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Health Insurance Solutions

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

Discover how Oracle is simplifying premium billing and claims processing.

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 improve efficiency with comprehensive policy and claims administration

Support commercial, government programs, and specialty lines on a single platform

Easily set up employer groups and enrollment rules, streamline the member enrollment process, and provide exceptional service with centralized member data.

Explore Policy Administration (PDF)

Streamline maintenance of provider contracts and boost claims auto-adjudication

Reduce operational costs and simplify administration of provider contracts with improved claims pricing and intelligent, automated claims adjudication.

Explore Claims Administration (PDF)

Automate billing, payments, and collections processes

Improve member satisfaction with timely, accurate, and transparent billing for all your plans: exchange, individual, group, 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 a 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

Deliver better individual member outcomes with data insights

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 Interoperability

Accelerate the launch and distribution of new products

Bring new products to market faster while complying with regulations by easily integrating with federal and private exchanges. Centralize rating data and eliminate anomalies between quoting engines and policy administration.

Explore Enterprise Rating (PDF)

Build programs to encourage healthier lifestyles and get members engaged

Create incentives for members to make improvements to their own health. Offer lifestyle coaching, rewards and loyalty programs, dashboards, and premium discounts and track their impact on member health.

Explore Health and Wellness (PDF)

Create personalized, omnichannel member experiences

Build meaningful customer relationships with consistent, timely, and personalized interactions across all touchpoints.

Explore Customer Experience Solutions

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

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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.

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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.