The AI Agent-powered platform for customer experience
Deliver proactive inbound and outbound engagement across every customer interaction — with compliance and auditability embedded by design.
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 the modern enterprise. Secure, compliant, and designed to resolve customer needs from start to finish.
Prior authorization communications and intake
Ability for providers and pharmacies to perform prior authorization inquiries, submit forms and information, and receive status updates
Prior Authorization transparency support
Ability for members to receive push notices for, or make inquiries about, prior authorization status
First Notice of Loss
Guide the Claimant through the process of reporting the death of a Policy Holder and filing a Claim.
Hospital discharge support
Support for inpatient to facility or home transitions to ensure safety and decrease readmissions
Appointment scheduling, reminders and rescheduling
Support for finding an in network provider and setting appointment via click-to-call or scheduling system integration
Shipping status updates
Shipment status updates
Live Member Service chats and warm call transfers
Ability for service representatives to chat within Ushur journeys, and to warm call transfer to them
Transition of care support
Support for inpatient to facility or home transitions to ensure safety and decrease readmissions
Proactive member out of pocket notifications
Proactive member out of pocket notifications – with support for “price shocks”
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
Redetermination journey support (Medicaid)
Support for member retention with ongoing redetermination process education, support and services - until redetermination is complete
Appointment scheduling, reminders and rescheduling (any provider type)
Patient appointment setting support with reminders and ability to reschedule
ER avoidance
Education on when to use sites of care that are alternatives to the ER (telehealth, urgent care)
Claims status
Ability for members to receive push notices for, or make inquiries about, claims status
Maternal health navigation
Support for full maternity journeys with education, appointment setting, wellness and more
Profile Updates
Update Member information and contact preferences.
Respiratory Care care management and navigation (COPD, Asthma)
Year-round support for members with Respiratory Disease - including education, wellness, care gap closure, appointment setting
Stay at Work
Guide the Member through potential insurance benefits and available workplace accommodations, reduced hours, and reassignments to help them decide between different disability options.
Proactive member out of pocket notifications
Proactive member out of pocket notifications – with support for “price shocks”
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
Email Triage
Automatically triage incoming servicing emails to identify intent and respond to service requests.
Support for shipping / delivery issues, returns and reshipment
Support for shipping / delivery issues, returns and reshipment
Member contact information collection / updates
Collection of cross-channel member contact information to support better communications
Policy Renewal
Guide the Policy Holder through renewing their policy.
Care education (preventative care)
Notifications to educate on the importance of adult and pediatric preventative care, related appointment setting
Digital Consent
Ability for Members to opt in to digital communications.
Pediatric Preventative Wellness
Ongoing pediatric preventative wellness education, appointment setting and other actions
Issues and Complaints
Proactively detect issues and escalate them as tickets to reduce complaints and improve satisfaction.
Supporting Documents
Remind and support Member in securely uploading required supporting documents for a Claim.
Bill pay - payment capture
Bill delivery with safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
Retail, mail order, 90-day medication refills
Support medication adherence with retail, mail order and 90-day refill request support
Sales appointment setting and reminders
Member appointment setting with service or sales agents in support of their buying process
Payment capture
Safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
Prior Authorization transparency support
Ability for members to receive push notices for, or make inquiries about, prior authorization status
Click-to-call or chat to speak to pharmacy staff member
Click-to-call or chat to speak to pharmacy staff member when needed
Medication reconciliation
Education and scheduling of Medication Reconciliation appointments
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
Incontinence education and support
Education and connectivity to support resources for incontenence
Retail-to-mail conversion
Support for education and retail-to-mail conversion
Annual Wellness Visit (AWV) outreach and scheduling
Education and appointment setting support for Annual Wellness Visits (AWV) with appointment reminders and reschedules
Payment Status
Provide Policy Holder with the current status of a payment on a Claim.
Make Payment
Securely accept full or partial payment of outstanding installment amount.
Member after hours support
Accurate, secure and compliant AI Agent member inquiry and task completion support 24x7
90-day fill conversion
Support for education and 90-day fill conversion
Transition of Care Support Readmission Avoidance
Support for inpatient to facility or home transitions to ensure safety and decrease readmissions
Extraction (Basic Life)
Extract Basic Life related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Pediatric preventative wellness
Ongoing pediatric preventative wellness education, appointment setting and other actions
Plan Design
Triage inbound RFP emails to identify key attributes regarding Broker, Employer, Quote, and requested Products and automate case setup in Quoting and Underwriting systems.
