UST HealthProof
UST HealthProof provides a cloud-based Business Process as a Service (BPaaS) platform for U.S. health plans, integrating core administration, risk adjustment, quality improvement, and member engagement. Post-September 2025 merger with HealthEdge under Bain Capital, the combined entity serves 115+ health plans covering 110M+ lives across 48 states.
- Company typePrivate
- Founded2016
- HeadquartersAliso Viejo, United States
- Headcount5,001–10,000
- GTM typeB2B
- OfferingSoftware
What UST HealthProof does
UST HealthProof is a U.S.-based private healthcare payer technology company headquartered in Aliso Viejo, California. It operates a cloud-based Business Process as a Service (BPaaS) platform that integrates core administration, risk adjustment, quality improvement and Stars management, member engagement, payment accuracy, and advisory services for health insurance plans across all lines of business — including Medicare Advantage, Medicaid, D-SNP, Special Needs Plans, and commercial plans.
The platform is built around an ecosystem of branded modules (Quality360 HEDIS Engine, Enrollment Plus, Engagement Plus, Integration Plus, Workflow Plus, Insitz Plus) supported by 120 prebuilt system integrations. UST HealthProof embeds AI, machine learning, NLP, and predictive analytics into claims processing, risk adjustment coding, and quality reporting workflows, with stated outcomes of 99.8% claims auto-adjudication rates, 30% average operational cost savings, and risk score improvements enabling 4+ Star Ratings. The platform holds HITRUST i1 security certification (Feb 2025) and NCQA Certified Measures Status for its HEDIS engine (Aug 2024).
UST HealthProof generates revenue primarily through multi-year enterprise BPaaS subscriptions, supplemented by professional services for health plan modernization and outcome-based performance fees tied to metrics such as Star Rating improvements. Distribution is exclusively direct enterprise field sales targeting health plan CEOs, CIOs, and operational leaders, with no reseller or marketplace channels. Following Bain Capital's September 2025 acquisition and merger with HealthEdge, the combined entity serves over 115 health plans covering more than 110 million lives across 48 states. Pre-merger, UST HealthProof operated as a subsidiary of UST; the Advantasure acquisition in March 2024 preceded the larger Bain Capital transaction.
UST HealthProof firmographics
Firmographics- Name
- UST HealthProof
- Legal name
- UST HealthProof
- Website
- https://usthealthproof.com
- Company type
- Private
- Founded year
- 2016
- Operating status
- Acquired
- Headcount range
- 5,001–10,000 employees
- Short description
- UST HealthProof provides a cloud-based Business Process as a Service (BPaaS) platform for U.S. health plans, integrating core administration, risk adjustment, quality improvement, and member engagement. Post-September 2025 merger with HealthEdge under Bain Capital, the combined entity serves 115+ health plans covering 110M+ lives across 48 states.
- Ownership category
- akta.pro rank
UST HealthProof industry classification
Industry- Product category
- Healthcare Payer Technology
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Computer Systems Design and Related Services (54151)
- SIC
- Services-Computer Integrated Systems Design (7373), Services-Computer Programming, Data Processing, Etc. (7370)
- akta.pro primary industry
- Data Aggregation, Interoperability & APIs for RPM (FHIR/IoMT Gateways) (HLACAFAO)
- akta.pro secondary industries
- Cloud Security (CSPM/CWPP/CIEM) for Health IT (HLACAJAG), Consent, Preference & Data Rights Management (incl. HIPAA/GDPR support) (HLACAIAG), Application & API Security for Digital Health (WAF/RASP/API gateways) (HLACAJAH)
Keywords
Where UST HealthProof is headquartered
LocationHeadquarters
- HQ city
- Aliso Viejo
- HQ country
- United States
- HQ region
- North America
Markets served
UST HealthProof business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure
Revenue model
- BPaaS Subscription and Services: Integrated platform subscription combining software licensing with managed services delivery. Health plans pay for access to the BPaaS ecosystem including core administration, risk adjustment, quality improvement, and advisory services. Revenue is recurring in nature with multi-year contract terms.
- Professional Services: Implementation, consulting, and advisory services for health plan modernization and transformation projects
- Outcome-based Performance Fees: Some engagements include performance-based fee components tied to measurable outcomes such as Star Rating improvements and cost savings
Go-to-market motion1 record
Distribution channels1 record
Marketing channels8 records
UST HealthProof product offering
Product offeringCore offering
UST HealthProof provides a cloud-based Business Process as a Service (BPaaS) platform for health insurance companies, integrating core administration, risk adjustment, quality improvement and Stars, and advisory services into a unified ecosystem. The platform leverages AI, machine learning, and advanced analytics to automate claims processing, enrollment, member engagement, payment accuracy, and regulatory reporting for Medicare Advantage, Medicaid, D-SNP, and commercial health plans.
