enGen

What enGen does

enGen is a Pittsburgh-based healthtech company and wholly owned subsidiary of Highmark Health that provides integrated technology and operations solutions to health plans and provider organizations. Founded in 2014 (originally as HM Health Solutions Inc., rebranded to enGen in 2024), the company operates a cloud-based Core Administrative Processing System (CAPS) that delivers front-, middle-, and back-office capabilities across enrollment, claims processing, and customer service, complemented by specialized modules including EZEnroll (AI-driven enrollment automation), ACE (AI Claims Examiner), Predictal (NCQA Pre-validated care management), AI Foundry, intelliGen (business intelligence), and Providius (provider data management).

The company serves 50+ Blue and non-Blue health plans representing 20 million+ members, processes 260 million+ annual claims at a 92-98% adjudication rate, and supports 150+ native and non-native system integrations. Its proprietary AI capabilities include document extraction at 95-96% accuracy, claims anomaly detection at 99.64% accuracy, AI-generated call summaries (1.6 million annually), and agentic AI assistants deployed via Salesforce Agentforce.

enGen employs more than 11,000 people and operates owned enterprise data center infrastructure in Pennsylvania with a disaster recovery site in Ashburn, Virginia. Its go-to-market is enterprise B2B with quote-based, demo-led consultative sales targeting large Blue Cross Blue Shield plans and provider networks, and its revenue model is anchored in recurring subscription-based contracts with annual billing.

Name

enGen

Legal name

HM Health Solutions Inc.

Website

https://goengen.com

Company type

Private

Founded year

2014

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

enGen is a Pittsburgh-based healthtech subsidiary of Highmark Health that provides cloud-based core administrative processing, AI-driven enrollment and claims automation, and care management solutions to 50+ health plans serving 20 million+ members.

Ownership category

akta.pro rank

Product category

Healthcare Administration Software

NAICS

Computer Systems Design and Related Services (5415), Computer Systems Design Services (541512), Software Publishers (513210), Computer Facilities Management Services (541513)

SIC

Services-Computer Integrated Systems Design (7373), Services-Prepackaged Software (7372), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

HIE Platforms & Network Services (Community/Regional/National) (HLACABAB)

akta.pro secondary industries

AI Integration & Orchestration Platforms (Connectors, Workflow, iPaaS for AI) (HDAEANAI), iPaaS (Cloud Integration Platforms) (HDAEAIAB)

Keywords

• Health plan administration
• Claims processing software
• Payer provider platform
• Care management solutions
• Enrollment automation

Headquarters

HQ city

Pittsburgh

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Infrastructure, Operations, Marketing or Sales

Revenue model

1. Enterprise Healthcare Technology Solutions: enGen provides integrated end-to-end technology solutions to health plans and their provider partners. As a wholly owned healthtech subsidiary of Highmark Health, enGen focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge, and integrated cloud-based platforms.

Pricing tiers

Go-to-market motion2 records

Distribution channels1 record

Marketing channels4 records

Core offering

enGen delivers a cloud-based Core Administrative Processing System (CAPS) that unifies front-, middle-, and back-office capabilities for health plans and provider organizations. The platform bundles AI-driven modules for enrollment automation (EZEnroll), claims processing (ACE AI Claims Examiner), and care management (Predictal), supplemented by AI Foundry for custom AI development, print and fulfillment services, and 24/7 global technology and operations support. Solutions are deployed under a TechOps approach that combines technology with operations to drive automation, interoperability, and measurable outcomes for 50+ Blue and non-Blue health plans covering 20 million+ members.

Product overview

enGen offers a unified healthtech ecosystem with CAPS (Core Administrative Processing System) as its central platform combining enrollment, claims processing, and customer service capabilities. The platform is complemented by specialized AI-powered modules including EZEnroll for enrollment automation, ACE for claims processing, Predictal for clinical care management, and AI Foundry for custom AI development. Supporting services include Print & Fulfillment, Global Technology & Ops Support, intelliGen for business intelligence, and Providius for provider maintenance. The company serves 50+ Blue and non-Blue health plans, processes 260 million+ annual claims, and supports 20 million+ members through its TechOps approach uniting technology and operations since 2014.

Differentiator

Problem solved

Functional benefit

Brands

• CAPS (Core Administrative Processing System): enGen's core administrative platform that automates enrollment, claims processing, and customer service workflows using AI-powered automation.
• EZEnroll
• ACE (AI Claims Examiner)
• Predictal
• AI Foundry

