Managing medical outcomes and costs

In a highly competitive marketplace, payers need to manage the ever increasing medical utilization costs. To manage the medical service costs, payers need to implement the clinical rules that ensure the appropriateness and effectiveness of the requested services in relation to the current medical condition of the member.

Oracle Health Insurance Authorizations provides you with a rule engine that gives you the flexibility to streamline your authorization, referral, and utilization management processes. The solution allows you to achieve high auto-authorization rates and to make the most efficient use of the clinical expertise of your staff.

Transforming your claims operations

Up to 80 percent of all premiums are spent on claim payments and associated charges. To keep cost under control, payers need a modern, flexible, and adaptable claims adjudication system that can reduce the amount of time spent managing claims processing and reduce the overall administrative costs.

Oracle Health Insurance Claims solution automates claim-benefit adjudication and supports straight-through processing. The solution leverages an adaptive, rules-driven architecture that allows payers to increase operational efficiency and claims payment accuracy.

Efficiently administer your reimbursement models

Reimbursing providers is becoming more complicated as value-based payment models replace fee-for-service models. Healthcare payers need a system that can handle different ways of doing things: multiple data sources to trigger payments, many calculation methods, and various ways to pay.

Oracle Health Insurance solution gives payers the speed and flexibility they need to implement value-based payment models. The solution can handle all types of payment arrangements allowing payers to streamline administration of innovative payment models.

Innovation and acceleration for healthy growth

Oracle Health Insurance and Wellness Platform is an end-to-end digital environment that enables payers, plan sponsors and members alike to control and reduce all aspects of health insurance cost, including an effective focus on improving member wellness. The wellness engagement framework, based on and validated with a global database of clinical data – more than 300 million person-years of it, offers a highly accurate predictor of health risks.

Transforming customer experience through digital engagement

Constant exposure to digital technology increases consumer expectations, putting pressure on insurers to continually evolve the customer experience to retain customers and attract new ones. Thus, a well-executed digital customer experience is a business strategy imperative for insurers.

Successful digital transformation centers on building customer intimacy to drive engagement. Oracle provides solutions such as Oracle Documaker, Oracle Service Cloud, Oracle Process Cloud Service, and Oracle Engagement Cloud to help insurers transform customer engagement across digital touchpoints. These solutions enable insurers to provide information and contextual responses and allow insurers to deliver a consistent message and experience on all channels.