Healthcare Insurance Solutions for a Digital World

Smarter Health Insurance. Stronger Business Outcomes.

Healthcare insurance operations get more complex every year.

Rulesware reduces the cost and complexity – and elevates your performance with personalized service and digital efficiencies. From automating enrollment and managing unruly claims, simplifying authorizations and superior customer service, to easy appeals, provider management and more, our solutions empower payers to streamline back-end processes while providing a superior customer journey.
Insurance Operations

Streamline the flow of content, reduce costs, and enhance service quality:

Operational Excellence

Processes take minutes instead of days, while Rulesware automation reduces operating and production costs.

Best in Class TCO

Easily maintained solutions with minimal custom development and a proven enablement model means clients are self-sufficient after deployment.

Business Agility

Solutions can easily adapt to changing requirements and support new programs, thanks to features that dynamically add, create, and modify complex business rules.

Higher Customer Lifetime Value

Personalized, relevant communications and offers boost engagement, while faster processes – from enrollment to one and done customer service and claim processing – increase customer loyalty.

"Our milestones could not have been achieved without Rulesware’s significant contributions.”

Health Insurance Client

Healthcare Solutions


Smarter data management improves the precision of your quotes, while automation accelerates enrollment processes across all channels and prevents improper claims payments and denials.


Your business rules are consistently applied to every customer the proper way every time. The decisioning capabilities should reside in the rules logic, not on sticky notes or knowledge management systems that support typical authorization applications. Approve or deny authorizations in minutes, do it consistently and do it right every time, the first time.

Claims Automation

Expedite the automated repair of claims during the pre-adjudication and post-adjudication process while always having clear insight to your claims inventory and management processes. Automating your continuously changing rules outside of your claims system is much faster and less costly to perform. The result is an increase in accurate claims payments and reduction of administrative costs of reprocessing or repairing incorrectly paid claims.


Apply AI-driven decisioning to attracting, enrolling, and servicing members. Support your call center by recommending next best actions to agents at every step of a member’s journey. Generate 1:1 personalized communications, issued at the right time, via their desired channel and with empathy.

Customer Service

An AI-driven engagement engine simplifies operating and regulatory requirements. By automatically selecting the best action to take, Rulesware optimizes the relevance and value of each interaction. The result: seamless customer service across all transactions and channels.

Success Story

Health insurer that connects the underserved community in NYC responds and absorbs rapid pandemic growth

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