Healthcare AI: Embedded Intelligence Built for Health Plans
Supercharge operations, decisions, and member experiences with AI built for healthcare.
Unlock the Power of AI in Healthcare: Softheon’s AI Engineering
To stay ahead, you need more than just dashboards – you need built-in intelligence.
Softheon’s cloud-based, agent component architecture lends itself to AI automation, offering traceability, auditability, and human-in-the-loop compliance. The platform’s modularity supports phased adoption, which benefits resource-constrained FQHCs and agile PSHPs alike.
Finally. AI that’s Purpose Built for Health Plan Success
In healthcare, automation without oversight creates compliance risk. Softheon’s Agentic AI is designed for full accountability, with every action from subsidy determination to premium payment application time-stamped, traced, and audited at every step of the workflow.
Softheon acts as a trusted digital backbone of health plan operations through our Agentic AI—autonomous, accountable, and fully transparent digital workers. We let health plans and government agencies focus on their core missions, while we handle the administration of ACA, ICHRA/CHOICE, dental, vision, and Medicare Advantage plans, with secure traceability and human-in-the-loop safeguards.
Specifically, our solutions:
Automate repetitive tasks across enrollment, renewal, billing, and member communications
Streamline eligibility, billing, payment, enrollment, reconciliation, and member communications with our 1,300+ digital agents
Transform raw data into clear, visual insights, supporting data-driven decisions and compliance
Innovation Not Only Drives Us, It’s in Our DNA
AI-Powered Workflows at Scale
Softheon has embedded Agentic digital workers into over 90% of its workflows, enabling end-to-end automation across eligibility, enrollment, billing, subsidy reconciliation, notices, and compliance reporting. Unlike traditional RPA or workflow automation, Agentic AI agents can independently orchestrate multi-step tasks. This autonomy reduces onboarding timelines from months to weeks, cuts administrative burden by up to 30%, and allows our clients to launch quickly and efficiently, without manual or consulting-heavy practices.
Solving Complex Healthcare Challenges? That’s Where We Thrive
With over 20 years of experience in building solutions for complex healthcare areas, including ACA, Medicare Advantage, and ICHRA, we deliver immediate value across every product. Our platform:
Expertise. Innovation. Support.
Why Health Plans Partner with Us
engineered for scale, accuracy, and security
solving hard problems in healthcare technology
guiding your use of our platform every step of the way
using Retrieval-Augmented Generation (RAG) to access and apply healthcare operations data, government regulations, and internal expertise
Higher Retention with Better Communication
With so many Health Plans on the market, members don’t need to tolerate frustration, delays or inaccuracies. Get the tools you need to stay relevant to your members at every step of their journey.
Automate outreach for every step of the member journey. Grow your relationship with customized Marketing Materials. Use customized templates to deliver Invoices and Renewal Notices, and deal with Delinquency, Termination & Cancellation Notices, without straining your team’s resources.
Improve the member experience by letting them choose how they hear from you. Many populations want to go paperless. Offering this option improves member satisfaction and reduces your communication costs.
Reduce Risk with Predictive Analytics
Unhappy members rarely renew. Understand what’s going on with your members at a glance and uncover any system-wide issues with Softheon’s Reporting and Analytics Capabilities.
Use member and payment data to inform your communication efforts. When the system identifies members as at-risk for lapsing, you can intervene with a tailored communication plan.
Report on member data in near-real-time, through our reporting platform and see patterns of member pain points while you can still do something about them.
Digital Engagement Reduces Costs, Increases Support
Softheon’s member portal gives members the control they crave while reducing your service costs. The right digital engagement strategy includes a range of support channels and helps you empower customers while minimizing strain on your staff.
Thanks to the digital age, your members expect instant gratification in all areas of their life, including Health Plans. Meet their expectations by offering the fast and accurate self-service tools they’ve grown accustomed to.
Reduce CRM backlogs with customizable and CMS-compliant templates for communication. Create and execute mass member outreach to communicate with the right members at the right time.
Stay Ahead of Healthcare Challenges with AI Engineering from Softheon
AI isn’t tomorrow’s promise — it’s today’s performance advantage. If you’re looking to reduce admin burden, enhance compliance, improve retention, or make smarter decisions — Softheon can help.
