Health Insurance Solutions
Achieve faster enrollments and accurate billing with our comprehensive SaaS solution for policy administration, revenue management, and billing. Stay competitive with frictionless onboarding, efficient member management, and flexible billing options.
See how our customers experience Oracle Health Insurance
Oracle Health Insurance spotlight
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Discover how the Oracle Health Insurance solution simplifies claims processing and premium billing
This end-to-end core administrative platform for small and large health plans enables them to modernize their systems at scale, introduce new products quickly, grow enrollments, and increase market share.
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Cruise Through the Health Plan Enrollment and Billing Journey
Learn how our solution helps payers surmount persistent data, performance, compliance, and security challenges to enable frictionless onboarding, a central golden member record, effective member management, and more accurate, efficient pricing and billing.
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Value-Based Payments: Scaling Up for Success
Oracle Health Insurance Value-Based Payments Cloud Service streamlines payments, helping enhance efficiency and patient outcomes. Payers benefit from reduced errors and manual tasks, supported by Oracle’s vital role in optimizing operational efficiency and payment model adaptation.
Deliver transparency and gain efficiency with comprehensive policy and claims administration
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Support commercial lines, government programs, and specialty lines on a single health insurance platform
Easily set up employer groups and enrollment rules, streamline the member enrollment process, and provide exceptional customer service with centralized member data.
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Streamline maintenance of provider contracts and boost claims auto-adjudication
Reduce operational costs and simplify claims administration with improved claims pricing and intelligent, automated claims adjudication. Efficiently manage provider contracts, getting complete traceability of your provider contract configurations and corresponding claims pricing.
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Automate billing, payment, and collection processes
Improve member satisfaction with timely, accurate, and transparent billing for all your plans—exchange, individual, group, administrative services only (ASO) billing with stop-loss, and government.
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Accommodate new and emerging provider contract models
Easily administer and automate payment contract models such as accountable care, capitation, and bundled payments. Focus your offerings on value, outcomes, and risk sharing so your members can benefit from lower costs and better quality of care.
Streamline your back office to empower your workforce with an insurance management system
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Get your bills out on time and on contract—very time
Enhance the experience for your members. Help them gain operational efficiency by managing pricing, billing, and collections for exchange, individual, group, government, and ASO with stop loss using a single core insurance management system.
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Take a strategic approach to IFRS 17 and LDTI compliance
Meet global regulatory requirements with an approach that incorporates risk assessments as part of your compliance strategy. Link data, models, systems, and processes between actuarial and accounting functions and review analytical requirements without the need to build integrations between various point solutions.
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Find the right talent and centralize HR operations across the business
Recruit, develop, and motivate the people who will move your business forward. Build an employee experience to attract the next generation. Manage compliance requirements and make better decisions with a single source of truth for HR data.
“You need to have a finance system that gives you the flexibility and access to information required to support the kinds of innovations we are investing in as a health plan and partner to hospitals and independent systems. We get that with Oracle.”
Build a strong foundation to meet your operational and member health goals
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Get a single view of your financial data and adapt quickly to changing requirements
Simplify your financial processes and gain better control on data quality and consistency through a unified data model and common analytics. Mitigate risk by getting better insights from policy and claims data through machine-learning–based anomaly detection.
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Put your data to work to design better plans and improve member health
Deploy Oracle's secure public cloud and Oracle Healthcare Foundation to support the Quadruple Aim model of cost, population health, patient experience, and clinician satisfaction. Predict risk in patient populations and uncover the factors affecting per capita cost while keeping clinical data secure.
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Improve your members’ onboarding and customer experience
Easily onboard new members and help them find answers about their coverage, benefits, and claims through the channels they prefer. Deliver instant access to answers, personalized advice, and tailored content. Provide 24/7 guidance with AI-enabled virtual assistants.
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Find the right talent and provide them the best employee experience to be successful
Deploy one system to connect your human resource processes, from hire to retire. Build a people strategy to stay ahead of changing markets and empower your teams to be successful at their jobs.
Watch a demonstration of how Oracle health products, including Oracle Health Clinical AI Agent (formerly Oracle Health Clinical Digital Assistant), Oracle Health EHR, and Oracle Health Care Management, are revolutionizing the healthcare experience.
Find resources and more
- Watch the webinar Embracing Healthcare: Accelerating Clinical Data Exchange and Value-Based Payments
- 4 Pain Points on Medicare Enrollment and Strategies to Excel the Digital Member Experience (PDF)
- Oracle Health Insurance: Modernizing Claims Processing and Adjudication
- Liftoff in Government Healthcare: Revenue Management and Billing for Medicare and Medicaid Plans (PDF)
- IDC Research: Trends in Digital Transformation and Member Engagements for Health Insurers
- How TPA's Can Move to Cloud to Mitigate Rising Costs, Adapt to Regulations and Meet Customer Needs (PDF)
- Quick Tour Demo: Enrollment and Billing
- Shaping the foundation for moving to the cloud (PDF)
- Datasheet: Oracle Healthcare Data Repository (PDF)