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Healthcare Payers

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Voice AI for Healthcare Payer CX

Health plans, TPAs, UM/CM providers, and PBMs are under cost and ratings pressures. Voicegain Casey is a payer-focused Voice AI suite that Automates routine calls, Augments agents, and Analyzes every conversation.

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The challenge

Payer operations have never been under more pressure.

70%

of payer contact center call volume is routine and repetitive — eligibility, claim status, coverage & benefits, prior authorization

24%

average agent turnover in health plan contact centers, driving constant retraining and inconsistent service.

$12B

spent annually across the industry on live-agent contact center operations for calls that could be automated.

Medicaid redeterminations, Medicare AEP surges, prior authorization reforms, and provider burnout have made payer contact centers one of the hardest operations to run. Legacy IVR can't keep up. Hiring more agents isn't scalable.

Three paths forward

How Voicegain fits your operation.

Depending on your situation — and what you've already built — there are three ways to deploy agentic voice AI with Voicegain.

Path 01 · Fastest

Deploy Casey

Pre-built AI Voice Agent for healthcare payers, ready to deploy against your eligibility, claims, and prior auth workflows.

  • ✓Member eligibility & benefits
  • ✓Claims status & appeals
  • ✓Prior authorization lookup
  • ✓Provider credentialing calls
  • ✓HIPAA identity verification
Explore Casey →
Path 02 · Flexible

Build on the Platform

Use the AI Voice Agent Platform to build a payer-specific agent tailored to your workflows and systems.

  • ✓Custom member workflows
  • ✓Your own plan documents (SBCs, SPDs)
  • ✓Proprietary LLM fine-tuned on your data
  • ✓Integrate with your EHR, CRM, core admin
  • ✓Deploy in your VPC for full data sovereignty
Explore the Platform →
Path 03 · Custom

Start with APIs

Compose your own solution from Voicegain's core APIs — full control over the build, on your own timeline.

  • ✓Streaming & batch STT
  • ✓Telephony bot API
  • ✓Real-time speech analytics
  • ✓MRCP for legacy IVR replacement
  • ✓On-prem or air-gapped deployment
Learn more →
←→
Use cases

What healthcare payers automate with Voicegain.

Eligibility & benefits

Providers calling to verify coverage. High volume, highly repetitive, easy to automate end-to-end.

Prior authorization

Status checks, decision communication, appeal filing. Automate routine cases, escalate complex ones.

Claims status

Providers and members asking “is this paid?” Casey pulls from your core admin in real time.

Member services

ID card requests, PCP changes, address updates, coverage questions — with HIPAA verification first.

Provider credentialing

Status calls from providers about their network participation, contracts, and effective dates.

Capacity increase

Surge capacity when call volume spikes. Scale voice AI instead of hiring temps.

Trust & compliance

The certifications your procurement team will want.

HIPAA

Full compliance with healthcare regulations.

SOC 2 Type 2

Audit complete on all 5 criteria of SOC 2.

PCI DSS

Complies with Level-2 v4.0 PCI guidelines.

E2E-Encryption

Secure solutions from call start to finish.

Customer stories

In their words.

"Our call center agents are the first point of contact for some of the most vulnerable Medicaid populations. Realtime guidance from Voicegain Casey means faster, more accurate answers for our most vulnerable members."

Sean Schreiber
EVP, Chief Innovation & Strategy Officer
Alliance Health Plan

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Routine provider calls were overwhelming our call center staff. We launched Voicegain Casey and today we automate 40% of our Claims ane Eligibility calls. This has freed up our Agents to truly engage with Members and increase our NPS.

Kirti Mutatkar
CEO
UnitedAg

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Voice AI under
Your Control

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