Case Study: Harvard Pilgrim Health Care achieves improved eligibility and claims efficiency with Oracle Health Insurance

Harvard Pilgrim Improves Eligibility and Claims Efficiency

Harvard Pilgrim Health Care, a 50-year-old New England health plan offering multiple product lines including Medicare Advantage, faced strategic imperatives to stabilize performance, improve member experiences and outcomes, and grow profitable membership. Its aging legacy systems—especially with the need to support ICD-10—left the organization needing an IT transformation to gain flexibility and comply with evolving requirements.

Harvard Pilgrim adopted Oracle Health Insurance Components, a component-based, SOA-built solution that fit its existing Oracle footprint and allowed modular deployment. Results included auto-adjudication rising from 85% to over 92%, lower spending despite added medical management programs, faster and more accurate claims processing, resilient remote operations during COVID-19, and the agility to respond quickly to regulatory changes.

Harvard Pilgrim Health Care

Deborah Norton

Chief Information Officer and Senior Vice President, Operations