AH113 - From Legacy Mainframe to Judi Cloud™: Modernizing Claims Adjudication, with Andy Kageleiry

On this episode of Astonishing Healthcare, Andy Kageleiry (SVP, Enterprise at Judi Health) returns to the studio for a discussion about the state of the technology powering most health plans' and third-party administrators' (TPAs') operations, and how modern enterprise health tech like Judi® eliminates administrative waste, supports flexible plan designs, and unifies medical, pharmacy, vision, and dental claims on one platform. He describes several surprising, common pain points that plan administrators regularly face, including manual claim review, limited data access, an inability to scale or pivot when needed, and point solution fatigue. Andy also introduces the Judi Cloud™ solution, which lets health plans and TPAs license the Judi platform directly.Key Takeaways‍A single claim can be incredibly time-consuming to process, but it doesn't have to be. Eligibility, network status, coverage rules, benefit design, and coordination of benefits all have to resolve correctly in real time. Legacy platforms built on decades-old mainframes can't keep pace, leaving operations teams to close the gap by hand.‍Infrastructure point solutions don't fix root cause problems. Every added vendor means another integration, another relationship, and more overhead. That administrative drag contributes to an estimated $1 trillion in annual healthcare waste, slower provider payments, and members who can't reconcile their EOB with their bill.‍A modern, unified CAPS turns the equation around. Judi Cloud lets health plans and TPAs license the Judi platform, enabling them to process medical, pharmacy, vision, and dental claims on one system, cutting manual work, supporting flexible plan designs, and giving clients full, self-serve access to their own data.Related ContentExplaining the Healthcare Claims Adjudication Process for Modern TPAsJudi Health™ Announces Capital Rx is Now Judi Rx™, Launches Judi Care™ and Judi Cloud™ to Power the Next Era of Health Benefits Administration and Patient CareAH111 - Building a Single Source of Truth for Medical and Pharmacy Benefits, with Kevin Sundquist & Liya LomsadzeJudi Health Partners with CLEAR as a Preferred Identity Verification Partner to Power Secure, Interoperable Health Benefits AccessReplay: The Future of Health Benefit Design: How Judi® Powers Seamless Care and Better OutcomesFor more information about this episode, please visit Judi Health Insights.