Purpose Built AI for Health Plans

From authorization to care plan to appeal: one clinical brain, not four vendors.

Clinical measures up; cost down, within the systems you already run. Start with one agent. Measure ROI. Expand. Scale.

See how it works
95%
intake automated, any channel
70–80%
staff time saved on decisioning
Weeks
to live — no rip-and-replace
Who we serve
MA & SNPs Medicaid MCOs Dental & Specialty Benefit Managers ACOs Commercial
Your AI adoption journey
Agent → Product → Platform

Proven in payer operations • Human-in-the-loop • Complete audit trail • Works with existing core systems.

01 / 06Engagement

Up to 75% cost savings

Outreach Agent

Multilingual voice and omnichannel outreach for HRAs, care gaps, and transitions.

02 / 06Intake & Risk

Up to 95% automated

Intake Agent

Any-channel case creation for UM, A&G, and Claims in under two minutes.

03 / 06Clinical

90 min to under 5

ICP Agent

Auto-generates federally mandated Individualized Care Plans.

04 / 06Analytics

Up to 60% time savings

Conversational Analytics

Natural-language queries across HEDIS, STAR, and operational metrics.

05 / 06Decisioning

Up to 70% time savings

UM Evidence Agent

Aggregates evidence and applies InterQual/MCG and gold-carding rules.

06 / 06Claims

Up to 80% time savings

Claims Pend Resolution

Resolves pended claims by assembling evidence from eight or more systems.

The Agent Library · Vol. 01

Meet the
agents

An agent is not a chatbot. It’s a purpose-built digital worker: it reads the case, applies your plan’s rules, drafts the decision or letter, and routes it to a nurse for approval — with a full audit trail. Each one clears a single bottleneck: the queue running late, the letters piling up, the reviews burning nurse hours. Clear one, and you recover the time and dollars it was quietly costing you.

01/06
Outreach Agent
Agent 1 of 6: Outreach Agent
The Agent Library · Vol. 01

Meet the
agents

An agent is not a chatbot. It’s a purpose-built digital worker: it reads the case, applies your plan’s rules, drafts the decision or letter, and routes it to a nurse for approval — with a full audit trail. Each one clears a single bottleneck: the queue running late, the letters piling up, the reviews burning nurse hours.

01/06
Swipe
See all 12 agents
AI intelligence · the agent library

Solve one problem. Measure ROI. Expand adoption.

Each of our 12 agents targets one bottleneck, so you manage adoption risk from a single point of entry. Begin with the function that burdens your team the most.

The product suite

When one agent isn't enough.

Fair warning: clearing one bottleneck creates appetite for the next. That’s why our agents group into four products. Pick a product, automate a department’s workflow, and scale without adding headcount.

Four products · pick a department
↓

From risk stratification to care plan — every member engaged.

Automate the entire care management lifecycle, with CareInsight Care Management.

Explore Care Management

Prior auth in hours, not days — evidence-backed.

Prior authorization is the bottleneck members and providers feel most.

Explore Utilization Management

Every case resolved in SLA. Every decision audit-ready.

Appeals and grievances are where health plans face their highest regulatory exposure and their most manual work.

Explore Appeals & Grievances

Intelligent letters. Compliant by design.

Every health plan runs on letters — EOBs, ID cards, claims and UM notices, provider communications, member correspondence.

Explore LetterIQ
The product suite

When one agent isn't enough.

Fair warning: clearing one bottleneck creates appetite for the next. That’s why our agents group into four products. Pick a product, automate a department’s workflow, and scale without adding headcount.

Four products · pick a department
001Gaps closed daily

From risk stratification to care plan — every member engaged.

Automate the entire care management lifecycle, with CareInsight Care Management.

Explore Care Management
002Decisions, documented

Prior auth in hours, not days — evidence-backed.

Prior authorization is the bottleneck members and providers feel most.

Explore Utilization Management
003On the compliance clock

Every case resolved in SLA. Every decision audit-ready.

Appeals and grievances are where health plans face their highest regulatory exposure and their most manual work.

Explore Appeals & Grievances
004Member-ready in seconds

Intelligent letters. Compliant by design.

Every health plan runs on letters — EOBs, ID cards, claims and UM notices, provider communications, member correspondence.

Explore LetterIQ
The platform layer

We bloom from our platforms.

As adoption expands, agents consolidate onto the platforms your whole plan runs on. See how each platform lifts plan performance →

The Brain

health3d.ai

Surface valuable insights that are hidden by fragmented data. Harmonize your disparate, multi-channel data silos into a single dynamic longitudinal member record, for accurate forecasting, trend analysis, and cost-saving resource allocation.

Explore → The Engine

careassistant.ai

Stop paying for systems that don't talk to each other. Your staff spends hours re-entering duplicate information across tools, and your members feel the friction. Unify your core operations into a single platform. Powered by our 12 built-for-purpose native AI agent library.

Explore → The Bridge

carewallet.ai

Give members and caregivers something no other patient portal can give—a whole-health story. Get engagement from even 'ghost members' who only show up in the ER, by enabling the power of a unified health picture in your members' pockets—close the care gaps that Stars and quality leaders need. Members and their caregivers will thank you.

Explore →
Compliance & integration

Integration without the learning curve

Our agents work inside your current systems—no rip and replace.

  • 01

    Connect

    Secure links to QNXT, Facets, TriZetto, your EMR and HIE.

  • 02

    Configure

    Select agents, map to your rules, timelines, and mandates. With APIs our FHIR-native data platform makes our integration a noninvasive procedure.

  • 03

    Deploy

    Go live in weeks with human-in-the-loop review at every step.

  • 04

    Scale

    Prove ROI, then add the next agent, product, or platform — on your timeline.

FHIR-native Human-in-the-loop Full audit trail CMS · NCQA · EQRO
Results
“The whole member story, intake to treatment, in one dashboard. It's night and day better than what we had before.”
Janet Musto · AVP Case Management, Liberty Dental Plans
0%
cost savings
0%
staff time saved
0
specialized agents
Weeks
to go live
Why CareInsight

Built by industry insiders to help carriers automate and scale with AI.

Regulatory-first

Built for the rules you're audited on. Our agents encode CMS, HIPAA, NCQA, and ACA requirements into every workflow, with decision trails your compliance team can review.

Lowest-risk entry point

As industry insiders we know the risk payers take to change administrative processes. So, we've made it easy. Let us demonstrate the value before commiting deep pockets. One agent, one bottleneck, measurable ROI — it's not a gimmick, it's our promise.

Reimagine, not retool

Your team keeps the tools they know while the manual load goes away. The dashboard sits there ready, so when a user is prepared to leave an old system behind, the replacement is already running — no cutover project, no big-bang switch, no migration deadline.

Start with one agent.

A 20-minute discovery call — no pitch. Tell us your biggest bottleneck and we'll build the demo around it.