Case Study: Humana achieves real-time claims processing with Oracle Health Insurance

Humana Moves to Real-time Claims With Oracle

Humana, a Louisville-based health insurer serving millions of medical and specialty members, faced a major modernization challenge: its claims platform dated to the 1980s and relied on batch processing, limiting the company’s ability to deliver real-time claims adjudication—an increasingly important capability as pricing transparency and operational efficiency become critical (industry estimates show more than 7% of claims are mispaid, costing billions annually).

Humana selected Oracle Health Insurance, a cloud-based, modular administration system, to enable a phased, claims-first transformation. Humana completed initial claims configuration and is building interfaces to about 25 systems, with core administration and user testing targeted before a planned early‑2022 go‑live; the move promises real-time adjudication and point‑of‑service payment options (Apple Pay, HSA, bank), plus future AI-driven decision support to improve outcomes, lower costs, and ease staffing pressures.

Humana

Mike Wheatley

Associate Vice President for the Claims Domain