HealthEdge and UST HealthProof have merged to form a leading AI-powered claims operating system for health plans, addressing modern challenges in the U.S. healthcare landscape.

Target Company Overview

HealthEdge and UST HealthProof have successfully merged to form a leading next-generation claims operating system tailored for payers, offering comprehensive AI capabilities across claims management, payments, care and utilization management, payment integrity, and member engagement. The combined entity, now operating under the name HealthEdge, serves over 115 health plans and reaches more than 110 million lives within the U.S. healthcare system.

This merger aims to leverage modern AI-enabled technology to assist health plans in reducing overall costs and enhancing operational efficiency. Supported by Bain Capital, with over forty years of experience in enhancing healthcare companies globally, HealthEdge is poised to innovate and improve patient experiences and outcomes across the healthcare landscape.

Industry Overview in the U.S.

The healthcare industry in the United States faces considerable pressure from escalating administrative costs, increasingly complex regulations, and rising expectations from members. Trad