Bain Capital Brings Together HealthEdge and UST HealthProof to Join Payer-Focused AI Tech

Bain Capital has brought together two payer technology businesses to integrate software, AI-driven tools and tech-heavy services.

Earlier this year, the private equity firm purchased HealthEdge from Blackstone in a transaction worth over $2.5 billion, including debt, according to the Financial Times. That deal closed in June.

Bain has since bought UST HealthProof from UST with the intention of merging it with HealthEdge. While financial details of the transaction weren’t disclosed, the combined company, operating under the HealthEdge name, now supports more than 115 health plans and over 110 million members.

Founded in 2005, HealthEdge develops software that helps health plans handle tasks such as processing claims, coordinating patient care, ensuring payment precision, overseeing provider networks, and engaging with members. 

HealthProof, established nine years ago, supplies an interoperability platform designed to upgrade legacy systems used by insurers.

Together, the companies form what CEO Kevin Adams – formerly of UST HealthProof and now leading HealthEdge – calls a comprehensive, end-to-end platform, integrating AI-driven tools for claims, payments, utilization oversight, payment integrity, and member services.

Adams said that the company now possesses a fully integrated ecosystem capable of covering 95% of a health insurer’s back-office requirements.

UST HealthProof’s platform is designed to ease the transition to cloud systems by minimizing migration risks, providing insurers with a more secure route to digital modernization and contributing to stronger clinical results for both patients and health plans, company leaders noted.

Executives added that HealthEdge is now strategically placed to deliver AI-powered tools and services that help insurers cut overall expenses and run their operations more efficiently.

Adams stated that the merger combined advanced payer technologies with smooth integration capacity and seasoned operational teams, helping reduce the daily administrative burdens faced by health plans. He noted that their unified approach offered a solution that is simpler to adopt while being more effective at providing the value organizations look for.

Adams co-established HealthProof in 2016 to support health plans in addressing their operational hurdles. The company’s offerings focus on key areas such as core administrative systems, risk mitigation, and quality improvement programs.

Adams explained that when he launched the business with Raj Sundar, they believed they had both a method and an opportunity to significantly cut operational expenses for health insurance firms. He added that they developed a mix of partner networks, proprietary technology, and a structured service model to eliminate roughly 30% of insurers’ operating costs, which he said could determine whether a company survived or failed.

Adams remarked that current AI-driven tools and services have the potential to totally eliminate inefficiencies within health plan back-office operations. He emphasized that leveraging full ownership of an end-to-end back-office system can allow firms to embed AI directly into their software, rather than layering it on afterward, which he believes could fundamentally reshape claims handling. 

He pointed out that claims processing is highly complex and suggested that even limited applications of AI could enable near-automated, touchless claim transactions, which he described as the ideal outcome for the insurance industry.