Healthcare

Member management

Empower members with 24/7, self-service access to health plan benefits and dependent management to reduce call volumes and improve member experience.

Capabilities

Instant access to member services

Automate routine member inquiries across all channels through AI agents

Zero hold time

Multichannel support

Enable seamless access to plan information across voice, chat, SMS, and web, with AI agents that interpret requests in natural language and deliver real-time answers.

HIPAA compliant

Member authentication

Verify member identity against the health plan’s core system of record with customizable authentication rules, ensuring secure access to member data.

Instant resolution

Full transaction coverage

Handle member self-service actions like generating ID cards, health statements, eligibility checks, copay, coinsurance, out-of-pocket details, estimates, and dependent enrollment.

Core systems integrated

Real-time data retrieval

Retrieve contextual information from core systems of record, without re-authentication between query types.

Plain-language summary

Benefits explanation engine

Translate copays, coinsurance, and out-of-pocket details into clear, member-friendly language.

Compliance logged

Confirmation & audit trail

Confirm completed actions in-session, update records in real time, and log interactions for compliance.

Outcomes

Elevate satisfaction, reduce call volume

Give members 24/7 self-service and cut call volume across eight routine plan transactions.

2x

higher satisfaction with digital benefits access

35–50%

reduction in human-serviced contacts

10–25%

reduction in payer administrative expenses

Related use cases

Complete the payer member experience

Ready to give members 24/7 self-service access?

See how Kore.ai automates routine member inquiries to reduce inbound call volume and improve member satisfaction scores.