Healthtech · Health Data & Interoperability · 50–200 · North America #b029_06

Context

We sell a standards based data platform to health insurers so they can meet federal access rules, exchange member data and automate prior authorization.

Industry

Healthtech · Health Data & Interoperability

Size

50–200 employees

Region

North America

Tools budget

$1K–5K per month

Needs

Claims & prior authorization. Insurers we serve must automate prior authorization on tight regulatory timelines and expect us to deliver it.

Today: platform ingests payer claims and explanation of benefit files into a lakehouse for clients · Urgency: this year

Regulatory reporting. Federal interoperability rules require metrics reporting, and assembling those reports for each insurer is manual.

Today: payer interoperability mandates handled by packaged APIs plus a dedicated compliance guide for clients · Urgency: now

Data governance & catalog. Our lakehouse holds member data for many clients and we need stronger lineage and access policy enforcement.

Today: governance described at product level with a public trust center, no separate tooling visible · Urgency: later

Who decides

head of product · security review

Expects from suppliers

Understands insurer interoperability mandates; Lineage across lakehouse tables; Supports standards based APIs natively

Not a fit

Provider only revenue tools; Products without insurer experience; Solutions storing data outside our tenancy

Stack

cloud: AWS-class hyperscaler, data warehouse: cloud, compliance tooling in place

Buying triggers

regulatory change, new market or product launch