Thursday Jun 06, 2013

Conquering Healthcare Reform and Rating Complexity with a Simple, Single System

We all know about the Patient Protection and Affordable Care Act that was upheld by the US Supreme Court in 2012.  Now, how do we respond and react to embrace this legislation while also providing quality service to our customers and maintaining an edge over our competition?  While states debate whether to expand Medicaid, launch health insurance exchanges, or both, payers have less than 18 months to plan their strategies, change their infrastructure and launch new products to capture market share. Payers must now learn to interface directly with end users. And they must learn the nuances of local markets. Flexible IT systems that enable unprecedented business agility will be critical to their success.

In executing on the individual mandate, payers need to take a hard look at their underlying rating infrastructure.

  • Is it flexible enough to accommodate new customers and roll out new products quickly?
  • Are the rating systems configurable so they do not require custom coding when the business needs change? 
[Read More]

Thursday Oct 06, 2011

Harvard Pilgrim Health Care Launches Claims Adjudication Solution from Oracle

This year, more than ever, Oracle OpenWorld is the place to be for insurance companies. More than insurance attendees were on hand to share experiences, network, and learn from each other. But even as the gathering wraps up, one healthcare payer is putting in long hours at its head offices to launch an ambitious transformation project.

Harvard Pilgrim Health Care will go live this month with its new claims adjudication system built on Oracle technology. Harvard Pilgrim is known for delivering consistently outstanding service in the areas of clinical quality and customer service. For eight years running, the payer has been ranked the number one private health plan in America by the National Committee for Quality Assurance. With its new Oracle Health Insurance claims engine, Harvard Pilgrim hopes to push its reputation for excellence to the next level.

Harvard Pilgrim seeks to put in place flexible, adaptive technologies that help the payer respond to the needs of the marketplace. Harvard Pilgrim also aims to reduce expenses , all while processing millions of yearly transactions consistently, accurately and effectively and maintaining an outstanding level of customer service to plan members.

“Our objective at Oracle Insurance is to provide flexible, rules-driven systems that help insurers meet their business goals: rapid introduction of new products, efficient customer service, compliance with industry regulations, and effective performance management,” said Don Russo, Senior Vice President and General Manager, Oracle Insurance. “We’re very proud to be part of helping Harvard Pilgrim Health Care achieve these business goals. With our new claims application expected to be widely available in the coming calendar year, we look forward to helping other healthcare payers achieve similar success.”

To learn more about the project and Oracle’s new claims engine for healthcare payers, read the press release on Oracle.com.

Lynne Sampson is senior marketer for Oracle Insurance.
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Oracle's flexible solutions can help insurers navigate the change necessary to meet today’s challenges and have the business agility to be prepared for the future.

For mor information, visit oracle.com/insurance.

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