.svg)
Health Insurance AI Agents
Multimodal builds agentic AI for health insurance automation, streamlining workflows like claims processing, eligibility verification, prior authorization, risk adjustment, and more. Our platform delivers end-to-end automation for health insurers.
.svg)
.svg)
.svg)
How Multimodal AI Agents work
Our AI Agents learn, think, and act with different built-in capabilities. We fine-tune these AI Agents on your company data and deploy them as APIs through our AgentFlow platform.
.svg)
Document AI
Trained on your schema to extract, label, and organize data from structured and unstructured documents.
.svg)
Decision AI
Ingests your internal manuals and guidelines, providing accurate data-driven decision recommendations for complex workflows.
.svg)
Database AI
Access company databases to answer queries, interpret datasets, and provide actionable insights.
.svg)
.svg)
Multimodal AI Agents Automate Health Insurance Tasks With Precision
Provider Network Management
50%
99%
Automated credentialing and contracting: Accelerate onboarding of new providers using AI-powered data extraction and database verification.
Dynamic network updates: Update provider directories in real time to ensure accuracy.
Performance analytics: Identify high-performing providers and optimize network composition with AI-powered data analysis and report generation.
Benefits Verification
95%
80%
Real-time eligibility checks: Provide instant eligibility verification to members, reducing claim processing times.
Automated pre-authorizations: Speed up approvals for medical procedures, ensuring timely care and minimizing manual reviews.
Intelligent claim adjudication: Detect potential fraud or errors, accelerating accurate claim decisions and expediting processing.
Eligibility Determination
98%
30%
Data integration and validation: Seamlessly access member data from multiple sources, reducing manual errors.
Instant eligibility decisions: Provide immediate answers to inquiries, improving customer service.
Automated enrollment and disenrollment: Streamline processes and reduce administrative overhead.
.png)
Intelligent Policy Servicing
60%
50%
Automated communication: Streamline follow-up and source additional documents automatically, expediting eligibility reviews.
Intelligent policy servicing: Automate renewals and cancellations, reducing manual effort and improving accuracy.
Personalized member communication: Deliver targeted messages and reminders, personalizing member communication, and improving engagement.
Why Health Insurance Companies Love Multimodal
Transparent & Explainable
Our AI Agents are explainable, helping you track decisions and stay compliant with coverage transparency and other regulations.
Integration & Flexibility
We provide complete integration with legacy workbenches like Guidewire and DuckCreek, enabling a no rip-&-replace AI transition.
Tailored Automation
Our AI Agents are trained on your company data, increasing accuracy, customer satisfaction, and specific risk identification.
Continuous Improvement
Our AI Agents are trained on your company data, increasing accuracy, customer satisfaction, and specific risk identification.
Security & Data Privacy First
Flexible Deployment
Our automation software is deployed on your infrastructure, either on your virtual private cloud (VPC) or on-premises.
Data Security
Your data stays within your systems, ensuring user privacy and compliance with regulations, enhancing business security.
Enhanced Protection
This setup safeguards your users, keeping your operations secure and compliant.
Book a 30-minute demo
Explore how our agentic AI can automate your workflows and boost profitability.
Get answers to all your questions
See how AI Agents work in real time
Learn AgentFlow manages all your agentic workflows
Uncover the best AI use cases for your business
FAQ
Health insurance AI automates repetitive tasks, streamlines workflows like claims processing and prior authorizations, and enhances accuracy. This results in faster service, reduced administrative costs, and a more personalized experience for members.
AI health insurance claims automation extracts, validates, and analyzes claim data to accelerate adjudication, flag anomalies, and ensure coding accuracy. This reduces turnaround times and helps detect fraud early.
Yes, our AI can automate prior authorization workflows by validating eligibility, extracting clinical data, and applying decision rules. This reduces delays, ensures compliance, and improves provider and patient satisfaction.
AI for health insurance automates manual processes like eligibility checks, claims validation, and appeals management. It reduces human error, shortens cycle times, and improves throughput without sacrificing compliance.
AI detects suspicious claims patterns, duplicate submissions, and anomalies in billing data. Real-time fraud detection protects payers from financial losses and enhances trust in the system.
Health insurance AI analyzes demographics, health history, and engagement behavior to recommend personalized care plans, communication preferences, and wellness interventions.
Common automation areas include:
- Claims processing
- Eligibility and benefits verification
- Prior authorizations
- Provider data management
- Appeals and grievances
- Member onboarding
- Compliance and reporting
Yes, our AI platform uses advanced encryption, access controls, and real-time auditing to meet HIPAA and other regulatory requirements. Automated compliance checks help reduce audit risk and ensure data protection.
Absolutely. Our platform offers robust APIs and low-code integration, enabling seamless connectivity with core systems like EHRs, claims engines, CRM, and policy administration platforms.
Yes, our AI solutions scale from regional health plans to national carriers. We tailor implementations based on workflow complexity, transaction volume, and organizational goals.
AI shortens response times, improves accuracy, and enables proactive support—leading to higher satisfaction among members and providers.
Pricing depends on factors like use case scope, integration needs, and scale. Contact us to explore flexible plans that align with your operational goals.