Product overview
UST HealthProof offers a unified BPaaS (Business Process as a Service) platform for health insurance companies, combining Core Administration, Risk Adjustment, Quality Improvement and Stars, and Advisory Services. The platform operates as an integrated ecosystem with specific branded solutions including Enrollment Plus™, Engagement Plus®, Integration Plus®, Workflow Plus®, and Insitz Plus for core operations. Risk adjustment offerings include Retrospective and Prospective Risk Adjustment Solutions, while quality solutions feature the NCQA-certified Quality360™ HEDIS® Engine and Stars Consulting Services. The company claims its integrated platform with AI capabilities could reduce operational costs for health insurance companies by approximately 30%.
Differentiator
Problem solved
Functional benefit
Brands
- Enrollment Plus™: Core administration solution for streamlining enrollment processes and increasing member satisfaction
- Engagement Plus®
- Integration Plus®
- Workflow Plus®
- Insitz Plus
- Quality360® HEDIS® Engine
- BPaaS Ecosystem
Products and services
- BPaaS Ecosystem An integrated ecosystem of scalable, turnkey solutions combining business process automation with AI-powered technology for health plans across all lines of business, available in full-service and unbundled models.
- Core Administration Cloud-based solutions for core administrative functions including claims processing, enrollment, and policy administration that help health plans optimize operations.
- Risk Adjustment Scalable solutions for coding, analytics, data integration, and risk adjustment accuracy including retrospective and prospective approaches for proper reimbursement and regulatory compliance.
- Quality Improvement and Stars Data-driven solutions with proven Stars strategies and NCQA-certified HEDIS engine that help plans measure, analyze, and implement quality improvement strategies.
- Advisory Services Expert advisory services helping optimize core health plan operations, reduce costs, enhance compliance, and drive improved member satisfaction and scalability.
- Enrollment Plus™ Streamlines enrollment processes and increases member satisfaction through automated enrollment workflows for health plans.
- Engagement Plus® Provides next-best-action data-driven personalized care and member engagement for health plans.
- Integration Plus® Seamlessly integrates systems and data for unified health plan operations, supporting 120+ prebuilt integrations.
- Workflow Plus® Automates and optimizes operations for improved efficiency across health plan back-office workflows.
- Insitz Plus Operational insights delivered better and faster for data-driven decision making in health plan operations.
- Retrospective Risk Adjustment Solutions Improves reimbursement accuracy, optimizes gap and chase, and streamlines submissions through chart review and coding analysis.
- Prospective Risk Adjustment Solutions Proactively closes gaps at the point of care and maintains compliance with risk adjustment requirements.
- Stars Consulting Services Pinpoints areas for improvement to maximize Star Rating potential through strategic planning and execution.
- Quality360® HEDIS® Engine NCQA-certified HEDIS engine for managing quality performance with end-to-end measure reporting and improvement capabilities.
Quantifiable outcome
- 30% average operational cost savings
- +7 more outcomes
Companies that use UST HealthProof
Customer profileNamed customers4 records
Segments2 records
Ideal customer profiles2 records
UST HealthProof technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability3 records
Feature10 records
UST HealthProof partnerships and signals
Strategic signalPartnerships
Four partnerships are on record, tiered core.
- Colorado AccesscoreColorado Access renewed its multi-year partnership with UST HealthProof, continuing to leverage the Core Administration Platform. The health plan, serving Colorado beneficiaries, has been a client since going live with the platform in June 2024.
- Zing HealthcarecoreZing Healthcare partnered with UST HealthProof for Core Administration BPaaS Solution, leveraging the platform for their health plan operations.
- Gateway HealthcoreMultiyear strategic partnership announced in February 2024 between UST HealthProof and HealthEdge jointly with Gateway Health, combining technology and services for the health plan's operations.
- Clover HealthcoreClover Health announced agreement to move its core plan operations to UST HealthProof's integrated technology platform. Expected to generate approximately $30 million in annual cost savings. Partnership allows Clover to focus on its differentiated Clover Assistant technology while UST HealthProof handles administrative operations.
Scale indicators8 records
Recent moves7 records
Expansion highlights5 records
UST HealthProof competitors and assessment
Company assessmentDirect peers
- HealthEdge: Now merged with UST HealthProof, HealthEdge is the most directly comparable peer, offering a cloud-native core administration, claims, and care management platform for health plans. Both target the same Medicare Advantage and commercial payer customers with overlapping product suites.
