HealthEdge Software is a healthcare technology company providing next-generation Core Administrative Processing Systems (CAPS) and integrated SaaS solutions to health insurance payers. Its flagship HealthRules Payer platform, along with payment integrity (Source/Burgess), care management (GuidingCare/Altruista), and digital member engagement (Wellframe) products, enables payers to administer benefits, configure plans, manage providers, and engage members. Following Bain Capital's 2025 acquisition and merger with UST HealthProof, HealthEdge has expanded into AI-powered payer technology and managed services for health plans.
HealthEdge has been acquired
This company is no longer available on our private secondary market.
Company data and valuation marks are estimates and may be incomplete, stale, erroneous, or revised.
Founded
2004
Employees
1,001–5,000
Total Funding
$739.48M
9 rounds
Latest Valuation
$0.7B
Apr 1, 2020
Funding data and valuation marks are estimates and may be incomplete, stale, erroneous, or revised.
Total raised $739.48M across 9 rounds
Last updated 06-25-2026
| Date | Round | Amount Raised | Valuation | Lead Investors |
|---|---|---|---|---|
| Apr 2020 | Blackstone Majority Recap | $700M | $0.7B | Blackstone |
| Jul 11, 2017 | Venture Debt | Not disclosed | — | Not disclosed |
| Feb 2015 | Series C2 / Follow-on | Not disclosed | — | Not disclosed |
Kevin Adams
Chief Executive Officer
Stephen Krupa
Board Member (former CEO)
Matt McLaughlin
EVP & Chief Financial Officer
Robert Duffy
Chief Technology Officer
Chris Conte
EVP & Chief Revenue Officer
Alan Stein
Chief Commercial Officer
Competitor list is illustrative and may be incomplete, stale, or erroneous.
TriZetto (Cognizant)
Cognizant-owned QNXT and Facets core administrative processing systems serve as the dominant legacy CAPS platforms for U.S. health plans and are HealthRules Payer's principal direct competitors.
Plexis Healthcare Systems
Provides real-time benefit administration, adjudication, EDI, and self-service portal software for health plans and TPAs, competing in mid-market payer core admin.
HealthAxis
Offers integrated claims processing, TPA services, and analytics to payers and provider-sponsored health plans.
Acero (PlanXpand)
PlanXpand transaction processing engine powers benefits administration products for health benefits administrators.
Inovalon
Cloud-based healthcare data and analytics platform for payers, providers, and life sciences; competes adjacent to HealthEdge in payer analytics, quality, and risk-adjustment workflows.
Edifecs
Provides interoperability, encounter management, and payment integrity software to health plans, competing with HealthEdge's payer integration and payment integrity offerings.
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