Administrative tasks make up a substantial portion of the over $4tn annual healthcare expenditure in the United States. Despite digital advancements, only a quarter of healthcare members actively engage with existing digital portals and apps. As a result, call centres remain overwhelmed, struggling to meet demand. But Ushur is helping to change that through its AI Agent for Member Service.
The demand for private, accessible, and empathetic member services is increasing. However, factors such as privacy concerns and low digital engagement create significant challenges.
According to a McKinsey report, 66% of Americans feel uncomfortable scheduling sensitive medical appointments over the phone due to concerns about judgment and discomfort when discussing personal health matters.
To address these issues, Ushur has introduced its AI Agent for Member Service, a HIPAA-secure, scalable, and intelligent solution designed to enhance member interactions for health plans.
Introducing Ushur’s AI Agent for Member Service
Ushur’s AI Agent is designed to tackle key challenges in healthcare member services by offering:
Healthcare-specific intelligence: The AI integrates Large Language Models (LLMs) with advanced workflow engines tailored to health plan policies, enabling precise and intuitive self-service capabilities.Empathetic and context-aware conversations: It manages sensitive discussions, including topics like substance abuse and domestic violence, with the ability to escalate to human representatives when necessary.Privacy, accessibility, and security: Fully compliant with HIPAA and the Affordable Care Act (ACA), the AI Agent safeguards Protected Health Information (PHI) while ensuring secure and inclusive interactions.
Key benefits for health plans
By implementing Ushur’s AI Agent, health plans can realise several advantages:
Faster resolutions: Automating common tasks such as password resets, ID card replacements, and Primary Care Physician updates reduces operational costs and wait times. Members can request services instantly, eliminating the need for lengthy hold times.Scalable support: The AI Agent efficiently manages 24/7 demand and peak periods, such as open enrolment, without increasing staffing requirements.Enhanced member satisfaction: By providing clear, accurate, and empathetic responses, the AI Agent helps improve customer experience and satisfaction scores.Proactive engagement: Automated two-way updates on appointments, benefits, and claims reduce frustration while alleviating employee workloads.Regulatory compliance: With built-in HIPAA compliance and secure data handling, health plans can ensure privacy and security for their members.
Advanced capabilities of Ushur’s AI Agent
Powered by the Ushur Platform, the AI Agent provides a range of advanced features:
Enterprise-specific intelligence: It integrates with CRMs and enterprise knowledge bases for personalised and data-informed interactions.Advanced workflow automation: Seamless integration with third-party applications allows for enhanced self-service functionalities.Interactive widgets: Features such as geo-location maps and document uploads enhance the user experience beyond basic text exchanges.Compliance and security measures: Built-in safeguards ensure responsible AI use while preventing unauthorised access to sensitive data.Omni-channel engagement: The AI Agent enables smooth transitions between digital channels, reducing call volumes and improving accessibility.Simplified information delivery: It translates complex healthcare details into a 6th-grade reading level for better comprehension.Multilingual support: Supporting English, Spanish, Chinese, Vietnamese, Korean, and Portuguese, the AI Agent promotes inclusivity and health equity.
Ushur’s AI Agent for Member Service is redefining healthcare engagement by combining automation, empathy, and compliance.
By streamlining member interactions and providing real-time, personalised support, health plans can enhance service efficiency while improving access to care.
With a fast implementation process requiring minimal IT resources, Ushur’s AI Agent offers a swift path to operational excellence and member satisfaction.
Read the full blog from Ushur here.
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