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
Member after hours support
Accurate, secure and compliant AI Agent member inquiry and task completion support 24x7
Email Triage
Automatically triage incoming servicing emails to identify intent and respond to service requests.
Enrollment in mail order program and Rx transfers
Education on benefits of mail order delivery and Rx transfer support
Proactive Rx status notifications
Proactive Rx status notifications (fill status, issues like prior auth)
Adult preventative wellness
Ongong adult preventative wellness education, appointment setting and other actions
Patient questionnaire automation
Capture of patient information updates and support for review and e-signature for new patient paperwork
Digital ID Card
Securely deliver a digital copy of Member's Insurance ID Card upon request.
SDOH resources (transportation, food)
Support for understanding and accessing SDOH resources such as nutrition, transportation
Traditional app and portal registration support
Support for member app download and app and portal initial registration
Retail-to-mail conversion
Support for education and retail-to-mail conversion
Patient after hours support
Accurate, secure and compliant AI Agent patient inquiry and task completion support 24x7
Provider appointment setting and reminders
Patient appointment setting support with reminders and ability to reschedule
Digital consent
Ability for members to opt in to digital communications
Experience and Net Promoter Score (NPS) surveys
Surveying capability for experiences and NPS scoring
Cost transparency and cost relief
Education on cost tranparency and cost relief options
Digital ID card delivery
Delivery of member ID cards digitally
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
Member contact information collection / updates
Collection of cross-channel member contact information to support better communications
Extraction (Voluntary Life)
Extract Voluntary Life related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Prior Authorization transparency support
Ability for members to receive push notices for, or make inquiries about, prior authorization status
Follow-up appointment scheduling
Patient appointment setting support with reminders and ability to reschedule
Update Beneficiaries
Update Beneficiaries and respond to major life events to ensure Member's benefits are paid to intended individuals.
Benefit awareness and literacy
Support for member education on benefits and how to utilize them throughout the plan year
Benefits Education
Answer Member questions on Plan benefits, coverage, and eligibility.
Chronic Condition Care Gap Closure
Education, navigation support and appointment setting for any chronic condition care gap (diabetes, CKD...)
Bill pay - payment capture
Bill delivery with safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
Medication reconciliation appointment setting
Education and scheduling of Medication Reconciliation
Cancer Screening outreach and scheduling
Education and appointment setting support for Cancer Screening with appointment reminders and reschedules
Employer Onboarding
Guide the Broker / Employer through the information required from them to onboard them into the Carrier's core systems.
KYC Supporting Documents
Remind and support borrower in securely uploading required supporting KYC documents during Onboarding.
Shipping status updates
Shipment status updates
New patient welcome and information gathering
Patient education on provider and information and documentation completion
Medication adherence:
Understand root causes of medication non-adherence and overcome them
Care Management connectivity
Notifications to educate on the importance of Care Management and set appointments
Payment capture
Safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
Brand-to-generic conversion
Support for education and brand to generic fill conversion
Appointment setting for preventive care screenings and visits
Proactive provider appointment reminders with the ability to reschedule rather than no show (any provider type)
Hardship Inquiry
Reach out to delinquent Borrowers with empathy to identify circumstances such as job loss, illness, divorce, deployment that may be eligible for relief measures.
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
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.
Refill reminders and ordering facilitation
Refill reminders and ordering facilitation (including payment capture)
Payment Status
Provide Member with the current status of a payment on a Claim.
Member information updates
Member information updates – including cross-channel contact details and change of insurance
Medication refills and reminders
Sharing of medication refills and reminders with ability to capture and overcome reasons for non adherence
Vaccination reminders, education, appointment scheduling, and paperwork
Medication adherence
Understand root causes of medication non-adherence and overcome them
Retail, mail order, 90-day medication refills
Support medication adherence with retail, mail order and 90-day refill request support
New member welcome
New member welcome, overview of PBM supports and services, info gathering / sharing (including insurance ID card capture)
Extraction (Vision)
Extract Vision related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Notification of lab and test results
Sharing of lab tests and results
Proactive member out of pocket notifications
Proactive member out of pocket notifications – with support for “price shocks”
Address Verification
Remind and support Borrower in securely verifying address and contact information during KYC Reviews.
