BUILT INSIDE A HEALTH PLAN · PROVEN ON LIVE CALLS
Healthcare AI Agents for Health Plans and Providers
Conversational voice AI that answers members and patients from your own documents, 24/7 and in 26+ languages, resolves the routine, and hands the rest to your staff with the whole story already in hand.
For health plans, hospitals, health systems and provider groups.
Offered through a Call Center Concierge portfolio partner. Live in days, not months. Our advisory services are complimentary.
24/7
Always answering
No shifts, overtime or gaps
<600 ms
Response time
Natural, human-paced dialogue
26+
Languages
Ready for diverse members
7,000+
Voices
Pre-built or custom
250+
Integrations
CRM, EHR and scheduling
QUICK ANSWER
What is a healthcare AI agent?
A healthcare AI agent is conversational software that answers and places calls, texts and chats for health plans and providers. It understands natural speech, answers from your own plan or practice documents, completes tasks like scheduling, eligibility checks and claim lookups, and transfers to a person with full context when the call needs one.
Updated October 2026 · Reviewed by the Call Center Concierge team
WHY IT'S DIFFERENT FROM GENERIC AI
Conversational AI for healthcare that started in healthcare
Most AI voice tools are built for retail and adapted for healthcare later.
This platform wasn’t built in a lab. Our partner created it inside a US health insurer to handle its own member calls, then opened it to other health plans and providers. Built by operators, for operators.
Answers from your plan
Every answer comes from your own plan documents and cites its source. It never quotes a dollar amount it didn't read in the record.
Sounds truly human
No phone menus. Replies in under 600 ms, handles interruptions and speaks with empathy, in 7,000+ voices and 26+ languages.
Every call graded
Not a 2% to 5% sample. A separate AI scores every connected call against a compliance rubric your team controls, with the quote and timestamp behind each score.
Compliance built in
HIPAA, DNC and TCPA enforced live on every call, with PHI protection, opt-out detection, recordings and full audit trails.
Intelligent escalation
When a caller needs a person, a warm transfer passes along the full history, so the member never starts over.
Private by design
ISO 27001 and 27701 certified, encrypted at rest and in transit, with independent penetration testing. Tested against hostile callers before go-live.
THE PROBLEM IT SOLVES
Call volume keeps growing. Your headcount doesn't have to.
Health plans and providers handle millions of calls that consume staff time yet still need a natural, human touch. AI voice agents take the routine volume so your people can focus where they matter.
TODAY
Enrollment and seasonal surges overwhelm staff
WITH AI
Thousands of simultaneous calls, no extra headcount
TODAY
Robotic "press 3" menus frustrate members
WITH AI
Natural conversation that understands and resolves
TODAY
True 24/7 coverage is too costly to staff
WITH AI
Always on, with no shifts, overtime or gaps
TODAY
Nurses and specialists tied up on routine calls
WITH AI
Experts freed for complex, high-value cases
USE CASES
AI voice agent use cases
for health plans and providers
Inbound and outbound calls, text and chat, from member services and claims to patient scheduling and screening outreach. One platform for payers, hospitals, health systems and provider groups.
Member services
24/7 benefit questions, eligibility, deductibles and general member support.
Claims
Claim status, prior authorization confirmations, EOB and EOP verifications.
Member engagement
Welcome calls, wellness checks, Rx refills and care coordination.
Appointment scheduling
Booking, reminders, rescheduling and cancellations, automated.
Provider network
Outreach, education, directory verification and availability checks at scale.
Verifications
Insurance eligibility, provider participation and demographic updates.
Patient outreach
Screening reminders and care-gap campaigns with clinical escalation.
Surveys and feedback
Post-visit calls, satisfaction surveys and quality assessments.
PROVEN IN PRODUCTION
Real results for a medical center and a health plan
Not pilots or projections. Both programs ran in production on real patients, members and providers, with every outcome measured.
ACADEMIC MEDICAL CENTER
About $2.5M in imaging revenue from one patient outreach campaign
The center lacked staff to contact 1,000+ high-risk patients due or overdue for lung cancer screening scans. AI agents called and messaged each patient, booked open appointments and escalated to nurses and physicians.
