AI Agent spotlight: How Intelligent Agents streamline workflows for healthcare payers

Healthcare payers face increasing pressure to reduce costs, streamline approvals, and accelerate value-based care in addition to handling widespread uncertainty caused by constrained reimbursement growth, a shifting product mix, and drastic policy and regulation changes. Combined, these factors make it more challenging than ever to stay profitable while continuing to ensure positive outcomes for members. Unfortunately, legacy systems and siloed point solutions contribute to inefficiencies and revenue leakage, leaving money on the table and preventing payers from truly innovating for success. 

AI Agents offer a future-ready solution for payers: a digital workforce that enhances human teams and automates core operations at scale. 

AI Agents for healthcare payers

AI Agents are software that can autonomously execute complex workflows. At Notable, Agents are built on an AI Platform that leverages NLPs, LLMs, clinical algorithms, and document processing to ensure the Intelligent Agent can integrate directly with EHRs and payer systems to tackle every step of the workflow.

AI Agents offer scalable automation, real-time decision-making, and high levels of customization for payers. At Notable, we offer AI Agents that are designed to transform payer operations by: 

1. Reducing administrative expenses
2. Assessing and managing risk 
3. Managing and streamlining the revenue cycle
   

These outcomes are achieved with AI Agents that can automate key workflows crucial to increasing productivity and efficiency at health plans: 

• Contact Center AI Agent: Our Contact Center AI Agent helps reduce administrative expenses by automating interactions with your members. An Intelligent Contact Center Agent can handle inbound member inquiries across different departments, from billing and claims to outbound calls for member outreach. By reducing administrative expenses internally, payers can improve margins and maximize profit. 
• Care Coordinator AI Agent: A Care Coordinator AI Agent can manage both administrative and clinical expenses, helping to complete new member onboarding, conduct health risk assessments, manage care transitions, and support adherence workflows. It gathers critical health information to inform care plans and ensure they deliver care efficiently.
• Revenue Cycle Management AI Agent: The Revenue Cycle Management AI Agent supports efficient financial and administrative operations, ensuring accurate documentation and coding to improve claims accuracy and reduce denials, quicker turnaround times for prior authorizations and other approvals. It also facilitates efficient collection of premiums, cleaner claims, and faster, more accurate reimbursement cycles.
  

What this means for payer operations

Payers using Notable’s AI Agents can expect higher-quality member experiences while also lowering medical and administrative costs. This results in improved revenue and millions of dollars in annual cost savings.

Security Health Plan, a not-for-profit health maintenance organization within the Marshfield Clinic Health System, brought Notable on as a one-stop shop for chronic condition review that integrates into the EHR. Following the implementation of Notable’s AI platform, Security Health Plan increased its accuracy rate of persistent HCC codes by 6.4%, uncovered $7.1M additional annual revenue attributed to provider documentation, and drove $467 PMPY additional revenue for patient care.

Achieving digital workforce transformation 

Payers need agility, scalability, and precision to operate as efficiently as possible and prevent revenue from slipping through the cracks. Notable’s AI platform allows payers to combine AI Agents to support cross-functional workflows, from referral to care gap closure, leading to full digital workforce transformation across the organization. 

Ready to see how AI Agents can streamline your operations? Book a demo to explore how we’re partnering with payers to automate what matters most.

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