HealthEdge
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Location
Headquarters: Burlington, Massachusetts, United States, North America
Region: Massachusetts
Country: US
Continent: North America
About
HealthEdge provides healthcare SaaS solutions designed to help health plans transform digital operations, reduce data silos, and improve payment accuracy and member engagement. Its integrated offerings support core administrative and processing needs, prospective payment integrity, provider data management, care management workflows, and population health insights across bar-coded healthcare ecosystems. The company markets to health plans primarily in the United States, with a range of solutions and partnerships to enable AI-driven analytics, data interoperability, and value-based care initiatives. HealthEdge products are deployed as standalone solutions or as an integrated platform, and the company presents a broad set of solutions including HealthRules, GuidingCare, Wellframe, and Source for payer and provider enablement.
HealthEdge provides healthcare software solutions to health plans, focusing on digital transformation and operational efficiency. Its integrated platform includes HealthRules for core administration, Source for payment integrity, GuidingCare for care management, and Wellframe for member engagement. These tools help insurers automate transactions, improve data interoperability, and support value-ba
HealthEdge Software, Inc.
2005
for_profit
active
Industries
Primary Industry: Software
Categories
Funding & Financials
Private Equity
69100000
200m-1b
private
Investors
Founders
Rob Gillette
Leadership
Matthew Kuntz — Chief Technology Officer
Craig Wilson — Executive Vice President and General Counsel
Kevin Adams — Chief Executive Officer
Sean Cashwell — Senior Support Engineer
Laura Tomaino — Vice President, People & Culture
Chris Conte — Executive Vice President & Chief Revenue Officer
Kim Ingram — Chief Nursing Officer
Technology Stack
Products
HealthRules Payer: A core administrative processing system for health plans that manages claims administration, payment accuracy, and business intelligence.
HealthEdge Source: A payment integrity platform that combines claims reimbursement, payment policy management, and analytics to improve claims editing and payment accuracy.
GuidingCare: A care management workflow platform that facilitates data integration, workflow management, and collaboration for health plans and providers.
Wellframe: A member engagement solution that combines clinical data with digital communication tools to support personalized care management and member interactions.
Care-Payer Integration: An API-based integration between HealthRules Payer and GuidingCare that enables real-time data exchange to improve authorization accuracy and utilization management.