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Health Insurance Solutions

Simplify your customers’ healthcare journeys with a complete core administration health insurance platform. Deliver more transparency, faster claims processing, and accurate premium billing.

Discover how Oracle Health Insurance technology simplifies claims processing and premium billing.

Humana upgrades to a cloud-based solution to process claims better for millions of customers
Anthem consolidates premium billing for faster billing cycles and more accuracy
Blue Shield of California gains a firm footing to quickly adjust to the COVID-19 pandemic
Harvard Pilgrim improves eligibility and claims efficiency with auto-adjudication exceeding 92%
EmblemHealth improves efficiencies by consolidating its back-office systems on Oracle

Deliver transparency and gain efficiency with comprehensive policy and claims administration

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.

Explore Policy Administration (PDF)

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.

Explore Claims Administration (PDF)

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.

Explore Revenue Management and Billing

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.

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.”

Mike Wheatley

AVP of IT, Humana

Improve healthcare data management as well as your members’ health outcomes

Make patient information interoperable, accessible, and reusable

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

Bring cloud capabilities to your core insurance platforms

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

Build programs to encourage healthier lifestyles and get members engaged

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)

Accelerate the launch and distribution of new insurance products

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.”

Sandra Clarke

Senior Vice President and Chief Financial Officer, Blue Shield of California

Build a strong foundation to meet your operational and member health goals

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.

Explore Insurance ERP

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.

Explore Oracle Analytics Cloud

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.

Explore Customer Experience Solutions

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.

Explore HCM for Financial Services

Navigating data interoperability is a game-changer for healthcare payers

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

Find resources and more

Shaping the foundation for moving to the cloud

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.

Get the ebook

Anthem and Horizon BCBSNJ: Navigating through the data interoperability challenge

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.

Watch the data interoperability video (1:14:12)