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Industries · Healthcare & Insurance

Every claim, every premium, settled clean.

We build and run the revenue backbone for payers, providers and insurers on Oracle Health Insurance and ORMB — premium billing, claims adjudication and reconciliation that hold up under audit.

Talk to an Advisor Explore our work
Where we operate

Pick a desk. See what we did.

Four practices, one revenue lifecycle. Choose the one that looks like your problem.

Health plans & insurers

Premium billing that keeps pace with the plan design

Group, individual and government lines rarely bill the same way, and most plans carry the workarounds to prove it. We consolidate premium billing on Oracle Health Insurance so a new rate structure is a configuration change, not a release.

  • Group, individual and government lines on one engine
  • Rate and benefit changes configured by business users
  • Retroactive enrolment and reinstatement handled cleanly
  • HIPAA and HITRUST controls built into the design
Health plan operations
Hospitals & health systems

Contract terms the revenue cycle actually enforces

Provider contracts are negotiated once and then quietly under-collected for years. We model the terms where the billing happens and reconcile payer remittances against what was contracted, line by line.

  • Payer contract terms modelled in the billing engine
  • Automated payer-provider reconciliation and variance flags
  • Underpayments surfaced before the appeal window closes
  • Clean integration with EHR and clearinghouse feeds
Hospital revenue cycle team
Adjudication & settlement

Fewer claims touched by a human

Manual adjudication is where cost and error live together. We tune OHI rules and pricing so straight-through processing rises, and route the genuine exceptions to people who can actually resolve them.

  • Higher straight-through adjudication rates
  • Pricing and benefit rules centralised, not scattered
  • Exception queues triaged by cause, not arrival time
  • Full audit trail from claim receipt to payment
Claims adjudication analytics
Members & brokers

Answers online, before the call centre picks up

Most member calls are billing questions with an obvious answer. We put statements, payment history and plan detail in self-service, so the contact centre handles the cases that need judgement.

  • Self-service statements, payments and payment plans
  • One 360-view of the member across billing and claims
  • Broker and employer group commissions handled in-platform
  • Lower billing-related call volume and faster resolution
Member service operations
Proof

Case studies.

Real results from real institutions — how payers, providers and insurers transformed revenue operations with RIA.

Published case study
Test Automation

Large Electric Utility, North America

A snapshot of how automated testing improves delivery speed, optimizes effort, and scales execution efficiency.

  • 0test cases executed in 20 days
  • 0%faster delivery
  • 0%reduction in testing effort
  • ●Execution cycle cut from 30 work days to roughly 20.
  • ●Testing team reduced from 8 to 6 across the same scope.
  • ●Total effort down from 180 to about 152 person-days.
Proof from our delivery practice
Let's build

Tell us where the claims pile up.

Premium billing, adjudication or reconciliation — describe what's slowing your plan or health system down and we'll come back with a specific approach, not a generic pitch.

[email protected]Email our advisory team Book a conversationA working session, not a sales call Request our capability deckPayer and provider engagements in detail