We combine deep industry domain expertise with agentic engineering and deterministic automation to catalyze and re-engineer how you work together with AI agents. Our custom-tailored solutions are grounded in the understanding of how your business runs.
AI agents can serve as autonomous digital workers — capable of executing multi-step workflows, and making decisions within complex payer systems.
Streamline Approvals, Remove Bottlenecks, Improve Patient Care, Lower Admin Costs
AI agents can extract clinical evidence from electronic health records (EHRs), cross-reference it against payer-specific medical necessity guidelines, and approve or compile a detailed summary for human review. Transform a slow, back-and-forth process into a near-instant, autonomous workflow.
Proactive Concierge Service, Reduce Call Center Volumes, Increase Member Satisfaction
AI agents can verify out-of-pocket costs, find high-quality, in-network providers, and book appointments across multiple systems based on the member’s schedule. They can also proactively reach out to members to explain confusing bills before a frustrated call is even made.
Intelligent Dispute Resolution, Increased SLA Compliance, Mitigated Regulatory Risk
AI agents can monitor appeals & grievances queues to dynamically prioritize cases at risk of missing regulatory deadlines. They pull the entire clinical and claim history, synthesize the dispute, and draft compliant, empathetic response letters for final human sign-off.
Zero-Touch Claims Resolution, Reduce Manual Touchpoints, Increase Payment Accuracy
AI agents can proactively fetch missing documentation from providers, validate codes against complex contracts, and adjudicate or auto-correct claims. For denied claims, agents can build an audit trail and generate the initial explanation of benefits.
Proactive Health Orchestration, Improve Health Outcomes, Boost HEDIS/Star Ratings
AI agents can identify at-risk members and independently trigger interventions. They orchestrate care pathways, such as scheduling post-discharge follow-ups, arranging non-emergency medical transportation, and sending tailored nudges to close critical care gaps.
Automated Intervention & Defense, Reduced Financial Leakage, Improved Cost Avoidance
AI agents can analyze massive datasets to uncover complex collusion networks or provider upcoding patterns. Once an anomaly is detected, the agent can freeze suspicious disbursements and build a comprehensive evidence package for investigators.