- SS&C Technologies (DST Health Solutions): SS&C's DST Health Solutions arm offers ALIP, a long-standing core administration platform for health plans, plus analytics and BPO services. Direct competitor to UST HealthProof's Core Administration and Risk Adjustment offerings.
- Inovalon: Inovalon provides cloud-based analytics and risk adjustment platforms for health plans, including the Converged Risk Adjustment suite. Highly comparable on the risk adjustment and quality analytics dimensions central to UST HealthProof's Stars and HEDIS work.
- Edifecs: Edifecs specializes in healthcare data interoperability, EDI, and value-based care analytics for payers and providers. Comparable to UST HealthProof's Integration Plus and quality/risk adjustment analytics modules.
Broad incumbents
- Cognizant (Trizetto): Cognizant acquired TriZetto to build one of the largest payer technology and operations practices globally. They offer core administration, consulting, and BPaaS services competing head-to-head with UST HealthProof's integrated platform for large health plan transformations.
- Optum (UnitedHealth Group): Optum's health services and analytics divisions serve health plans with risk adjustment, quality, claims, and care management capabilities. They are a broad incumbent with overlapping products and much larger scale, often embedded inside the UnitedHealthcare enterprise.
- Change Healthcare (Optum): Now part of Optum, Change Healthcare provides claims processing, revenue cycle, and clinical data exchange infrastructure for payers and providers. Comparable to UST HealthProof on the claims and interoperability dimensions of core administration.
- NTT Data Services (Healthcare): NTT Data delivers large-scale IT services and payer solutions including core administration modernization and BPaaS for health plans. Competes on multi-year transformation engagements of similar scope and contract value to UST HealthProof's enterprise deals.
Emerging players
- CitiusTech: CitiusTech offers healthcare technology services and platforms for payers, providers, and life sciences with strong analytics and risk adjustment capabilities. Competes with UST HealthProof on analytics-led services and Medicare-focused engagements.
- Infosys (Healthcare / Payer): Infosys provides payer technology services, claims automation, and digital transformation programs for health plans. Comparable as a services-led competitor with growing product capabilities that overlap with UST HealthProof's BPaaS and integration offerings.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks5 records
Key highlights7 records
Customer concentration
UST HealthProof social profiles
Digital presenceUST HealthProof compliance and trust
Trust signalCompliance2 records
UST HealthProof financial estimates
Financial estimateRevenue estimate
Valuation estimate
UST HealthProof leadership team
Management profileNumber of profiles
Profiles5 records
UST HealthProof subsidiaries and ownership
Company hierarchySubsidiaries2 records
UST HealthProof funding detail
Funding detailFunding overview
Funding rounds4 records
Investors3 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
UST HealthProof M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about UST HealthProof
What does UST HealthProof do?
UST HealthProof provides a cloud-based Business Process as a Service (BPaaS) platform for health insurance companies, integrating core administration, risk adjustment, quality improvement and Stars, and advisory services into a unified ecosystem. The platform leverages AI, machine learning, and advanced analytics to automate claims processing, enrollment, member engagement, payment accuracy, and regulatory reporting for Medicare Advantage, Medicaid, D-SNP, and commercial health plans.
Is UST HealthProof a public or private company?
UST HealthProof is a private company. It is classified as private equity controlled and is currently acquired.
When was UST HealthProof founded?
UST HealthProof was founded in 2016. It employs 5,001 to 10,000 people.
Where is UST HealthProof based?
UST HealthProof is headquartered in Aliso Viejo, United States, in the North America region.
How does UST HealthProof make money?
Three revenue lines are on record. BPaaS Subscription and Services are the primary driver. The others are professional Services and outcome-based Performance Fees.
Who are UST HealthProof's main competitors?
Direct peers on record are HealthEdge, SS&C Technologies (DST Health Solutions), Inovalon and Edifecs. Broad incumbents are Cognizant (Trizetto), Optum (UnitedHealth Group), Change Healthcare (Optum) and NTT Data Services (Healthcare). Emerging players are CitiusTech and Infosys (Healthcare / Payer).
Does UST HealthProof have an API?
No public API is recorded for UST HealthProof.
What industry is UST HealthProof in?
UST HealthProof's product category is Healthcare Payer Technology. Its primary akta.pro industry code is HLACAFAO, Data Aggregation, Interoperability & APIs for RPM (FHIR/IoMT Gateways), with a secondary code of HLACAJAG, Cloud Security (CSPM/CWPP/CIEM) for Health IT. Its NAICS code is 524292 and its SIC code is 7373.