For decades, health plans have relied on call centers as the backbone of provider support — fielding a constant stream of calls to verify benefits, check claims, and manage credentialing updates. The work was necessary but never strategic. Each inquiry meant minutes on hold, multiple handoffs, and rising administrative costs.
Today, that model is breaking. The provider experience has become just as critical to care delivery as the member experience — and health plans are under pressure to make it faster, simpler, and more reliable.
To address this, Ushur is launching the first AI Agent specifically designed for provider servicing. This initiative aims to transform provider support, shifting it from a manual cost center to a proactive, intelligent layer that enables better care.
The Old Problem: Administrative Overload
Provider relations and contact center teams spend much of their time handling repetitive, high-volume questions:
- Is this procedure covered?
- What documentation is missing from my claim?
- How do I update my directory profile?
These questions dominate provider call centers. In many plans, benefits verification alone can make up 60–70% of all calls. Each interaction is time-consuming and expensive — costing payers dollars in administrative overhead and costing providers time they could spend with patients.
The New Model: Always-On, Intelligent Support
Ushur’s AI Agent for Provider Service brings conversational automation directly into the provider’s workflow — through their portal, chat, or even voice — to deliver immediate, accurate answers around the clock.
Instead of waiting on hold, providers can now:
- Instantly verify coverage and authorization requirements before treatment.
- Check claim status and upload missing documentation in real time.
- Complete credentialing updates and compliance checks without faxing forms.
By integrating with a health plan’s benefits, claims, and credentialing systems, the AI Agent can resolve inquiries that used to take days, in seconds — all while maintaining strict compliance with HIPAA and healthcare regulations.
Purpose-Built for Healthcare
Generic chatbots can’t handle the complexity or compliance needs of healthcare. Ushur’s AI Agents are trained on payer-specific data and healthcare workflows — everything from provider agreements and benefit eligibility systems to network processes and documentation standards.
Each interaction is safeguarded by healthcare-grade guardrails, including privacy controls, role-based access, and off-topic steering to ensure every exchange stays compliant and precise.
The Business Impact
For payers, the ROI is clear and immediate. Automating high-volume inquiries through digital channels lowers the cost to serve, while fewer back-and-forths on missing documentation speed up claim adjudication. Providers get the help they need even after hours, keeping care delivery moving without delay. And when provider operations run more efficiently, patients feel the impact — with faster answers, faster payments, and faster care.
From Cost Center to Experience Center
The provider service function is evolving from a reactive support line into an intelligent engagement layer that keeps healthcare flowing smoothly. Ushur’s AI Agent for Provider Service marks the next step in that evolution — helping payers replace administrative friction with clarity, speed, and trust.
Because when providers can focus on care instead of paperwork, everyone wins.