AI Agent Studio for Medicare Advantage
Cut your intake processing costs up to 50%
AI agents that sit inside existing Medicare workflows, with governed oversight and full audit trails. No system replacement required.
- ✓ Layers onto Facets, QNXT, AMISYS and other core systems
- ✓ Full CMS audit trail on each AI decision
- ✓ Human-in-the-loop controls at each critical step
- ✓ 60- to 90-day pilot with a clear rollback path
30 minutes. We start with what you’re dealing with, not what we’re selling.
Schedule an architecture briefing
30 minutes. Focused on how this fits the systems you already run.
No vendor pitch. Governance-first conversation.
Briefing requested
We’ll follow up within one business day with scheduling options tailored to your architecture and plan size.
+ 14 more
When intake depends on manual classification and data pulls, each new case adds latency across the entire resolution pipeline. Here’s where it shows up.
CMS rule changes outpace the systems that enforce them
Each regulatory update becomes a project. Audit cycles expose gaps that take months to close. The architecture wasn’t built for this pace of change.
Point solutions are multiplying without shared visibility
Shadow IT, contractor dependencies and tools that don’t share data. The result: security exposure and escalations that reach the CEO’s desk.
Case aging starts before an investigator sees the file
Misclassified cases, incomplete data pulls and manual routing add days to intake. By the time a case reaches investigation, timeliness is already at risk.
Headcount can’t scale with volume, but SLA deadlines don’t adjust
Appeals, grievances and provider disputes keep growing. Hiring takes months. Training takes longer. Member and provider experiences absorb the delay.
See how this maps to the systems and constraints you’re working with.
Request My Briefing →AI agents configured for Medicare Advantage workflows, layered onto the claims and UM systems already in place.
Cases classified in minutes, not days
The AI Intake Agent receives appeals, grievances and provider disputes from any channel. It applies CMS and plan-specific rules to classify each case by type, urgency and routing before a person touches it.
Complete case packages, assembled automatically
The AI Agent pulls member, provider, authorization and claims data from core systems and assembles everything an investigator needs to begin work. No copy-paste across systems.
Staff stay in control. AI handles the prep work.
Each case is prepared and delivered to the team for investigation and resolution. Full audit trail logged on every AI action. Decision authority stays with staff.
Measurable differences in a 60- to 90-day pilot against real case volume.
Validate against real case volume in a 60- to 90-day pilot.
Ready to scope your pilot?
One workflow, one line of business, success metrics defined before go-live. Clear rollback if targets aren’t met.
Request My Briefing →Tailored to plan size and systems.
Design decisions were made for CMS-regulated operations.
Audit logs on each decision
Actions logged with full traceability. What was classified, what rules applied, what data was pulled and when.
Deterministic execution
AI agents execute against defined rule sets, not probabilistic models. Same input, same result.
Human-in-the-loop controls
AI prepares. People decide. Investigation and final determinations stay with staff.
Defined rollback
60- to 90-day scope, one workflow, one LOB. Success metrics set before go-live. Clear exit at any point.
Designed for how procurement and IT teams actually evaluate technology.
Risk reversal
If the pilot doesn’t meet the success criteria defined upfront, you walk away. No lock-in, no stranded costs, no production dependencies.
A 30-minute conversation about how governed AI agents fit specific Medicare infrastructure.
- ✓ 30 minutes, not a product demo
- ✓ Starts with the architecture in place, not ours
- ✓ Governance and compliance controls covered
- ✓ Tailored to plan size and systems
- ✓ Follow-up within one business day
Schedule a briefing
No vendor pitch. Governance-first conversation.
Briefing requested
We’ll follow up within one business day with scheduling options tailored to your architecture and plan size.