Traditional app and portal registration support
Support for member app download and app and portal initial registration
Weight loss support
Support for eating well, exercising as well as weight loss medications like GLP1
Claim Status
Provide Policy Holder with the current status of a Claim.
Member contact information collection / updates
Collection of cross-channel member contact information to support better communications
Shipping status updates
Shipment status updates
Sales appointment setting and reminders
Member appointment setting with service or sales agents in support of their buying process
Timely notifications to meet regulatory requirements
Ability to send notifications to members more timely to meet regulatory timing requirements
Debt Management Plan
Proactively reach out to delinquent Borrowers to educate them on eligible Debt Management Plan options available and support their decision.
Pre visit preparation instructions
Sharing of pre visit preparation instructions with ability to automate answers to inquiries
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)
Medication (Rx) reconciliation
Education and scheduling of Medication Reconciliation
Member After hours Support
Accurate, secure and compliant AI Member inquiry and task completion support 24x7
Loan Modification
Proactively reach out to delinquent Borrowers to educate them on eligible Loan Modification options available and support their decision.
First Notice of Loss
Guide the Claimant through the process of reporting the death of a Policy Holder and filing a Claim.
Claim status, adjudication and payment updates
Ability for providers to inquire about claim status, adjudication and payments
Claim Status
Provide Member with the current status of a Claim.
Payment Status
Provide Policy Holder with the current status of a payment on a Claim.
Redetermination journey support (Medicaid)
Support for member retention with ongoing redetermination process education, support and services - until redetermination is complete
Return to Work
Confirm Claimant's Return to Work date as well as any supporting documentation from the doctor.
Care appointment reminders
Proactive care and provider appointment reminders with the ability to reschedule rather than no show (any provider type)
Schedule Appointment
Schedule follow up call with Sales Representative with reminders and rescheduling.
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
New member welcome
New member welcome, overview of PBM supports and services, info gathering / sharing (including insurance ID card capture)
Shipping status updates
Shipment status updates
Behavioral Health care management and navigation
Year-round support for members with Behavioral Health conditions - including education, wellness, care gap closure, appointment setting
Care education (preventative care)
Notifications to educate on the importance of adult and pediatric preventative care, related appointment setting
Appointment reminder and rescheduling
Member appointment reminders for care management, provider appointments (any type), home health visits and more
First Notice of Injury
Guide the Claimant through reporting an injury and filing a Claim.
Social Determinant of Health SDOH surveys
Social Determinant of Health SDOH survey completion with feeds to core systems for follow-up
Extraction (Basic Life)
Extract Basic Life related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Co-payment collection
Safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
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.
Extraction (Hospital Indemnity)
Extract Hospital Indemnity related keys required for underwriting from structured Census files, semi-structured Prior Year Plans, and unstructured email body.
Care education (chronic condition management)
Notifications to educate on the importance of chronic condition management, related appointment setting
Pediatric preventative wellness
Ongoing pediatric preventative wellness education, appointment setting and other actions
SCRA Protection
Securely collect proof of Active Duty Servicemembers in order to trigger financial protections.
Ongoing website, portal, & app adoption and utilization
Support for member ongoing utilization of website, traditional apps and portals
Schedule Appointment
Schedule follow up call with Sales Representative with reminders and rescheduling.
Update Beneficiaries
Update Beneficiaries and respond to major life events to ensure Policy Holder's benefits are paid to intended individuals.
Member ID card and driver's license digital collection
Safe and secure collection of member ID card(s), driver's license images
Claims status
Ability for members to receive push notices for, or make inquiries about, claims status
Payment capture
Safe and secure collection of payment information (credit, debit, ACH) to pass to payment processing
SDOH Resources (transportation, food)
Support for understanding and accessing SDOH resources such as nutrition, transportation
Retail-to-mail conversion
Support for education and retail-to-mail conversion
Financial Health Education
Support Borrowers with advice, reminders, and empathy to guide them towards financially healthy payment behavior.
Diabetes care management and navigation
Year-round support for diabetic members including education, wellness, care gap closure, appointment setting
Waitlisting
Proactive notifications of appointment availability for patients on wait lists
Borrower After hours Support
Accurate, secure and compliant AI Agent Borrower inquiry and task completion support 24x7
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.
