurance in the new normal

Australian health insurers are navigating a period of ever-increasing change and uncertainty as they speed up their appreciation of digital transformation. FST Media and Oracle hosted a virtual roundtable to discuss how Australian health insurers can navigate a true digital path ahead.

Highlights:

  • Industry experiences throughout the pandemic, and considerations and objectives for innovation in a time of uncertainty
  • The future of private health insurance, and what is needed for success
  • Examining new digital capabilities to drive improved health outcomes and better member experiences
Read the summary paper (PDF)
Health Insurance
Foundation Cloud

Shaping the foundation for moving to cloud

Health insurers can see the importance of digitizing old processes, and how digital transformation can deliver a better member experience, lower costs, and better health outcomes for members. Find out how digitization is enabling businesses to improve their regulation lifecycle, modernize processes, and scale enrollments through technical innovation.

Read the ebook

Oracle Financial Services for Health Insurers

Oracle wants to partner with you to help accelerate your health insurance innovation journey. We offer an end-to-end core administration platform for small and large health plans to modernize their systems at scale, introduce new products quickly, grow enrollments, and increase market share. The Oracle Health Insurance Platform offers componentized and transparent applications for a better member experience.

Explore Health Insurance Resources

Exploring AI and machine learning in health insurance

As AI technology becomes more accepted, its applications within the health insurance world are evolving in lockstep. Here’s a look at two use cases for AI in health insurance that are starting to make headway.

IDC Research: 3 Big Trends in Digital Transformation for Health Insurers

Understand how Oracle is marrying comprehensive core administrative processing and personalized proactive member engagements in a healthcare ecosystem with partners such as dacadoo.

Oracle Health Insurance: Modernizing Claims Processing and Adjudication

Claims management is a key area where relationships are sealed or severed, and business performance is strengthened or forfeited. Oracle surveys the healthcare landscape and offers a plan for happier customers and stronger business performance.