~$2.5M
imaging revenue generated
1,000+
high-risk patients reached
9
late-stage cancers found early
US COMMERCIAL HEALTH PLAN
250,000+ provider calls in one year, without adding a seat
Practices held wrong plan details, so members were billed as self-pay. Calling a network of about 117,000 providers had never been staffed. The AI worked the list, graded every call and corrected roughly 15,000 records.
250,659
calls placed in 12 months
~15,000
directory errors corrected
$743K
yearly staffing value
Results from our portfolio partner's own production records, September 2025 to September 2026; first-party figures, not independently audited. More case studies
SECURITY AND COMPLIANCE
HIPAA-ready AI, compliant on every call
Most vendors promise compliance on a roadmap. This platform was built inside a health plan’s own operations and checks the rules during each conversation, not in a report afterward.
HIPAA
ISO 27001
TCPA
DNC
ISO 27701
PEN TESTED
HIPAA-ready architecture
End to end across the data path, with BAA terms confirmed per engagement.
ISO 27001 and 27701
Certified to ISO 27001:2022 for security and ISO 27701:2019 for privacy.
DNC and TCPA enforced live
Checked before every dial and during the call, with local quiet hours and consent on file.
Implicit opt-out detection
Catches the soft refusals a script would miss, like "I’m at work, thanks."
PHI protection
A graded compliance floor: requests for patient information declined correctly on 99.5% of calls.
Encryption and access control
Encrypted at rest and in transit, with zero-trust RBAC, SIEM logging and IP allowlisting.
Safety and crisis monitoring
Legal threats and crisis language flagged on every turn and sent to a named person the same day.
Full audit trail
Recordings, transcripts, roles and versioned agents, with every change recorded.
Independently pen tested
Internal and external security audits, with regular penetration testing.
THE CALL CENTER CONCIERGE DIFFERENCE
AI for the routine. People for what matters.
We also represent 24 vetted, HIPAA-compliant BPO partners with 100,000 agents. Pair the AI agent with experienced human teams, in the U.S., nearshore or offshore, for escalations, complex cases and seasonal surges like open enrollment.
24
vetted BPO partners
100,000
agents in 20 countries
1
point of contact
Fits the contact center you already run
250+ pre-built integrations and APIs for your CRM, EHR and scheduling systems, with a visual workflow builder. Deployment takes days, not months.
Genesys
Amazon Connect
Five9
NICE
Cisco
Avaya
Twilio
RingCentral
Vonage
Salesforce
HOW IT WORKS
Live in days, not months
01
Book a 30-minute demo
Hear the agent handle real health plan and patient calls, start to finish.
02
Pilot on your own data
Start with one phone number and one use case, built in a visual workflow builder.
03
Go live and grow
Add use cases, campaigns and human backup as the results come in.
FAQ
Healthcare AI agent questions, answered
Not seeing your question? Call 561-559-9065 or book a demo.
What is a healthcare AI agent?
A healthcare AI agent is conversational software that answers and places phone calls, texts and chats for health plans and providers. It understands natural speech, answers from your own plan or practice documents, completes tasks like scheduling or claim lookups, and transfers to a person when needed.
Is the AI agent HIPAA compliant?
The platform has HIPAA, DNC and TCPA support built in, is certified to ISO 27001:2022 and ISO 27701:2019, encrypts data at rest and in transit, and keeps call recordings, transcripts and full audit trails. BAA terms are confirmed per engagement.
Does it work for hospitals and provider groups?
Yes. Providers use it for appointment scheduling and reminders, insurance verification, patient outreach and screening campaigns, and post-visit surveys. One academic medical center generated about $2.5 million in imaging revenue from a single outreach campaign.
How is it different from a chatbot or IVR?
It holds natural, two-way conversations in under 600 ms instead of “press 3” menus, cites the plan document behind each answer, grades every connected call for compliance, and passes full context to staff on transfer.
Will it replace our call center staff?
No. In the reference deployment the work had never been staffed, so nobody was removed from a payroll. It takes routine, high-volume calls so nurses, specialists and agents can focus on complex cases, and Call Center Concierge can pair it with human teams from our BPO partners.
How long does it take to go live?
Days, not months. With 250+ pre-built integrations for CRM, EHR and scheduling systems, most organizations start with a scoped pilot on one phone number and one use case.
