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Empowering Healthcare Innovation with AI and Analytics

Unlock the potential of your data and operations for better outcomes. Softheon Analytics and AI enterprise tools are designed to support health plans across a range of challenges.

Softheon has been a Gartner sample vendor in AI + Analytics for multiple years in a row.

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The Power of Health Plan Data – Brought to Life

Feeling overwhelmed by the possibilities for leveraging all the data from your health plans? You’re not alone.

Navigating the limitless application of analytics and AI to create great member and administration experiences, increase operational and automation effectiveness, and even improve health outcomes, all while preserving the human touch, can be challenging. Many leaders are wondering, “Where do I start?”

Building on a strong data and reporting foundation in Foundry BI Softheon can integrate siloed data across your health plan member, core administration, and even claims data, to help plans analyze performance, and train AI models to accelerate operations and automations.

Softheon + AI
Softheon + AI

Your Expert Companion

AI can help support the unique needs of today’s complex health plans. Softheon helps healthcare organizations identify areas that would benefit the most from AI-powered insights and automation. Softheon +AI can layer onto existing data and processes to power growth, scale, and better outcomes.


Top 5 Considerations for Health Plans Getting Started with Generative AI

Read our blog about the top questions healthcare organizations should be asking before investing in AI.

Overview of Softheon +AI Capabilities

Introducing Softheon’s AI Chatbot

You’ve heard the hype around new Large Language Model (LLM) tools. Now, Softheon is introducing a suite of tools designed with security, accuracy, and enterprise-scale in mind. Here are the top considerations for health plans and government agencies interested in AI.

Privacy and Security

General purpose LLM can put your data at risk. Ensure that your proprietary and member data is kept safe by designing a protected system that complies with Safe Harbor HIPAA standards.

Accuracy and “Hallucinations”

Reduce hallucinations and ensure accuracy by lowering the temperature parameter. Softheon implements feedback loops such as reinforcement learning to mitigate degradation of AI-generated content.

AIME’s 3 domains of knowledge prevent data degradation by cross referencing:

  1. Industry-specific knowledge and best practices
  2. Softheon’s internal processes and product infrastructure
  3. Your data

Prioritized Operations

Getting started can be challenging, but it all begins with identifying the operational gaps that have the greatest impact on your enterprise’s bottom line.

How Can AI Help You?

Member Engagement
Call Center Agent Assist
Knowledge Repository and Management
Data Analytics

Intelligent Automation

Healthcare organizations require integrated and accurate workflows to provide timely access to coverage for all members. As an early adopter of AI tools and Robotic Process Automation (RPA). Here’s how Softheon helps organizations.

Automated Enrollment

Craft an automated and personalized shopping & enrollment experience to compete in competitive markets.


Billing & Payment Efficiency

Streamline billing & payment processes to achieve an average 95%+ effectuation rate.


Targeted Member Retention

Keep more members with smarter outreach that targets the right people with the right message at the right time.


Data-Driven Reporting

Make effective, data-driven decisions with a user-friendly suite of reporting capabilities integrated with all your billing and enrollment data.


Softheon Insights Platform

Using a mix of AI tools and expert guidance, Softheon helps healthcare organizations improve clinical outcomes by changing member behavior.

Softheon has been recognized multiple times in Gartner Hype Cycles for its work in Healthcare Consumer Persuasion Analytics and Healthcare Consumer Insights as a Service.

Care Management
Utilization Management
Provider Network Performance
Risk Adjustment
Quality Ratings & Improvement
Member Acquisition & Retention

For more on Softheon Insights including case studies, read more here.