Create a seamless experience for health plans, government agencies, and their members through Softheon’s vertically integrated cloud modules that offer eligibility, enrollment, premium billing, reporting, payment, reconciliation, and communication solutions.

Enroll, Bill, and Renew Your Health Plan Members with Advanced Automation

With over 20 years of experience, Softheon's platform has touched millions of people and processed tens of billions of dollars in premiums since ACA's inception.


Licensed Carriers

Premiums Processed

Health Plan Solutions

Streamline Eligibility Determinations

Convenient User Experience on and Reconciliation Automation with Softheon’s Eligibility and Enrollment Modular Solution


Simplify Your Enrollment Processes

100% of Enrollment Scenarios Covered with Softheon’s Enhanced Direct Enrollment (EDE) Phase 3 Solution

Reduce Human Error Through Automation

Simplify and Automate Your Plan Catalogue to Eliminate Costly Mistakes

Improve User Experience & Reduce Overhead

Provide Convenience for Users with Member Self-Service and Support

Decrease Fraud & Empower Your Members

Handles all Financial Management & Payment Processing with Our Automated and Intuitive Solutions

Enhance the Consumer

Provide Powerful Outreach Tools that Scale Communication

Retain Membership While
Growing Your User Base

Reduce Member Abrasion Through a Seamless, End-to-End User Journey That Addresses Many Pain Points Experienced by Members

Effortlessly Organize & Interpret
Relevant Information

Compile Member Data Ops & Intelligence All in One Place with Reporting

Government Solutions

Softheon Streamlines State Exchange and Eligibility Systems through Modular Technology – No Overhauls Required

Integrate your existing systems and start seeing experiencing efficiencies in months, rather than years.

State Health and Human Services and Medicaid Agencies Use Softheon to Operate State Exchanges and Verify Medicaid Eligibility.

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Prevent Fraud and Abuse
with Enhanced Eligibility

Quickly Prioritize High Risk Individuals with Our Multi-Source Medicaid Enhanced Eligibility Verification Solution

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Protect & Grow State Resources

Avoid the Clog of Medicaid Reassessments at the End of the PHE Via Overnight Bath Processes

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Improve Your Technology & Avoid Overhauls

Integrate Already Established Eligibility Systems with Softheon’s Flexible and Modular Products to Create a Customized Solution

State Based Marketplace
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Improve Your User Journey & Prevent Drop Off


Offer a Seamless Experience for Your Members with an All-in-One Platform Solution


Increase User Retention and Satisfaction

Provide Consumers with Decision Support Tools to Create a Seamless Experience While Empowering Them to Manage Their Payment Options

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Save Time and Reduce Overhead

Automate all Sections of Your System via Rule-Based Configurations to Easily Manage Your Health Plan Offerings

Trusted by Eight State Agencies and CMS

*MS still in development


A Trusted Leader That’s Partnered with Over 90 Carriers


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What People Are Saying about Softheon

  • Softheon was able to provide outstanding job training and outline a clear understanding of the work progress. Because Softheon leveraged the cloud to automatically scale to fit our product’s demands, we did not have to continually pay for extra space.
    Kelly Gunther
    CIO, Connect for Health Colorado
  • Softheon’s knowledge of health insurance industry best practices combined with its customizable solutions made them an ideal technology partner for CHP in this endeavor.  
    Eric Smith
    CIO at Capital Health Plan
  • Softheon’s expert knowledge of the ACA marketplace coupled with their leading enrollment and billing technology has made them the perfect partner during Hometown Health’s first open enrollment period on the exchange.  
    David Hansen
    Hometown Health CEO
  • We are in a unique position where we can blend the latest technology with local experience to offer high quality health and wellness services for our Members.
    Theresa Scepanski
    President & CEO for Community First Health Plans

As Seen In

Authority Magazine
Bloomberg Law

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