Medication adherence
Medication Adherence (overcome barriers - cost, transportation, adverse effects)
Trailing Documents
Remind and support Applicant in securely uploading required supporting documents post Application.
Product Comparison
Support for Applicants to find Insurance Plan options that best fit their needs.
Member information updates
Member information updates – including cross-channel contact details and change of insurance
Vaccination reminders, education, appointment scheduling, and paperwork
Debt Management Plan
Proactively reach out to delinquent Borrowers to educate them on eligible Debt Management Plan options available and support their decision.
Prior authorization education and updates for transparency
Ability for patients to receive push notices for, or make inquiries about, prior authorization status
Product Comparison
Support for Applicants to find Lending options that best fits their needs.
Shipping status updates
Shipment status updates
Brand-to-generic conversion
Support for education and brand to generic fill conversion
Benefits Education
Answer policy holder questions on Plan benefits, coverage, and eligibility.
Policy Reinstatement
Guide the Policy Holder through re-instating a lapsed policy.
Shipping status updates
Shipment status updates
Digital Consent
Ability for Borrowers to opt in to digital communications.
Enrollment in mail order program and Rx transfers
Education on benefits of mail order delivery and Rx transfer support
Surgery Confirmation
Collect detailed surgical information, including operative reports, discharge summaries, and post-operative recovery plans from the Claimant.
Retail-to-mail conversion
Support for education and retail-to-mail conversion
Care plan adherence
Notifications to educate on the importance of care plan adherence, related appointment setting
Care education (chronic condition management)
Notifications to educate on the importance of chronic condition management, related appointment setting
Enrollment in mail order program and Rx transfers
Education on benefits of mail order delivery and Rx transfer support
Cost transparency and cost relief
Education on cost tranparency and cost relief options
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)
Digital ID Card
Securely deliver a digital copy of Member's Insurance ID Card upon request.
Post-discharge information / education
Support for inpatient to facility or home transitions to ensure safety and decrease readmissions
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.
Update Beneficiaries
Update Beneficiaries and respond to major life events to ensure Member's benefits are paid to intended individuals.
Click-to-call or chat to speak with Care Manager
Click-to-call or chat to speak to Care Manager / Navigator when needed
Chronic Condition care gap closure
Education, navigation support and appointment setting for any chronic condition care gap (diabetes, CKD...)
Digital ID card delivery
Delivery of member ID cards digitally
Cost transparency (Good Faith Estimate)
Providing out of pocket cost transparency via Good Faith Estimates
Extraction (Long Term Disability)
Extract Long Term Disability related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Escrow Review
Guide Borrower through shortfalls or excesses in their escrow account, the tax or insurance payments that led to the shortfall, and to securely accept payments for any shortfall.
New member welcome
New member welcome, overview of PBM supports and services, info gathering / sharing (including insurance ID card capture)
Cost transparency and cost relief
Education on cost tranparency and cost relief options
Follow-up appointment scheduling
Patient appointment setting support with reminders and ability to reschedule
Member contact information collection / updates
Collection of cross-channel member contact information to support better communications
Vaccination reminders, education, appointment scheduling, and paperwork
Chronic Kidney Disease CKD care management and navigation
Year-round support for members with Chronic Kidney Disease - including education, wellness, care gap closure, appointment setting
Delivery Confirmation
Collect detailed delivery information, hospital discharge summaries from the Claimant to trigger benefits.
Find a Provider
Patient support in finding in network doctors (of any type) that best fit their needs
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
Renewal education and reminders
Support for member retention with renewal education and reminders
SDOH Resources (transportation, food)
Support for understanding and accessing SDOH resources such as nutrition, transportation
Email Triage
Automatically triage incoming servicing emails to identify intent and respond to service requests.
Clinical guideline requests and inquiries
Ability for providers to request clinical guidelines
Follow-up appointment scheduling
Patient appointment setting support with reminders and ability to reschedule
Traditional app and portal registration support
Support for member app download and app and portal initial registration
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
Shopper plan compare support
Member support in finding a health insurance plan that best fits their needs
Musculoskeletal (MSK) care management and navigation
Year-round support for members with Musculoskeletal conditions - including education, wellness, care gap closure, appointment setting
Medication reconciliation appointment setting
Education and scheduling of Medication Reconciliation
Proactive Rx status notifications
Proactive Rx status notifications (fill status, issues like prior auth)
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.
