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Healthcare Payers: Innovate, Adapt, Accelerate

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


Drive efficiency across enrollment and billing

In order to grow more revenue and compete better in the market, many payers are looking to offer highly customizable benefit plans to provide the best possible service to their members. The challenge is to develop and maintain a large volume of custom plans while retaining the agility to deal with the influx of legislative changes.

The Oracle Health Insurance solution enables the healthcare insurance market to deal with high member volumes. The solution allows you to administer plans and billing across all lines of business, including Medicare, Medicaid, individual/small group, vision, dental, and specialty.

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.

Change is Constant in Healthcare: Are You Ready to Make the Most of It in 2020?

Industry observers believe that HIPAA may be in for a significant update in 2020. Let’s take a look at three key regulatory developments, their expected impact on health insurers, and strategies insurers can adopt to accelerate their readiness. Discover which regulations you should be prepared for in the future.

Health Insurance Innovation

Shaping the Foundation for Moving to Cloud

Healthcare innovation is essential to keep pace with the rapidly transforming industry. Regulation activity, consumerism, digitalization, and advances in healthcare are major challenges business must grapple with. More than ever, health insurers and payers need to move with lightning speed to effectively create new products, modify plans, and execute new reimbursement models. Health insurance innovation with cloud services provide a secure and cost-effective solution to legacy modernization. Discover how the Oracle Health Insurance Cloud Services offer rich functionality and flexibility for increasing operational efficiency, transparency for improving customer service and member engagements, and an easy to manage system for growth and scalability.

Customer Success Stories

Harvard logo

Harvard Pilgrim Healthcare Increased Auto Adjudication Rate to 92 Percent and Reduced Claims Cost


Harvard Pilgrim Healthcare

In our new environment with Oracle, we're achieving 90-92 percent auto-adjudication. That means we don't need humans to touch those claims and means those claims are processed more accurately.
Deborah Norton, CIO & SVP of IT and Operations, Harvard Pilgrim HealthCare
VGZ logo

VGZ Lowered Administrative Costs by 30 Percent and Achieved Saving in Millions


With Oracle Health Insurance Back Office, we have reduced operational costs related to claims processing and policy administration by 30 percent.
Chris Nieuwenhuize, Manager, Information Management, VGZ
Delta Dentallogo

Delta Dental of California Gets Faster to Market with Oracle Revenue Management and Billing


Delta Dental of California

Replacing our legacy billing systems with Oracle Revenue Management and Billing allowed us to implement complex products and pricing rules that made our enrollment process easier for our members.
Hari Makkala, Head of Information Technology, Delta Dental of California
Fonasa logo

Fonasa, the Chilean Public Health System, uses Oracle Technology to Modernize Healthcare and Manage 13.5M Members



With the Oracle solution, we have all the information and we can perform online evaluations applying all the required business rules.
Marcelo Gonzales, Project Director, Fonasa
Learning Library

Innovative Strategies to Lower Administrative Costs, Drive Automation, and Manage Regulatory Changes

Gain insight from our perspectives on strategies, operational excellence, digital transformation, and other topics that your organization is facing in a dynamic market.