What you Need to Know about Health Insurance Software Development

Blog / What you Need to Know about Health Insurance Software Development

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    Leonardo Koshoni
    Leonardo KoshoniMay 30, 2022

    Head of Business Analysis

    In an increasingly digitized world, no industry can escape from the growing demand for tech. Consumers expect to be able to manage most of their lives themselves, and this includes their healthcare. 

    Artificial Intelligence, Augmented Reality, and Real-Time Data are just some of the latest innovations being tested in the healthcare sector. The primary aim is to improve patient care, and provide more positive outcomes. 

    However, not all healthcare technology is as exciting as AR in operating rooms and robot physicians. Real advancements are being made behind the scenes, too. Healthcare software is changing, as the industry looks to improve efficiency for physicians, and cater to the overall patient experience. 

    In such an exciting industry, it can be easy to forget about growth in the health insurance sector. Generally, each time a patient interacts with a healthcare provider, they interact with their insurer. 

    The health insurance experience is also critical to patient outcomes. A positive experience has the potential to considerably reduce stress at a challenging time. So, what do you need to know about health insurance software development, and how to get it right?

     insurance software development

    Types of Health Insurance Software

    Health insurance software potentially services two parties. First, there is software that deals with the patient or customer, and might help them manage their coverage. On the other hand, insurance agencies themselves need software to manage data and carry out their policy processes. 

    Claims Processing

    Typically, when a patient needs to make a claim on health insurance, they’re going through a challenging time in their lives. The process needs to be as easy and pain-free as possible, so they can focus on what really matters. 

    Traditionally, many claims are taken over the phone. However, this isn’t always necessary. More health insurance companies are looking to make the claims procedure as remote as possible

    Health insurance claims software can be implemented on a website or, preferably, a mobile app. Patients can submit data at a time that suits them, without having to wait in phone lines. 

    Policy Management

    Similarly, policy management software allows customers to update or make changes to their policy remotely. Health insurance phone lines can produce lengthy queues, which is unnecessary for small data changes. Again, mobile apps or web apps are useful for these smaller and more simple processes. 

    Not only is policy management software convenient for the consumer, but the health insurance company itself benefits from it. They ensure that the company always has the most up-to-date details, and can carry out their processes efficiently, while allowing staff to focus on the patients that really need assistance. 

    Risk Assessment

    Health insurance software isn’t only for use by the consumer. Software can protect the insurer, too. For instance, fraudulent applications and incorrect data are common. Ultimately, a human agent cannot always spot inconsistencies and problems with data records. 

    Digital risk assessment or management software can automate this process. A health insurance company might handle thousands of claims or applications per day, so software is a key tool in preventing mistakes, and increasing efficiency. 


    Sales is still a vital part of the health insurance business. There’s plenty of competition, and insurers need to reach consumers that are relevant to their offering. 

    Data analytics, using marketing data and some machine learning processes, can help to identify future prospects and leads, and further understand their market. Statistical data might also be used to offer personalized coverage products, that are tailored to the individual and their location, lifestyle, or coverage needs. Custom insurance solutions are favorable, and should improve sales figures.

     insurance software development


    The healthcare industry is highly regulated. Anyone that handles private data around a patient's health or identity must operate securely. Needless to say, patient privacy is paramount, even in the health insurance sector. 

    HIPAA (Health Insurance Portability and Accountability Act) was created in 1996 to protect patient data during transfer or storage. In fact, originally, it was implemented to protect health insurance coverage as people changed jobs. 

    Now, the regulation dictates the safe and secure transfer or storage of protected health information across any healthcare provider, insurer, or facility. Anyone that handles patient health data is bound by HIPAA rules. 

    Health insurers are expected to prioritize the protection of patient data, during their dealings directly with patients, claims processes, transfers between healthcare providers, and more. By extension, health insurance software needs to be HIPAA compliant. 

    Health insurance software development projects are bound by HIPAA. Therefore, it’s important that development companies have a strong understanding of HIPAA requirements, and can provide compliant solutions. 

    Customer Experience

    Needless to say, compliance is critical. However, when building software solutions for the healthcare industry, it can be easy to forget about the customer experience. Ultimately, for some solutions, patients are the end-user. Software needs to be easy to understand, and navigable. 

    Health insurance software development requires strong front-end development. The customer experience is not only important in keeping the customer happy, but a poor experience could result in errors in coverage, or mistakes with claims. If insurance software is meant to improve efficiency for insurance companies, mistakes need to be minimized. 


    The healthcare industry is known for being relatively outdated compared to many other industries. Interoperability is a continuous struggle

    The latest innovations in the sector have considerable potential to improve patient outcomes and the efficiency of healthcare systems. However, most face difficulties in implementation, due to outdated healthcare systems and processes.

    Innovations in health insurance software need to be integrable. That is to say, they should be able to be implemented in current healthcare systems. To be of value, they need to be able to work with current healthcare softwares, as well as the patient’s home technologies (ie smartphones). 

    The Future of Health Insurance

    Needless to say, the future of health insurance is tech. Healthcare industries around the world are known for lagging behind in technological advancements. Despite this, the industry will be forced to expand its abilities, and give more autonomy to the patient. 

    Currently, healthcare systems are overwhelmed, and staff are overworked. Integrating the latest tech, such as wearables, mHealth apps, and insurance software, will allow patients to manage their own health and, when they do need to interact with providers and insurers, simplify lengthy admin processes. Ultimately, health insurance software development is critical in the fight to improve efficiency and quality of care in the healthcare industry. 

    At Vertrical, we have teams of top developers, project managers, and compliance specialists ready to start work on your digital health project. We can supplement your existing teams, and keep your insurance products on track. Get in touch with us today to discuss your staffing needs.



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