AI for Health Plans & Payers
Empower your health plan with generative AI to streamline operations, reduce administrative costs, and deliver exceptional member experiences.
15%
Reduction in Claim Processing Costs
Automating adjudication and review
20%
Improvement in Member Satisfaction
Through 24/7 instant support
30%
Faster Prior Authorization Turnaround
Reducing delays in care
10%
Decrease in Fraud, Waste, and Abuse
Via intelligent pattern detection
Knowledge Domains
Member Engagement & Support
- Personalized plan recommendations
- 24/7 automated benefits support
- Proactive health & wellness tips
- Seamless new member onboarding
Claims & Reimbursement Automation
- Automated claim adjudication
- Real-time status tracking for providers
- Intelligent fraud & abuse detection
- Streamlined payment integrity
Provider Network & Operations
- Provider credentialing & directory management
- Contract modeling & performance analytics
- Automated prior authorization processing
- Value-based care performance tracking
Real-World Examples
A member is asking about their out-of-pocket costs for an upcoming surgery. Can you summarize their plan details?
The member has a $500 remaining deductible and 20% coinsurance up to a $5,000 max. Their estimated responsibility for the procedure is $2,400. [Source: Member Plan Details]
This claim for physical therapy looks unusual. Can you check for red flags?
The system has flagged this claim for potential upcoding based on the provider's billing patterns and member history. Recommend for further review. [Source: Provider Analytics & Claims History]
What is the performance of our new value-based care agreement with the hospital system?
Last quarter, they achieved a 92% quality score, reduced readmissions by 15%, and generated $1.2M in shared savings, trending above the network average. [Source: VBC Performance Dashboard]
Key Benefits
Enhance Member Experience
Provide instant, accurate, and personalized answers to member inquiries 24/7, improving satisfaction and retention.
Reduce Administrative Costs
Automate manual, repetitive tasks in claims processing, prior authorization, and member support to lower operational overhead.
Improve Operational Efficiency
Streamline workflows between payers, providers, and members, accelerating processes like prior authorization and claims payment.
Strengthen Payment Integrity
Leverage AI to proactively identify and prevent fraud, waste, and abuse, safeguarding financial resources.