A woman for a health plan that enjoys using Ushur AI Agents to self-serve easy tasks.
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AI Agents for Member Service

Redefine member engagement with AI Agents

Empower your members with personalized, adaptive intelligence through agentic self-service experiences.

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Solution overview
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Context Aware

AI Agents provide tailored responses based on plan and member details, ensuring every interaction remains relevant and effective.

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Scalable Support

Offer 24x7 support without additional staffing, addressing time sensitive requests — especially during periods of peak demand.

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Compliant & secure

Designed with native guardrails and industry-leading standards like HIPAA, Ushur's AI Agents ensure proper usage while maintaining privacy and trust.

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Adaptable & accessible

Support a diverse member base with multilingual capabilities and a clear, easy-to-understand information tailored to a 6th-grade reading level.

AI Agent use cases screen
Program Eligibility
Program Eligibility
Simplify checking eligibility for wellness programs.
Prescription Refills or Transfers
Prescription Refills or Transfers
Automate prescription refills and pharmacy transfers.
Coverage Verification
Coverage Verification
Instantly verify coverage details for member inquiries.
Plan Options
Plan Options
Simplify exploration of healthcare plan options.
Pharmacy Network
Pharmacy Network
Help members find in-network pharmacies easily.
Prescription Coverage
Prescription Coverage
Instantly verify prescription drug coverage details.
Prior Authorizations
Prior Authorizations
Automate prior authorization requests for faster approvals.
Claims Disputes
Claims Disputes
Assist with resolving claims disputes efficiently.
Claim Status
Claim Status
Provide real-time updates on claim statuses.
Cost Estimation
Cost Estimation
Provide accurate cost estimates for medical services.
Second Opinions
Second Opinions
Simplify access to second opinions for better decisions.
Referral Assistance
Referral Assistance
Facilitate referral requests quickly and seamlessly.
Appointment Scheduling
Appointment Scheduling
Streamline scheduling of appointments for members.
Preventative Care Benefits
Preventative Care Benefits
Clarify available preventative care benefits.
Enrollment Status
Enrollment Status
Provide real-time updates on enrollment status.
Primary Care Provider Changes
Primary Care Provider Changes
Simplify provider change requests for members.
Contact Information Updates
Contact Information Updates
Automate contact details updates with ease.
ID Card Requests
ID Card Requests
Instantly process ID card requests for members.
Benefit Explanation
Benefit Explanation
Clarify benefit details quickly for member understanding.
Document Uploads
Document Uploads
Streamline secure uploads of required member documents.
Mobile App Support
Mobile App Support
Solve mobile app problems with minimal member effort.
Portal/Website Help
Portal/Website Help
Provide quick assistance for website navigation issues.
Password Resets
Password Resets
Automate password reset requests instantly and securely.

Automate key touchpoints across the healthcare member journey

Healthcare organizations can now elevate member experiences by automating critical touchpoints throughout the member journey. Ushur AI Agents enable fast, accurate, and personalized services, empowering members with access to the information they need without delays, reducing frustration and improving overall satisfaction.

Enable faster, more equitable access to member care — at scale

Despite available online help options, members continue to call in for routine inquiries. Eliminate barriers to essential information, ensuring members get the care they need — without overburdening your staff or compromising compliance.

Comprehensive, Compliant and Built for Healthcare

  • Trusted, Compliant Intelligence: Purpose-built for healthcare with deep domain expertise, delivering highly accurate responses while ensuring strict regulatory adherence.
  • Seamless, Scalable Engagement: An omnichannel platform that automates end-to-end member interactions across all digital touchpoints.
  • Rapid ROI, Faster Time-to-Value: Prebuilt for common call drivers with full customization, enabling enterprises to deploy quickly and see immediate impact.
Explore AI Agents

Features of AI Agents for Member Services

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Decision Making
Proactive Resolution
Multi-Modal Communications
Built-in Guardrails
Omni-Channel Engagement
Information Distillation
Multilingual Support

Adaptive Decision-Making

A powerful reasoning engine analyzes data from CRMs, enterprise knowledge bases and other sources to extract insights, determine the best course of action, and dynamically refine recommendations in real-time.

AI Agents for Member Services with enterprise specific intelligence

Proactive Resolution

Integrates with third-party applications and downstream systems, enabling proactive member support and streamlined resolutions.

AI Agents for Member Services with advanced workflows

Multi-Modal Communications

Enhances engagements with dynamic components like geo-location map integration and document uploads, enriching the experience beyond traditional text-based exchanges.

Interactive widgets for AI Agents

Built-in guardrails for compliance and security

Ensures responsible use by guiding members within appropriate boundaries, such as refraining from providing medical advice or responding to life threatening concerns in an empathetic yet compliant manner.

AI Agents with guardrails

Omni-channel engagement

Transitions the conversation across preferred channels, such as deflecting calls from voice to digital or sending summaries via text or email.

AI Agents that can communicate across channels

Information Distillation

Breaks down intricate healthcare details into clear, 6th-grade reading level language, enhancing accessibility and understanding.

AI Agents enabled for content simplification

Multilingual support

Supports English, Spanish, Chinese, Vietnamese, Korean and Portuguese to serve broader member demographics and support health equity.

AI Agents that are multilingual

Intelligent, Personalized Support — Anytime. Anywhere.

Leverage real-time data, plan-specific insights and proactive recommendations to deliver 24/7 support. Tailor guidance to each member by contextualizing their insurance plan and offering personalized, actionable recommendations.

AI Agents that know you
Custom branding & personas
Policy awareness & real-time validation
Cost transparency & health literacy
Enterprise-specific intelligence
Personalized, location-based options

Ready out of the box

Knowledge

Leverages organizational documents and data to deliver precise, context-aware answers to member inquiries, enhancing trust and satisfaction.

Summarize

Distills enterprise knowledge into clear, concise answers that are personalized for member action.

Reach your members wherever they are — with confidence and peace of mind

Rest assured the proper protocols are in place to keep every interaction compliant and secure.

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Trusted by top leaders in regulated industries

In industries where security and empathy matter most, Ushur AI Agents for Member Services is redefining customer engagement with seamless, compliant, and personalized experiences.

A Large Medicaid & Medicare Health Plan scales empathetic engagement

  • Handled 18% of web traffic through seamless self-service, reducing the need for live agent support.
  • Automated 21% of requests for four top call drivers—Member ID card requests, PCP changes, address updates, and contact information updates—streamlining common inquiries.
  • Resolved 36,000+ interactions independently, alleviating pressure on member service teams and improving efficiency.
  • Delivered over 20% of responses outside business hours, ensuring members received timely support whenever they needed it.
A Large Medicaid and Medicare Health Plan
In the past, AI technology wasn’t advanced enough to be trusted, often proving error-prone and unsuitable for sensitive situations like healthcare.Ushur’s AI Agent has changed that narrative by implementing robust guardrails that make AI reliable and accessible for regulated industries. Members now gain immediate access to personalized resources directly from our homepage, while our staff can focus on complex cases requiring human expertise.