Insurance Pre-auth Agent AI Agent
Automate insurance pre-authorization across Email, WhatsApp while improving pre-auth TAT and reducing billing delays.
Example: Insurance Pre-auth Agent that collects documents and coordinates with payers quickly.
Front Desk, Patient Support, Billing Ops, Care Coordination
Website widget · Inbound number · WhatsApp deep link · Email · App chat
Secure actions, supervised handoff, and full audit trails.
Built for teams that need speed and control
Outcomes-first jobs your buyers care about
Collect pre-auth docs
How: Requests reports and estimates.
Outcome: Faster submissions
Submit to payer
How: Uploads to TPA portal.
Outcome: Reduced delays
Track status
How: Updates patient and billing.
Outcome: Fewer follow-ups
Handle queries
How: Responds to payer clarifications.
Outcome: Higher approval rate
Step-by-step flow buyers expect to see
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1
Trigger: admission
Pre-auth needed.
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2
Document capture
Collect reports and estimate.
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3
Submission
Send to TPA.
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4
Action
Track status.
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5
Exceptions
Denials escalated.
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6
Wrap-up
Approval shared.
Real scenarios with clear resolution paths
Agent: Pre-auth approved for 1.2L.
Agent: Please upload latest MRI report.
Agent: Denial received. Escalating to insurance desk.
Systems connected with secure actions
Systems of record
HIS/EMR, Lab system, Billing
Service stack
Ticketing, Knowledge base
Comms
Voice, WhatsApp, SMS, Email
Action tools
Appointment scheduling, Pre-auth, Payment links, TPA portal, Document upload, Billing system
Enterprise readiness built in
What you will improve
No-show rate
Missed appointments as a percent.
Average wait time
Time from arrival to consult.
Pre-auth TAT
Time to payer approval.
Billing query rate
Billing calls per 1,000 visits.
Lab report inquiry
Status requests per 1,000 tests.
Readmission rate
Avoidable readmissions (where applicable).
CSAT
Patient satisfaction scores.
Call deflection
Queries resolved without staff.
Flexible to your policies, tone, and tools
A phased rollout with clear deliverables
Discovery + call listening
- Workflow map and intent list
- SOP alignment and compliance notes
- Success metrics and QA plan
Pilot on 1 channel + 1 workflow
- Agent prompts and guardrails
- Test cases and failover scripts
- Live dashboard with baseline KPIs
Expand intents + integrate systems
- System actions and data sync
- Multi-channel coverage
- Supervisor playbooks
Optimize + scale
- Continuous QA coaching
- A/B tested prompts and flows
- Governance and reporting
Buyer objections, answered
How do you handle exceptions?
The agent routes exceptions to a human with full context, suggested next steps, and a clear disposition.
What happens when the agent is unsure?
It asks clarifying questions, consults the approved knowledge base, or escalates based on confidence thresholds.
Can we restrict what it can say or do?
Yes. Guardrails lock sensitive responses and require approvals for authenticated actions.
How are transcripts stored?
Transcripts and action logs are stored with retention controls and audit access.
How does handoff work with our CRM or ticketing?
The agent writes structured notes, tags, and next steps directly into your system of record.
What languages and accents are supported for voice?
Major Indian and global languages with configurable voice and accent options.
See this agent live on your workflow
See the agent live with your data, policies, and channels.
Deploy an AI-supervised agent for your highest-volume workflow.
We consult, design, build, and manage the agent end-to-end.