Products and services

• CAPS (Core Administrative Processing System) A centralized, cloud-based administration hub delivering front-, middle-, and back-office capabilities for payers and providers. Powers enrollment, claims processing, and customer service workflows with embedded automation and AI.
• EZEnroll AI-driven enrollment automation solution that digitizes and transforms unstructured enrollment forms into ready-to-process transactions, achieving 95-96% accuracy and reducing quality-check time by 65% for health plans.
• ACE (AI Claims Examiner) AI-powered claims processing system that analyzes suspended claims, identifies patterns, recommends resolutions, and processes high-confidence scenarios automatically using machine-learning models, achieving 99.64% accuracy and resolving 2.19 million suspended claims.
• Predictal Flexible, automated care management platform offering modular or full-platform solutions for Authorization, Utilization, Case, Disease, and Appeals and Grievances Management, with 360-degree member/patient profiles and smart workflow automation.
• AI Foundry AI platform enabling health plans to develop and deploy AI solutions with governance and operational integration across enrollment, claims, customer service, and care management.
• intelliGen Business intelligence solution that provides analytics and insights for health plan operations.
• Providius Optimized provider maintenance solution powered by enGen for managing provider data and relationships.
• Print & Fulfillment Services Healthcare communications across digital, print, and mail channels with secure and timely fulfillment at low cost for health plans.
• Global Technology & Ops Support 24/7 international assistance, diagnostics, and innovation services providing enterprise flexibility and scalability for health plan technology environments.
• Enrollment Solutions Comprehensive enrollment automation and management solutions for health plans, including digitized intake, validation, and matching capabilities.
• Clinical Solutions Clinical care management solutions including prior authorization, utilization management, case management, and population health tools.

Quantifiable outcome

• 2.19 million suspended claims resolved through ACE AI Claims Examiner
• +9 more outcomes

Named customers3 records

Segments2 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability8 records

Feature8 records

Partnerships

Seven partnerships are on record, tiered core and strategic.

• PredictalcoreTechnology or IntegrationPredictal provides flexible, automated care management solutions integrated with enGen's ecosystem. The partnership enables modular or full-platform solutions for Authorization, Utilization, Case, Disease, and Appeals and Grievances Management.
• AbacusstrategicTechnology or IntegrationenGen and Abacus collaborate to enable health plans with integrated technology solutions for administrative processing and operations.
• LagunastrategicTechnology or IntegrationenGen and Laguna collaborated to provide AI assistance for case managers, with Laguna's capabilities integrated into enGen's AI Foundry.
• Opus HealthstrategicStrategic or Co-development PartnerOpus Health and enGen announced a strategic alliance for healthcare technology solutions.
• SalesforcecoreTechnology or IntegrationenGen uses Salesforce Service Cloud and Agentforce for AI-powered solutions including Open Enrollment Assistants and volunteer coordination platforms. enGen's Salesforce team designed and deployed Agentic AI solutions within the Salesforce ecosystem.
• Highmark HealthcoreOthersenGen is a wholly owned healthtech subsidiary of Highmark Health. The company focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans.
• Salesforce MapscoreTechnology or IntegrationenGen leverages Salesforce Maps for proximity-based volunteer coordination, enabling real-time visualization of available resources within geographic radius. The integration reduced matching time from nearly 24 hours to approximately 5 minutes.

Scale indicators20 records

Recent moves8 records

Expansion highlights4 records

Others

• Salesforce Health Cloud: Salesforce is enGen's underlying platform partner (Agentforce, Service Cloud, Maps) and a strategic enabler rather than competitor — included because Salesforce's vertical healthcare push directly affects enGen's agentic AI roadmap and pricing.

Emerging players

• Infinx Healthcare: Infinx provides AI-driven patient access, prior authorization, and revenue cycle automation for providers and payers — overlapping enGen's Predictal care management and ACE claims automation capabilities.
• Health Catalyst: Health Catalyst provides data and analytics platforms for healthcare systems and payers, overlapping enGen's intelliGen business intelligence offering and clinical decision-support ambitions.

Broad incumbents

• Optum (UnitedHealth Group): Optum is UnitedHealth Group's health services and technology arm, combining data, analytics, and care operations to serve payers, providers, and pharmacies — directly comparable to enGen's payer-side technology and operations (TechOps) model.
• Cognizant Healthcare: Cognizant's healthcare business provides IT services, systems integration, and digital transformation for payers and providers at large enterprise scale, overlapping enGen's managed services and core-administration work.
• NTT Data Healthcare: NTT Data delivers enterprise IT services, core modernization, and managed services for U.S. healthcare payers — comparable to enGen's broader IT/system integration delivery model for health plans.

Direct peers

• Change Healthcare: Change Healthcare (now part of Optum) processes billions of healthcare transactions and provides claims, payments, interoperability, and analytics — a deep peer for enGen's claims adjudication and 260M+ claims processing footprint.
• Edifecs: Edifecs provides healthcare data interoperability and value-based care analytics for payers and providers, comparable to enGen's integration ecosystem and its push into clinical/administrative workflow automation.
• Availity: Availity operates the largest healthcare information network connecting payers and providers, offering eligibility, claims, and interoperability services — directly overlapping enGen's 150+ integration ecosystem and payer-provider data exchange focus.

Regional players

• Mphasis Healthcare: Mphasis delivers application services and digital transformation for U.S. payer and provider clients, comparable to enGen's global technology and ops support function and cloud-based admin delivery model.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/engenhealthtech
• Xx.com/enGenHealthtech
• Facebookfacebook.com/enGenHealthtech

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about enGen