The AI Agent-powered CX platform for regulated industries
Purpose-built for regulated industries, delivering proactive outbound and inbound engagement — with compliance and auditability embedded into every interaction.
AI Agents That Deliver Better CX — Built on Trust
Trust-Native Architecture
Built-in governance embeds guardrails, policy enforcement, and human oversight directly into AI execution.
Maintain real-time visibility into agent behavior, reasoning, and performance.
Replay conversations end to end and generate regulator-ready records on demand.
Safeguard PHI, PII, and financial data with policy-aware segmentation and governed access.
The Ushur Agentic Platform
Enterprise AI Agents
AI agents that plan, reason, retrieve data, validate inputs, and resolve complex customer requests end-to-end — with built-in governance, human-in-the-loop safeguards, and full audit visibility.
One Platform. Endless Possibilities
A curated suite of Customer Experience Automation use cases built for regulated enterprises. Secure, compliant, and designed to resolve customer needs from start to finish
Traditional app and portal registration support
Support for member app download and app and portal initial registration
Live Member Service chats and warm call transfers
Ability for service representatives to chat within Ushur journeys, and to warm call transfer to them
Profile Updates
Update Member information and contact preferences.
Sales appointment setting and reminders
Member appointment setting with service or sales agents in support of their buying process
Trailing Documents
Remind and support Applicant in securely uploading required supporting documents post Application.
SDOH Resources (transportation, food)
Support for understanding and accessing SDOH resources such as nutrition, transportation
Refill reminders and ordering facilitation
Refill reminders and ordering facilitation (including payment capture)
Issues and Complaints
Proactively detect issues and escalate them as tickets to reduce complaints and improve satisfaction.
Follow-up appointment scheduling
Patient appointment setting support with reminders and ability to reschedule
Balance Inquiry
Provide Borrower with details of the current balance on their account.
Prior authorization communications and intake
Ability for providers and pharmacies to perform prior authorization inquiries, submit forms and information, and receive status updates
Borrower After hours Support
Accurate, secure and compliant AI Agent Borrower inquiry and task completion support 24x7
Support for shipping / delivery issues, returns and reshipment
Support for shipping / delivery issues, returns and reshipment
Certificate of Insurance (COI)
Respond to Policy Holder requests for copies of Certificate of Insurance (COI) with secure delivery of documents.
Member information updates (i.e. add dependant)
Collection of member information updates such as adding dependants, changing address, etc
Pediatric preventative wellness
Ongoing pediatric preventative wellness education, appointment setting and other actions
Member after hours support
Accurate, secure and compliant AI Agent member inquiry and task completion support 24x7
Care education (chronic condition management)
Notifications to educate on the importance of chronic condition management, related appointment setting
Appointment reminder and rescheduling
Member appointment reminders for care management, provider appointments (any type), home health visits and more
Prior Authorization transparency support
Ability for members to receive push notices for, or make inquiries about, prior authorization status
Email Triage
Automatically triage incoming servicing emails to identify intent and respond to service requests.
Medication adherence
Understand root causes of medication non-adherence and overcome them
Member information updates
Member information updates – including cross-channel contact details and change of insurance
Make Payment
Securely accept full or partial payment of outstanding installment amount.
Transition of Care Support Readmission Avoidance
Support for inpatient to facility or home transitions to ensure safety and decrease readmissions
Employer Onboarding
Guide the Broker / Employer through the information required from them to onboard them into the Carrier's core systems.
Policy Cancellation
Guide the Policy Holder through cancelling their policy.
Appointment scheduling, reminders and rescheduling (any provider type)
Patient appointment setting support with reminders and ability to reschedule
Maternal health navigation
Support for full maternity journeys with education, appointment setting, wellness and more
Pediatric Preventative Wellness
Ongoing pediatric preventative wellness education, appointment setting and other actions
Incontinence education and support
Education and connectivity to support resources for incontenence
Payment Status
Provide Policy Holder with the current status of a payment on a Claim.
Retail-to-mail conversion
Support for education and retail-to-mail conversion
Benefits Education
Answer Member questions on Plan benefits, coverage, and eligibility.
Medication reconciliation
Education and scheduling of Medication Reconciliation appointments
ER avoidance
Education on when to use sites of care that are alternatives to the ER (telehealth, urgent care)
Care Management connectivity
Notifications to educate on the importance of Care Management and set appointments
First Notice of Injury
Guide the Claimant through reporting an injury and filing a Claim.
Explanation of Benefits (EOB) notices and education
Education and notices on Explanation of Benefits (EOB)
Schedule Appointment
Schedule follow up call with Sales Representative with reminders and rescheduling.
Cancer Screening outreach and scheduling
Education and appointment setting support for Cancer Screening with appointment reminders and reschedules
Post care Surveys (NPS, CAHPs and HOS- like)
Post care and pharmacy visit surveys to understand experience gaps for proactive outreach and support as needed
Loan Modification
Proactively reach out to delinquent Borrowers to educate them on eligible Loan Modification options available and support their decision.
Live clinical chats and warm call transfers
Ability for clinical representatives to chat within Ushur journeys, and to warm call transfer to them (RN, Pharma, Care Manager)
Extraction (Vision)
Extract Vision related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Digital consent
Ability for members to opt in to digital communications
Brand-to-generic conversion
Support for education and brand to generic fill conversion
Payment Status
Provide Member with the current status of a payment on a Claim.
