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
Sales appointment setting and reminders
Member appointment setting with service or sales agents in support of their buying process
Redetermination journey support (Medicaid)
Support for member retention with ongoing redetermination process education, support and services - until redetermination is complete
Issues and Complaints
Proactively detect issues and escalate them as tickets to reduce complaints and improve satisfaction.
Medication adherence
Understand root causes of medication non-adherence and overcome them
Address Verification
Remind and support Borrower in securely verifying address and contact information during KYC Reviews.
Patient after hours support
Accurate, secure and compliant AI Agent patient inquiry and task completion support 24x7
Balance Inquiry
Provide Borrower with details of the current balance on their account.
Care Management connectivity
Notifications to educate on the importance of Care Management and set appointments
90-day fill conversion
Support for education and 90-day fill conversion
Member contact information collection / updates
Collection of cross-channel member contact information to support better communications
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
Paperless Statements
Ability for Borrowers to opt in to digital delivery of Statements.
Clinical guideline requests and inquiries
Ability for providers to request clinical guidelines
Annual Wellness Visit (AWV) outreach and scheduling
Education and appointment setting support for Annual Wellness Visits (AWV) with appointment reminders and reschedules
Notification of shipment with tracking number and delivery instructions
Notification of shipment with tracking number and delivery instructions (i.e. someone needs to be home at delivery)
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
Social Determinant of Health SDOH surveys
Social Determinant of Health SDOH survey completion with feeds to core systems for follow-up
Adult preventative wellness
Ongong adult preventative wellness education, appointment setting and other actions
Provider search and selection support (any provider)
Support member ability to search for any type of in network provider and click-to-call to set appointments
HIPAA Release
Securely upload a signed HIPAA release form from the Claimant.
Cost transparency (Good Faith Estimate)
Providing out of pocket cost transparency via Good Faith Estimates
Retail-to-mail conversion
Support for education and retail-to-mail conversion
Notification of shipment with tracking number and delivery instructions
Notification of shipment with tracking number and delivery instructions (i.e. someone needs to be home at delivery)
New patient welcome and information gathering
Patient education on provider and information and documentation completion
Cardiac Disease care management and navigation
Year-round support for members with Cardiac Disease - including education, wellness, care gap closure, appointment setting
Post-visit check-in and follow-up details / instructions
Sharing of pre visit instructions with ability to automate answers to inquiries
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
Extraction (Critical Illness)
Extract Critical Illness related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Chronic Condition care gap closure
Education, navigation support and appointment setting for any chronic condition care gap (diabetes, CKD...)
Profile Updates
Update Member information and contact preferences.
Click-to-call or chat to speak with Care Manager
Click-to-call or chat to speak to Care Manager / Navigator when needed
Click-to-call or chat to speak to pharmacy staff member
Click-to-call or chat to speak to pharmacy staff member when needed
Surveys - Health Risk & Need Assessments, SDOH, Post Care / Rx Fill Experiences
Member surveys of health risks and needs, SDOH and post care experience and NPS surveys
Provider roster directory updates
Ability for any provider to update their roster information for provider directory accuracy
Claim Status
Provide Policy Holder with the current status of a Claim.
Debt Management Plan
Proactively reach out to delinquent Borrowers to educate them on eligible Debt Management Plan options available and support their decision.
Medication adherence
Medication Adherence (overcome barriers - cost, transportation, adverse effects)
Medication reconciliation
Education and scheduling of Medication Reconciliation appointments
Cancer Screening outreach and scheduling
Education and appointment setting support for Cancer Screening with appointment reminders and reschedules
Post Disaster Outreach
Proactively reach out to Policy Holders after a Disaster, such as storm, wildfire, or flood to connect them to required services and relief, and to file any Claims if required.
Loan Modification
Proactively reach out to delinquent Borrowers to educate them on eligible Loan Modification options available and support their decision.
Digital consent
Ability for members to opt in to digital communications
Prior authorization education and updates for transparency
Ability for patients to receive push notices for, or make inquiries about, prior authorization status
Care education (preventative care)
Notifications to educate on the importance of adult and pediatric preventative care, related appointment setting
Grievance filing and updates
Ability for members to understand and file Grievances, and receive status updates
Overview of pharmacy supports and services
Overview of pharmacy support and services and population health and quality programs
Provider appointment setting and reminders
Patient appointment setting support with reminders and ability to reschedule
Schedule and prep instructions for PT / OT / other visits
Patient appointment setting support with visit prep instructions, reminders and ability to reschedule
SDOH Resources (transportation, food)
Support for understanding and accessing SDOH resources such as nutrition, transportation
Support for shipping / delivery issues, returns and reshipment
Support for shipping / delivery issues, returns and reshipment
Ongoing website, portal, & app adoption and utilization
Support for member ongoing utilization of website, traditional apps and portals
Product Comparison
Support for Applicants to find Insurance Plan options that best fit their needs.
