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Health Insurance Simplified. Innovation Delivered.

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

Flexibility to manage business rules for different lines of business on a single platform
Scalable for small and large health to create products quickly, grow enrollments, and increase market share
Transparent for claim adjudications and claims processing for a better member experience
All on a secure, affordable cloud platform

Health Insurance Simplified. Innovation Delivered.

Benefits

Transparent Member Experience

Improve the enrollment experience with faster premium calculations, better policy administration, quicker benefits adjudication, and accurate billing that can be deployed on-premises and in the cloud.

Faster enrollments with digital ID cards
Secure member privacy database
Accurate billing with automated payments
Visible end-to-end transactions
Transparent member engagements

Faster Time to Market

Enable faster response to market and regulatory changes by eliminating the need for source code changes. Improve operational efficiency and bring new products to market faster through collaborative product development.

Flexible, rules-driven configuration
Update components and features more easily
Create products quickly
Turnkey for faster deployment
Scalability to grow market share

Operational Efficiency

Lower health insurance claims management costs significantly by automating processes and increasing auto claims adjudication rates by using business rules-driven workflow.

Automated Claims Pricing and Claims Adjudication
Simplify claims operations with pre-built dashboards
Quickly determine authorization approvals with configurable rules
Efficiently manage provider data with healthcare claims management software
Optimize Value-based payments

Simplifying Health Insurance Innovation

Health Insurance software is essential to keep pace with the rapidly transforming industry. Discover how the Oracle Health Insurance Cloud Services offer rich functionality and flexibility for operational efficiency, an easy health insurance management system for growth and scalability and transparent member engagements.

oracle health insurance cloud

Modernizing Health Insurance Claims Management and Processing for Health Insurers

When it comes to health insurance claims management, few areas of the healthcare lifecycle deliver greater opportunity and risk. Learn how healthcare claims processing software is ripe for innovation.

Modernizing Claims Processing and Adjudication

Key Product Features

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Policy Administration

Grow Enrollments and Easily Manage Memberships

Oracle provides ease of case setup, enrollment, and member services for commercial and government business, all on a single health insurance software platform.

Simplified group and membership management
Automated multichannel enrollment processing
Seamless premium calculation with automated retro calculations
Complete data transparency for member service excellence
Next-gen rules-driven architecture with robust model for data and process extensions
Designed to handle large volumes with proven scalability
Comprehensive SaaS offering on secure and scalable Oracle Cloud Infrastructure

Grow Enrollments and Easily Manage Memberships

Claims Administration

Drive Operational Efficiency with Healthcare Claims Processing Software

Oracle automates claim-benefit adjudication and supports straight-through processing, allowing health insurers to increase operational efficiency and claims payment accuracy.

Business-user friendly claims product/benefit definition
Simplified provider contracting and claims pricing
Intelligent and automated claims adjudication
Integrated authorization management
Next-gen rules-driven architecture with robust model for data and process extensions
Designed to handle large volumes with proven scalability
Comprehensive SaaS offering on secure and scalable Oracle Cloud Infrastructure

Drive Efficient Claims Processing and Adjudication

Enterprise Rating

Flexible, enterprise rating engine that improves speed to market

Reduces total cost of ownership by creating a single rating engine for payers to create, modify, and maintain rates
Easy-to-use tool allows insurers to design new products and bundles easily and deploy them to market faster
Enhances distribution management by easily integrating with federal and private exchanges and enabling straight-through processing
Improves risk management with multivariate pricing and rate analysis, creating more competitive products and broadening the book of business
Fast, precise rules engine allow insurers to provide quick and accurate rates

Authorizations

Gain Quicker Authorizations for Healthcare Services

Full authorization and referral management
Ability to receive authorizations from multiple case and clinical management systems
Ability to key in one-off authorizations directly into the health insurance management system
Ability to have authorizations in amounts, units, or time periods
Unlimited service lines per authorization
Ability to capture extended data and attachments with the authorization
Fully configurable preauthorization matching rule
Built to handle large volumes, architected for scalability

quicker authorizations for healthcare services

Value-Based Payments

Deliver Accurate Payments to Providers

High configurability through business rules written in natural language
Automates value-based payments
Calculation engine natively handles trial calculations, final calculations, and recalculations
Detailed traceability for all value-based payments
Accepts member input data from multiple sources
Reusable contract setup components and templates
User interface adjusts to customer and payment model configuration
Retroactive and prospective payments
External interoperability, integrates with third-party systems

deliver accurate payments