Case Study: Harvard Pilgrim Health Care achieves faster processing of ~1M monthly claims and improved customer satisfaction with Oracle Health Insurance Components on Oracle Exadata

Harvard Pilgrim Health Care Speeds Transactions for Approximately 1 Million Claims Monthly Improves Customer Satisfaction and Delivers Peace of Mind

Harvard Pilgrim Health Care is a not‑for‑profit health plan serving about 1.2 million members across New England that needed to efficiently and accurately process millions of medical claims while keeping customer service strong, lowering administrative costs, automating manual workflows, speeding product delivery, and improving transparency in explanations of benefits.

By implementing Oracle Health Insurance Components on Oracle Exadata (integrated with Oracle E‑Business Suite) in a phased, service‑oriented rollout, Harvard Pilgrim now processes roughly 1 million claims per month with a 90–92% automated adjudication rate, in some cases improving processing speeds by up to 90%. The solution produced a 360‑degree view of members and providers, standardized and accelerated payments, simplified benefit explanations to reduce contact center volume, freed IT staff for strategic work, and enabled faster launch of new insurance products.

Harvard Pilgrim Health Care

Deborah Norton

CIO and Senior Vice President, IT and Operations