HealthEdge Sets Course to Become an AI-Native Enterprise with Enterprise-Wide Migration to AWS

May 21, 2025 at 09:00 AM EDT

HealthEdge Works with AWS and Loka to Integrate AI and Agentic Systems into the Core of its Operations, Products, and Platform Infrastructure

HealthEdge^®, a leading provider of next-generation core administrative processing systems (CAPS) and care management solutions, today announced that it is migrating its operations to AWS (Amazon Web Services) and integrating generative artificial intelligence (AI) and agentic systems into the core of its operations, products, and infrastructure. Loka, AWS partner of the year in 2024, will use Amazon Bedrock to build and scale generative AI applications that help transform HealthEdge into an AI native enterprise and deliver new efficiencies for its business, products and customers.

“AI is unlocking opportunities that we almost couldn’t imagine a few short years ago. This is especially true in healthcare, an industry that has grown increasingly complex over time due to its distributed nature, ever-evolving policies and payment models, world-changing medical innovations and other distinct realities,” said Robert Duffy, Chief Technology Officer at HealthEdge. “As we break down data silos from across the healthcare industry migrating our operations to AWS will enable us to enhance our digital presence, ensuring our services are more robust, flexible, and scalable. Further, AI is uniquely suited to help extract value from almost immeasurable volumes of data that would be impossible for humans to use, even with traditional technology. To realize that value, we need a roadmap, and this initiative puts HealthEdge on the cutting-edge of defining that path forward for the industry at large.”

To fully transform into an AI native enterprise, HealthEdge will focus on three core pillars:

Workforce Efficiency. Widespread use of AI tools within the HealthEdge workforce is well underway, with adoption across functions including engineering, product development, finance, marketing and sales. The company is committed to offloading 15% of employees’ current work to AI over the next 12 to 18 months to improve speed and efficiency, enabling team members to focus on higher-value tasks. Advancing AI literacy of the HealthEdge Workforce and the subsequent efficiency gains will necessitate and justify further investments in AI to support and scale enhanced product features.

Product Enhancements. Empowering customers by integrating AI into the HealthEdge platform is a central component of becoming an AI-native enterprise. Just as HealthEdge improves its own internal efficiencies with AI, it will help customers do the same, across all functions of the health payer business. This includes making claims processing faster, more accurate and touchless, allowing business users and health plan members to ask direct questions and find information easily through use of Large Language Models (LLMs), and more.

AI and Agentic Platform. Building a robust AI-driven platform on AWS ensures that the computational power and scalability necessary for vast AI initiatives is available to support internal tooling and advanced product features. This investment in HealthEdge infrastructure will ensure that AI tools and systems are seamlessly integrated and scalable, enabling faster time to market for internal workflows, customer driven workflows, and product features. Putting this advanced technology in place also provides the foundation to support an AI-first culture, with elements such as HealthEdge Agent Lab to deliver agent-led workflows in two-week sprints.

To accelerate this transformation, HealthEdge is working with Loka, a Silicon Valley-based consultancy with a track record of successful projects in generative AI, machine learning, big data, DevOps, and design. AWS is providing the secure, scalable infrastructure and AI capabilities needed to support the aggressive deployment of AI-driven systems, enabling rapid experimentation and enterprise-wide implementation.

“AI is at its best when it’s working for you, not the other way around. That’s why agentic AI is impactful—it’s not just automation, it’s adaptive intelligence that learns and improves over time,” said Emily Kruger, CIO at Loka. “With HealthEdge, we’re proving that AI can be more than just an IT project. It’s a capability that transforms how work gets done in healthcare and beyond."

“Amazon Bedrock allows HealthEdge to rapidly integrate AI capabilities that unlock insights from healthcare data, automate administrative processes, and create more personalized customer interactions,” said Ben Schreiner, Head of AI and Modern Data Strategy Business Development, AWS. "This transformation will deliver tangible benefits to HealthEdge customers through reduced operational costs, faster claims processing, and improved decision-making accuracy—all while maintaining the security and compliance requirements essential in healthcare."

About HealthEdge

HealthEdge® is building a future without limits for health plans, where they can deliver better service and care, make more informed decisions and streamline operations. Through an integrated platform of solutions for core administration (HealthRules® Payer), payment accuracy (HealthEdge Source™), provider network management (HealthEdge Provider Data Management), care management (GuidingCare®) and member experience (Wellframe™), health plans can converge their data and harness automation to drive more informed decisions, improve touchless transaction processing and payment accuracy, foster meaningful collaboration and enhance service and care delivery. HealthEdge is trusted by over 130 health plans, covering more than 110 million lives across 48 states. See what it means to converge without limits at HealthEdge.com and follow us on LinkedIn.

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