About Us
The HealthEdge Story
HealthEdge® was founded in 2005 to deliver a next-generation Core Administrative Processing System – one that would not only increase accuracy and efficiency but also enable health plans to innovate and bring new lines of business to market swiftly.
That product – HealthRules® Payer – quickly gained traction in the market and has been recognized by Gartner as a next-generation core administrative processing system sample vendor for 14+ years. HealthEdge has continuously innovated since its founding, adding new capabilities, solutions and services to fulfill a broader range of customer needs and empower health plans to converge without limits.
Today, the HealthEdge solution suite is comprised of 5 solutions and Global Professional Services. HealthRules(R) Payer is a next-generation core administrative processing system designed to drive transformational outcomes and unmatched business agility for health plans of all sizes. HealthEdge Source(TM) is a cutting-edge payment accuracy and integrity solution that unifies claims pricing, editing, and real-time analytics in one streamlined platform. HealthEdge Provider Data Management offers a powerful, cloud-based solution to streamline healthcare provider data management. GuidingCare(R) is a comprehensive care management solution designed to help health plans enhance coordination, improve communication, and boost member engagement. Wellframe(TM) is an innovative digital member engagement solution designed to help payers build stronger connections with members, gain actionable health insights, and deliver modern tools that enhance satisfaction and outcomes. Global Professional Services helps customers unlock the full potential of their HealthEdge solutions to drive meaningful business results.
Working together, the HealthEdge solution suite enables a truly connected ecosystem. Whether connecting to our own market-leading applications or other third party solutions, HealthEdge enables health plans to access data within and between systems for increased transparency and improved business intelligence.
By using our digital healthcare software to automate business workflows and seamlessly exchange data in real time across the ecosystem, HealthEdge customers experience the business attributes of improved end-user and consumer centricity, ever-reducing transaction costs, ever-increasing quality and ever-increasing service levels and business transparency.
5
Solutions
Health Plan Customers
Million Covered Lives
States Supported With 23 Medicare Advantage Clients
Our Mission and Vision for Healthcare
Our mission is to drive a digital transformation in healthcare through transaction automation and the enablement of real-time business and clinical engagement among healthcare payers, providers and patients.
HealthEdge is working to usher in the era of:
Touchless transaction processing
Automation that you can trust to correctly process time-intensive transactions is
key to reducing manual intervention and unproductive interactions
Care integrity
Bring higher efficiency, greater access and higher levels of efficacy to the care that’s delivered to members
Prospective payment integrity
Technology that gets payments right—the first time—will significantly reduce provider abrasion and the time and costs associated with recovering funds
AI-driven business intelligence
Leverage AI to help plans sift through mountains of data to gain the detailed,
business-level intelligence they need to make smart, informed decisions about growth
Our Team
Healthcare visionaries. Technology gurus. Industry-leading consultants. Customer advocates. Operational experts. Meet the HealthEdge team driving the digital transformation of healthcare.
leadership team
Awards
Join Our Team
There’s never been a more dynamic time in the history of the healthcare industry. And there’s never been a better time to join the company leading the digital transformation of healthcare. Make a career – and make a difference – at HealthEdge.
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