AI Agents for Health Plan Provider Services: 24/7 Coverage, Unlimited Scale
See How It Works
Marpai Health reduces call center service costs by 40% with Opyn Agents
- Angela Williams, Director of Customer Service
This isn't a fancy IVR—these are autonomous AI agents doing the work of human reps
Deflection & Verifiable ROI
70% Containment: Resolves high-volume inquiries end-to-end without human intervention.
Full Transparency: Complete administrative access to call logs, transcripts, and analytics.
Continuous Optimization: Real-time analytics identify edge cases and continuously expand agent scope.
Built by Healthcare Veterans, Not Consultants
Native Expertise: Purpose-built for healthcare operations, claims, and complex benefit structures.
Flexible Integration: Supports traditional EDI and flat-file extracts alongside real-time APIs.
Unmatched Task Depth: Complex network guidance, claim submission info, plan limits and exclusions and carrier specific prior auth rules, and more.
Enterprise Compliance & Strict Guardrails
Complete Traceability: Every interaction generates a case scored for resolution value and logged with NPI/TIN and provider name. Unresolved cases route seamlessly to internal teams.
Isolated Context Engine: Answers are generated strictly from your member files and SPDs—never public data.
Strict Guardrails: Rigid guardrails eliminate hallucinations and execute escalations when queries exceed agent scope.
Dual-Modality Access (Web + Voice)
Zero-Password Web Portal: NPI-gated access authenticated live against NPPES—no credentials required.
Intelligent Voice Agent: Immediate inbound NPI/TIN verification.
Unified Memory: Centralized case logs combine all web and voice interactions per provider/member.
SPD-Level Benefit Clarity
Procedure-Level Precision: Benefit limit tracking, specific cost-share, network tiers, and exact coverage definitions.
Complex Plan Rules: Intutive guidance for any kind of plan design — reference-based pricing, facility wraps, carve-outs, indemnity, dental, and vision.
Prior-Auth Routing: Surfaces exact pre-cert rules and transfers calls to the correct department.
Precision Escalations & Warm Handoffs
Smart Routing: Directs escalated calls to specific client or group lines to preserve SLA metrics.
Rich Context: Representatives receive real-time transcripts, audio, and AI summaries to speed resolution.
75% Work Completed: Our AI resolves most of the caller's request upfront, drastically reducing human handle time even on complex escalations.
Efficiency for service teams. Clarity for providers.
Reduce the clutter and focus on moments that matter
- Reduce call center volume and increase first-contact resolution
- Scale your business without adding headcount
- Trigger escalations to UM teams only when needed
- Mirror workflows across chat, voice, and portal
Faster access to the answers providers need
- Voice and web chat support for eligibility, benefits and claims
- NPI authentication with no login to set up
- Handle thousands of calls at one time
- Real-time data access with fewer delays or errors
Works with the systems you already use.
Opyn’s AI agents integrate directly into your existing engagement platforms and workflows—no replacement, rebuild or migration required. Use the agents on their own or connect them into the full Opyn platform whenever you're ready.
