The Agentic Healthcare Payer

Healthcare payers face clear and compounding challenges. Claims volumes continue to rise, fraud and payment leakage erode margins, and regulatory scrutiny grows more intense. Meanwhile, members expect seamless, consumer-grade experiences that most payers are not structurally designed to deliver. Fragmented systems, manual processes, and reactive service models make it difficult to control costs without compromising performance.

This POV introduces the agentic healthcare payer enterprise and shows how to build the foundational capabilities needed to power one. It explores the steps payers can take to shift from manual, queue-based operations to intelligent systems that learn continuously and act in real time to elevate accuracy, speed, and member experiences.

Download this whitepaper to learn:

• How agentic AI transforms claims operations and payment integrity by acting across the full payment lifecycle
• Where autonomous agents can improve member engagement, retention, and service efficiency
• How payers can maintain provider directory accuracy and credentialing compliance at scale
• Practical starting points for piloting agentic capabilities with measurable ROI