HealthEdge, founded in 2005 and headquartered in Burlington, Massachusetts, provides a next-generation Core Administrative Processing System (CAPS) and digital healthcare platform for health plans in the United States. The company's core offering, HealthRules, is a patented product suite designed to process claims and enable health plans to bring new products to market and transform their business models. HealthEdge operates across 48 states, serving over 130 health plan customers that collectively cover more than 110 million lives.
The company's technical work spans several domains relevant to AI-driven healthcare innovation, including AI-driven business intelligence, payment integrity, care management, and digital member engagement. HealthEdge has raised over $125 million in funding to support its mission of enabling digital transformation in the payer market.
