The Challenge

A regional health plan serving a diverse member population handles approximately 25,000 member calls every month. Many of those calls are driven by routine needs: understanding benefits, changing contact information, replacing an ID card, or checking the status of a claim.

While straightforward, these interactions traditionally required members to contact the member service line and wait for an available representative. The health plan saw an opportunity to make these high-volume services easier to access while allowing its service teams to focus their time on members with more complex needs.

The organization also needed to serve members across a wide range of language preferences. Any new digital experience needed to make self-service accessible without sacrificing accuracy, trust, or connection to the health plan’s approved information and systems.

The Solution

The health plan partnered with Ushur to launch a dedicated AI agent for member self-service.

Available to members on demand, the AI agent provides immediate assistance for four common member needs:

• Benefits questions: Answers member questions using the health plan’s approved knowledge base.
• Contact information updates: Enables members to update information such as their address and phone number through self-service.
• Member ID card reissue: Allows members to request a replacement ID card without involving a service representative.
• Claim status: Retrieves claim information against live data to provide members with current status information.

Rather than simply answering questions, the AI agent combines conversational assistance with the ability to complete member service workflows—turning interactions that previously required a phone call into immediate digital self-service.

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Serving Members in Their Preferred Language

Accessibility was central to the health plan’s approach. Using Ushur, the organization supports its member experience in English, Spanish, Vietnamese, Chinese, Tagalog, Russian, and Farsi.

These experiences draw on Ushur’s broader platform support for more than 75 languages, enabling the health plan to extend digital self-service to a multilingual member population rather than limiting automation to English-speaking members.

The Impact

With the AI agent live in production, the health plan can now resolve routine member needs instantly rather than routing every interaction through its member service line.

For an organization receiving 25,000 member calls each month, that creates a significant opportunity to shift appropriate interactions toward self-service and preserve human capacity for more complicated member needs.

Early engagement is encouraging: thousands of self-service interactions have already been completed, and member adoption has continued to grow week over week since launch.

The result is a new service model in which members can get answers and complete routine tasks in seconds, while member service representatives can concentrate on the conversations where human assistance matters most.

Why It Worked

The health plan and Ushur grounded the AI agent in the organization’s accurate, approved member knowledge, helping ensure responses reflect trusted health plan information. The teams worked cross-functionally across business, architecture, delivery, and quality assurance, with rapid iteration continuing through launch.

That combination of trusted information, live system connectivity, multilingual support, and workflow automation allowed the organization to move beyond a traditional chatbot and deploy an AI agent capable of actually serving members.

A New Front Door for Member Service

For this leading health plan, AI-powered self-service is not simply another digital channel. It is becoming a new front door to member service—giving members faster access to routine information and services while helping the organization use its human service capacity where it delivers the greatest value.

With Ushur, routine member requests that once started with a phone call can now be resolved through an intelligent, multilingual self-service experience—instantly and at scale.