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.
IDC research paper for healthcare payers
This report examines the role of subledgers in the health payment ecosystem and the importance of a clean, flexible financial data structure, workflow, and governance for payers.
Easily set up employer groups and enrollment rules, streamline the member enrollment process, and provide exceptional customer service with centralized member data.Explore Policy Administration (PDF)
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.Explore Claims Administration (PDF)
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.Explore Revenue Management and Billing
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.Explore Value-Based Payments (PDF)
“The vast majority of Humana’s claims are taking anywhere from four to five days.... The expectation with Oracle is that 80% of our claims are finalized within four hours of receipt.”
AVP of IT, Humana
Reduce costs and improve patient outcomes by consolidating healthcare data—including discrete clinical data, clinical documents, and patient summary records—in a single repository.Explore Healthcare Data Management
Rapidly deploy your most important applications in the cloud with the security and data protection that health insurers require. Whether you are running legacy workloads or new cloud native applications, get exceptional performance and scalability with consistent support for regulatory compliance.Explore Oracle Cloud Infrastructure
Create incentives for members to improve their own health. Offer lifestyle coaching, rewards and loyalty programs, dashboards, premium discounts—and track their impact on member health.Explore Health and Wellness (PDF)
Bring innovative or complex health insurance products to market faster by centralizing rating data. Eliminate anomalies between quoting engines and policy administration systems. Comply with regulations by easily integrating with federal, state, and private healthcare exchanges.Explore Enterprise Rating (PDF)
“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.”
Senior Vice President and Chief Financial Officer, Blue Shield of California
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.Explore Insurance ERP
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.Explore Oracle Analytics Cloud
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.Explore Customer Experience Solutions
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.Explore HCM for Financial Services
Pam Fleury, Senior Director, Healthcare Product Management, Oracle
Healthcare regulations are constantly changing and healthcare payers are operating amid significant disruption and compliance challenges. COVID-19 is upending core operations as new mandates on data interoperability and transparency issued by the Centers for Medicare & Medicaid Services (CMS) put data competencies under a microscope.Read the complete post
Health insurance technology is essential to keep pace with the rapidly transforming industry. Discover how Oracle Health insurance cloud services offer rich functionality and flexibility for operational efficiency, an easy-to-manage health insurance platform for growth and scalability, and transparent member engagements.
Learn more about the greater data challenge for health insurers and providers due to the implementation of the 21st Century Cures Act and the FHIR Data Interoperability standards.