AI Agents in Healthcare: Scaling Member Service for Faster, More Equitable Access

Medicaid and Medicare health plans face increasing member expectations, especially during seasonal surges like renewals and redetermination, open enrollment, and new plan year transitions. Limited live resources can make it difficult to deliver timely, effective support to members.

AI-powered Agents offer a scalable, secure, and empathetic solution—helping members complete self-service tasks such as updating primary care provider (PCP) selections, requesting ID cards, and getting answers to common benefits, services and support questions, all within digital platforms.

Join this session to learn how AI Agents are transforming health plan member engagement while ensuring HIPAA compliance and seamless escalation for complex inquiries.

Key takeaways include:

• Enhancing member support by quickly delivering benefits education and resolving routine requests.

• Ensuring compliance and accuracy with built-in guardrails that prevent AI “hallucinations” and enable warm transfers to live agents when needed.

• Leveraging human-in-the-loop strategies to maintain trust, empathy, and precision.

• Driving operational efficiency and member satisfaction with personalized, 24/7 digital assistance.

Presenters:

Dustin Roberts

Solution Consulting, Manager

Ushur

Yvonne Daugherty

Global Head of Industries

Ushur

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Automation platform built specifically for regulated industries. Purpose-built for delivering ideal self-service, Ushur infuses intelligence into digital experiences for the most delightful and impactful customer engagements. Equipped with guardrails and compliance-ready infrastructure, Ushur powers vertical AI Agents for healthcare, financial services and insurance use cases. Designed for rapid code-less deployment with flexible, advanced capabilities for IT and business teams, enterprises can transform customer and employee journeys at scale, driving faster time-to-value and improved outcomes.