Ushur Launches AI Agent for Member Service to Unlock Faster, More Equitable Access to Healthcare Information

New AI-driven solution accelerates HIPAA compliant member service delivery while fostering more empathetic and effective interactions.

Santa Clara, CA – March 4, 2025 – Ushur, a leader in Customer Experience Automation (CXA), today introduced its AI Agent for Member Service, the first-of-its-kind solution purpose-built to revolutionize health plan support. Powered by generative and agentic AI, this solution analyzes data, makes informed decisions and guides members to fast, seamless resolutions. By automating requests with empathetic, real-time assistance, Ushur’s AI Agent empowers health plans to scale service delivery while ensuring more equitable access to care.

With increasing demand for healthcare services and a shortage of resources, health plans are struggling to meet the needs of their members. In fact, despite digital investments, call centers remain inundated with only 25% of members and patients actively engaging with portals and apps, according to the National Institute of Health. Ushur’s AI Agent bridges this gap by offering fast, accurate, and empathetic responses, ensuring that members can access the support they need—at any time—without burdening already overworked customer support teams.

Health plans benefit from Ushur’s AI Agent in multiple ways, including:

  • Faster Resolutions: Automates common tasks–like benefits explanations, ID card replacements and Primary Care Physician updates–reducing turnaround times and operational costs.
  • Scalable Support: Manages 24x7 demand and peak periods like open enrollment without requiring additional staff.
  • Enhanced Member Satisfaction: Provides clear, accurate and empathetic responses that improve satisfaction and experience scores.
  • Proactive Engagement: Automates two-way updates for appointments, benefits information and claims progress to reduce member frustration and employee burden.
  • Compliance Adherence: Fully HIPAA-compliant with secure handling of sensitive data, ensuring peace of mind for both health plans and members.

"In our work with highly regulated industries, we recognize the critical importance of innovation rooted in security and trust," shares Simha Sadasiva, Co-Founder and CEO of Ushur. "Ushur’s AI Agent that we developed  is tailored with healthcare-specific guardrails, ensuring compliance and protecting customer data. These safeguards empower health plans to deliver round-the-clock personalized assistance to their members, achieving unprecedented levels of intelligence and efficiency. "

Powered by Ushur’s Customer Experience Automation™ platform, Ushur’s AI Agent seamlessly supports health plans to deliver intelligent, compliant, and empathetic member interactions.

  • Healthcare-Specific Intelligence: Finely tuned Large Language Models (LLMs) and knowledge graphs ensure precise, policy-driven responses tailored to payer-specific language.
  • 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.
  • Goal-Based Task Completion: Integrates with third-party applications and downstream systems, enabling proactive member support and streamlined resolutions.
  • Multimodal & Omni-Channel Engagement: Enhances interactions with dynamic elements like geo-location maps and file attachments, while seamlessly transitioning conversations across preferred digital channels, from text and email to voice and web portals.
  • Empathetic, Context-Aware Conversations: Built-in safeguards handle sensitive topics with care, escalating issues to human resources when needed while simplifying complex healthcare information to a 6th-grade reading level.
  • Privacy, Accessibility & Compliance: Adheres to HIPAA, the Affordable Care Act (ACA), and other regulations to protect Private Health Information (PHI), while supporting multiple languages, including English, Spanish, Chinese, Vietnamese, Korean, and Portuguese.

Health Plans are seeing rapid adoption and impactful results within just a few months – handling 18% of web traffic through seamless self-service to reduce live agent support, with 20% occurring after hours when staffing costs peak. Ushur is revolutionizing customer engagement for highly regulated industries with secure, empathetic and AI-driven solutions at scale. The AI Agent for Member Service embodies Ushur’s mission to enhance healthcare access and transform customer experiences for both businesses and the people they serve.

To see how Ushur’s AI Agent can help you provide faster, more equitable care, please visit www.ushur.com or contact us at anthony@scribewise.com.

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About Ushur

‍Ushur delivers the world’s first Customer Experience Automation platform built specifically for regulated industries. Purpose-built for delivering ideal self-service, Ushur infuses intelligence into digital experiences for the most delightful and impactful customer engagements. Equipped with guardrails and compliance-ready infrastructure, Ushur powers vertical AI Agents for healthcare, financial services and insurance use cases. Designed for rapid code-less deployment with flexible, advanced capabilities for IT and business teams, enterprises can transform customer and employee journeys at scale, driving faster time-to-value and improved outcomes.