Care education (chronic condition management)
Notifications to educate on the importance of chronic condition management, related appointment setting
Digital ID card delivery
Delivery of member ID cards digitally
Supporting Documents
Remind and support Member in securely uploading required supporting documents for a Claim.
Update Beneficiaries
Update Beneficiaries and respond to major life events to ensure Member's benefits are paid to intended individuals.
Cost transparency and cost relief
Education on cost tranparency and cost relief options
Click-to-call or chat to speak to other clinical staff member
Click-to-call or chat to speak to other clinical staff member when needed
Provider after hours support
Accurate, secure and compliant AI Agent provider inquiry and task completion support 24x7
Payment capture
Safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
Overview of PBM supports and services
Overview of PBM support and services and population health and quality programs
Medication refills and reminders
Sharing of medication refills and reminders with ability to capture and overcome reasons for non adherence
Chronic Condition Care Gap Closure
Education, navigation support and appointment setting for any chronic condition care gap (diabetes, CKD...)
90-day fill conversion
Support for education and 90-day fill conversion
Policy Reinstatement
Guide the Policy Holder through re-instating a lapsed policy.
Medication adherence:
Understand root causes of medication non-adherence and overcome them
Digital consent
Ability for members to opt in to digital communications
Proactive member out of pocket notifications
Proactive member out of pocket notifications – with support for “price shocks”
Experience and Net Promoter Score (NPS) surveys
Surveying capability for experiences and NPS scoring
Timely notifications to meet regulatory requirements
Ability to send notifications to members more timely to meet regulatory timing requirements
Eligibility & benefits verification
Ability for providers and pharmacies to perform eligibilty and benefits verification at the member level
Patient after hours support
Accurate, secure and compliant AI Agent patient inquiry and task completion support 24x7
Preventative wellness actions and care gap closure
Education, navigation support and appointment setting for any preventative wellness care gap (immunizations, cancer screenings)
Surveys - Health Risk & Need Assessments, SDOH, Post Care / Rx Fill Experiences
Member surveys of health risks and needs, SDOH and post care experience and NPS surveys
Policy Review (KYC)
Remind and support Member in securely uploading required supporting KYC documents during Policy Review.
Medication reconciliation appointment setting
Education and scheduling of Medication Reconciliation
First Notice of Loss (FNOL)
Guide the Policy Holder through reporting a loss and filing a Claim.
Payment capture
Safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
Click-to-call or chat to speak to pharmacy staff
Ability for pharma representatives to chat within Ushur journeys, and to warm call transfer to them
Behavioral Health care management and navigation
Year-round support for members with Behavioral Health conditions - including education, wellness, care gap closure, appointment setting
Pediatric preventative wellness
Ongoing pediatric preventative wellness education, appointment setting and other actions
Surgery Confirmation
Collect detailed surgical information, including operative reports, discharge summaries, and post-operative recovery plans from the Claimant.
Census Upload
Guide the Broker / Employer through uploading an updating Census file, Transforming it to the standard format required by the Carrier, and identifying any issues.
Appointment setting for preventive care screenings and visits
Proactive provider appointment reminders with the ability to reschedule rather than no show (any provider type)
Adult Preventative Wellness
Ongong adult preventative wellness education, appointment setting and other actions
Prior authorization communications and intake
Ability for providers and pharmacies to perform prior authorization inquiries, submit forms and information, and receive status updates
First Notice of Injury
Guide the Claimant through reporting an injury and filing a Claim.
Traditional app and portal registration support
Support for member app download and app and portal initial registration
Extraction (Hospital Indemnity)
Extract Hospital Indemnity related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Post-discharge information / education
Support for inpatient to facility or home transitions to ensure safety and decrease readmissions
Trailing Documents
Remind and support Applicant in securely uploading required supporting documents post Application.
Financial Health Education
Support Borrowers with advice, reminders, and empathy to guide them towards financially healthy payment behavior.
Retail-to-mail conversion
Support for education and retail-to-mail conversion
Trailing Documents
Remind and support Applicant in securely uploading required supporting documents post Application.
Digital Consent
Ability for Policy Holders to opt in to digital communications.
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)
Experience and Net Promoter Score (NPS) surveys
Surveying capability for experiences and NPS scoring
Fall prevention education and action
Education and connectivity to support resources for fall prevention (movement, home safety...)
Member contact information collection / updates
Collection of cross-channel member contact information to support better communications
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
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.