Timely notifications to meet regulatory requirements
Ability to send notifications to members more timely to meet regulatory timing requirements
Records transfer paperwork
Completion of forms and e-signing records transfer paperwork
Vaccination reminders, education, appointment scheduling, and paperwork
Digital ID Card
Securely deliver a digital copy of Policy Holder's Insurance ID Card upon request.
Appointment setting for preventive care screenings and visits
Proactive provider appointment reminders with the ability to reschedule rather than no show (any provider type)
Annual Notice of Change (ANOC) FAQs
Proactive notifications and inquiry handling about Medicare Annual Notices of Change. Including FAQ support for top ANOC call drivers
Member contact information collection / updates
Collection of cross-channel member contact information to support better communications
Chronic condition care navigation
Education, care management, navigation support and appointment setting for any chronic condition (diabetes, CKD...)
Medication reconciliation
Education and scheduling of Medication Reconciliation appointments
Social Determinant of Health SDOH surveys
Social Determinant of Health SDOH survey completion with feeds to core systems for follow-up
Paperless Statements
Ability for Borrowers to opt in to digital delivery of Statements.
Extraction (Voluntary Life)
Extract Voluntary Life related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Timely notifications to meet regulatory requirements
Ability to send notifications to members more timely to meet regulatory timing requirements
Retail-to-mail conversion
Support for education and retail-to-mail conversion
90-day fill conversion
Support for education and 90-day fill conversion
Behavioral Health care management and navigation
Year-round support for members with Behavioral Health conditions - including education, wellness, care gap closure, appointment setting
Grievance filing and updates
Ability for members to understand and file Grievances, and receive status updates
Profile Updates
Update Borrower information and contact preferences.
Appeal filing and updates
Ability for members to understand and file Appeals, and receive status updates
Census Transformation
Identify Census files in an inbound RFP and Transform the file to the standard format required by the Carrier and identify any issues.
Proactive member out of pocket notifications
Proactive member out of pocket notifications – with support for “price shocks”
Post Care Surveys (NPS, CAHPs and HOS- like)
Post care and pharmacy visit surveys to understand experience gaps for proactive outreach and support as needed
Schedule Appointment
Schedule follow up call with Sales Representative with reminders and rescheduling.
Support for shipping / delivery issues, returns and reshipment
Support for shipping / delivery issues, returns and reshipment
Sales appointment setting and reminders
Member appointment setting with service or sales agents in support of their buying process
Digital Consent
Ability for Policy Holders to opt in to digital communications.
Proactive Rx status notifications
Proactive Rx status notifications (fill status, issues like prior auth)
Click-to-call or chat to speak to member service
Ability for service representatives to chat within Ushur journeys, and to warm call transfer to them
Debt Management Plan
Proactively reach out to delinquent Borrowers to educate them on eligible Debt Management Plan options available and support their decision.
Extraction (Basic Life)
Extract Basic Life related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Clinical guideline requests and inquiries
Ability for providers to request clinical guidelines
Extraction (Dental)
Extract Dental related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Live Member Service chats and warm call transfers
Ability for member service representatives to chat within Ushur journeys, and to warm call transfer to them
Experience and Net Promoter Score (NPS) surveys
Surveying capability for experiences and NPS scoring
Medication reconciliation
Education and scheduling of Medication Reconciliation appointments
Provider credentialing with Plan
Support for provider credentialing information submission and status updates
Overview of PBM supports and services
Overview of PBM support and services and population health and quality programs
Experience and Net Promoter Score (NPS) surveys
Surveying capability for experiences and NPS scoring
Click-to-call or chat to speak to pharmacy staff member
Click-to-call or chat to speak to pharmacy staff member when needed
Payment capture
Safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
Policy Review (KYC)
Remind and support Policy Holder in securely uploading required supporting KYC documents during Policy Review.
Preventative wellness
Education and appointment setting for preventative wellness medications, immunizations and tests
Update Beneficiaries
Update Beneficiaries and respond to major life events to ensure Policy Holder's benefits are paid to intended individuals.
Chronic Condition care gap closure
Education, navigation support and appointment setting for any chronic condition care gap (diabetes, CKD...)
Medication refills and reminders
Sharing of medication refills and reminders with ability to capture and overcome reasons for non adherence
Cost transparency and cost relief
Education on cost tranparency and cost relief options
Hospital discharge support
Support for inpatient to facility or home transitions to ensure safety and decrease readmissions
Extraction (Accidental Death & Dismemberment)
Extract Accidental Death and Dismemberment related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Enrollment in mail order program and Rx transfers
Education on benefits of mail order delivery and Rx transfer support
Respiratory Care care management and navigation (COPD, Asthma)
Year-round support for members with Respiratory Disease - including education, wellness, care gap closure, appointment setting
Click-to-call or chat to speak to sales representative
Ability for service or sales representatives to chat within Ushur journeys, and to warm call transfer to them
First Notice of Loss
Guide the Claimant through the process of reporting the death of a Policy Holder and filing a Claim.
Don’t see the use case you are looking for? Let’s talk about your unique requirements. Schedule time with our team to explore what is possible.
