AI Agent Studio for Medicare Advantage
Cut your intake processing costs Up to 50%
AI agents that layer onto your existing systems, driving better member and provider experiences with structured oversight at every step.
30 minutes. We start with your use case, not ours.
One workflow. One LOB. Measurable outcomes.
- ✓ Layers onto your existing claims and UM systems
- ✓ Full CMS audit trail documentation
- ✓ Human-in-the-loop governance controls
- ✓ Clear rollback path at any point
- ✓ Success metrics defined upfront
See the measurable difference AI Agent Studio delivers to your intake workflow.
Validate in a 60–90 day pilot with your real case volume.
If your intake operation depends on manual classification and data pulls, every new case adds latency across your entire resolution pipeline.
Your systems are under audit pressure
Every CMS rule change becomes a project. Every audit cycle exposes gaps that take months to close. Your legacy architecture wasn’t built for this pace of change.
Vendor sprawl is creating risk you can’t see
Shadow IT, contractor dependencies, and point solutions that don’t share data. The result: security exposure and escalations reaching your CEO’s desk.
Your SLA problems start at intake
Misclassified cases, incomplete data pulls, and manual routing add days before your investigator sees the file. Case aging traces back to one place: intake.
Your staffing can’t match your volume growth
Appeals, grievances, and provider disputes keep growing. Hiring takes months. Training takes longer. Meanwhile, your member and provider experiences are being damaged.
See how this fits your specific architecture. We’ll walk through your systems, your constraints, and your volume in 30 minutes.
Request My Briefing →AI agents configured for your Medicare Advantage and Medicaid workflows, layered onto your existing systems, with structured oversight at every step.
Cases classified in minutes, not days
The Classification Agent ingests appeals, grievances, and provider disputes from any channel, then applies CMS and plan-specific rules to categorize each case before a human ever touches it.
Investigation-ready cases from day one
The AI Agent pulls member, provider, auth, and claims data from your core systems, assembling a structured case package with the documentation your team needs immediately.
Your staff stays in control
Every case is prepared and handed off to your team for investigation and resolution. AI handles volume. Your people handle judgment. Governance authority never transfers to the machine.
One workflow, deployed in 90 days, measured against outcomes you define upfront.
Ingest
Receives appeal, grievance, and provider dispute data from emails, faxes, PDFs, and portal submissions.
Classify
Applies CMS rules and your plan-specific logic to categorize by type, urgency, and routing.
Enrich
Integrates with your Member, Provider, Auth, and Claims systems to pull relevant data into a complete case package.
Generate
Creates a structured, investigation-ready case file with full documentation.
Handoff
Passes the prepared case to your team. Full audit trail logged. Your staff’s decision authority preserved.
Ready to Scope Your Pilot?
One workflow. One line of business. Success metrics defined upfront. Clear rollback if targets aren’t met.
Request My Briefing →We’ll tailor the conversation to your plan size and systems.
Every design decision was made with CMS-regulated operations in mind.
Explainability and Audit Logs
Every decision is logged with full traceability: what was classified, what rules applied, what data pulled, and when.
Deterministic Behavior
Your AI agents execute against defined rule sets, not probabilistic outputs. Same input, same result. The predictability your health plan requires.
Human-in-the-Loop Controls
AI prepares. Your people decide. Investigation and final determinations stay with your staff. Governance authority never transfers.
Pilot with Defined Rollback
60 to 90 day scope. One workflow. One LOB. Your success metrics upfront. Clear exit at any point. No production dependencies during pilot.
Designed for how your procurement and IT teams actually evaluate new technology.
60–90 Days
Enough to validate against your real case volume without open-ended risk.
One Workflow
One intake workflow. One line of business. Success criteria agreed upon upfront with your team.
Layer On
Layers onto your existing claims, UM, and reporting systems. No changes to your core platform.
50%+ Cases
Over 50% of your cases processed by our Intake Agent, with full audit documentation.
Clear Exit
Clear exit path at any point. No production dependencies created during your pilot.
Risk Reversal
If the pilot doesn’t meet the success criteria you defined, you exit with no lock-in, no stranded costs, and no production dependencies.
A 30-minute conversation about how governed AI agents fit your specific Medicare infrastructure.
- ✓ 30 minutes, not a product demo
- ✓ Starts with your architecture, not ours
- ✓ Heavy on governance and compliance controls
- ✓ Tailored to your MA plan size and systems
- ✓ Follow-up within one business day
Schedule Your Briefing
No vendor pitch. Governance-first conversation.
Your Briefing Is Requested ✓
We’ll follow up within one business day with scheduling options. Your briefing will be tailored to your specific architecture, compliance requirements, and plan size.