Health Insurance Simplified. Innovation Delivered.

The Oracle Health Insurance Management System enables insurers to simplify healthcare IT, achieve greater levels of operational efficiency, reduce costs, and adapt quickly to ongoing market and regulatory demands.

  • Flexibility to manage business rules for different lines of business on a single platform
  • Scalable for small and large health to create products quickly, grow enrollments, and increase market share
  • Transparent for claim adjudications and claims processing for a better member experience
  • All on a secure, affordable cloud platform


Transparent Member Experience

Improve the enrollment experience with faster premium calculations, better policy administration, quicker benefits adjudication, and accurate billing that can be deployed on-premises and in the cloud.

  • Faster enrollments with digital ID cards
  • Secure member privacy database
  • Accurate billing with automated payments
  • Visible end-to-end transactions
  • Transparent member engagements

Faster Time to Market

Enable faster response to market and regulatory changes by eliminating the need for source code changes. Improve operational efficiency and bring new products to market faster through collaborative product development.

  • Flexible, rules-driven configuration
  • Update components and features more easily
  • Create products quickly
  • Turnkey for faster deployment
  • Scalability to grow market share

Operational Efficiency

Lower health insurance claims management costs significantly by automating processes and increasing auto claims adjudication rates by using business rules-driven workflow.

  • Automated Claims Pricing and Claims Adjudication
  • Simplify claims operations with pre-built dashboards
  • Quickly determine authorization approvals with configurable rules
  • Efficiently manage provider data with healthcare claims management software
  • Optimize Value-based payments
Modernizing Health Insurance Claims Management and Processing for Health Insurers

When it comes to health insurance claims management, few areas of the healthcare lifecycle deliver greater opportunity and risk. Learn how healthcare claims processing software is ripe for innovation.

Key Product Features

Grow Enrollments and Easily Manage Memberships

Oracle provides ease of case setup, enrollment, and member services for commercial and government business, all on a single health insurance software platform.

  • Simplified group and membership management
  • Automated multichannel enrollment processing
  • Seamless premium calculation with automated retro calculations
  • Complete data transparency for member service excellence
  • Next-gen rules-driven architecture with robust model for data and process extensions
  • Designed to handle large volumes with proven scalability
  • Comprehensive SaaS offering on secure and scalable Oracle Cloud Infrastructure

Drive Operational Efficiency with Healthcare Claims Processing Software

Oracle automates claim-benefit adjudication and supports straight-through processing, allowing health insurers to increase operational efficiency and claims payment accuracy.

  • Business-user friendly claims product/benefit definition
  • Simplified provider contracting and claims pricing
  • Intelligent and automated claims adjudication
  • Integrated authorization management
  • Next-gen rules-driven architecture with robust model for data and process extensions
  • Designed to handle large volumes with proven scalability
  • Comprehensive SaaS offering on secure and scalable Oracle Cloud Infrastructure

Flexible, enterprise rating engine that improves speed to market

  • Reduces total cost of ownership by creating a single rating engine for payors to create, modify, and maintain rates
  • Easy-to-use tool allows insurers to design new products and bundles easily and deploy them to market faster
  • Enhances distribution management by easily integrating with federal and private exchanges and enabling straight-through processing
  • Improves risk management with multivariate pricing and rate analysis, creating more competitive products and broadening the book of business
  • Fast, precise rules engine allow insurers to provide quick and accurate rates

Gain Quicker Authorizations for Healthcare Services

  • Full authorization and referral management
  • Ability to receive authorizations from multiple case and clinical management systems
  • Ability to key in one-off authorizations directly into the health insurance management system
  • Ability to have authorizations in amounts, units, or time periods
  • Unlimited service lines per authorization
  • Ability to capture extended data and attachments with the authorization
  • Fully configurable preauthorization matching rule
  • Built to handle large volumes, architected for scalability

Deliver Accurate Payments to Providers

  • High configurability through business rules written in natural language
  • Automates value-based payments
  • Calculation engine natively handles trial calculations, final calculations, and recalculations
  • Detailed traceability for all value-based payments
  • Accepts member input data from multiple sources
  • Reusable contract setup components and templates
  • User interface adjusts to customer and payment model configuration
  • Retroactive and prospective payments
  • External interoperability, integrates with third-party systems

Oracle Health Insurance Data Exchange Cloud Service

Data Exchange Cloud Service is built on AI-powered Oracle Cloud Infrastructure and designed to meet the specific integration needs and challenges of the health insurance industry. With this service, you get a secure, scalable, and future-proof data exchange platform powered by Oracle Autonomous Database and the latest Oracle technology stack.