THE PAYER
AI PLATFORM

The Operating System for the Modern Health Plan.

Payer
AI Platform

Benefits Lifecycle Provider
Operations Claims
Operations Customer
Experience Performance
Intelligence

AI-driven decisions across the front, middle, and back office. Built on the Payer Ontology. Powered by expert agents. Designed to operate across your core systems.

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30%Operational Cost Savings

70+Health Plan Clients

18+Years of Experience

FIVE DOMAINS.
ONE UNIFIED OPERATING SYSTEM.

Built on a unified context layer for payers, our solution brings all operational domains together, combining 18 years of industry expertise with AI agents running on a shared data model to drive consistency, efficiency, and scalability.

What if the benefits you sell, file, pay, and deliver were always aligned?

Disconnected systems create inconsistencies across sales materials, CMS filings, claims, and member communications. Our AI-driven platform unifies benefits management with a single source of truth, keeping every plan, filing, configuration, and document synchronized.

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Meet Unified Benefits.

What you sell, file, pay, and deliver finally aligns.

80%

Reduction in plan year build cycle

Zero

Filing defects from configuration drift

70%

Reduction in sales quoting turnaround time

What if your provider data existed in one trusted source?

Fragmented provider data drives inefficiency, inaccuracies, and administrative burden. Our AI-driven platform creates a continuously synchronized provider record that powers credentialing, directories, contracting, and pricing from a single source of truth.

Explore Provider Operations ›

Meet the Provider Data Advantage.

One provider record. Unified workflows. Total audit confidence.

84%

Reduction in onboarding time

90%

Reduction in manual tasks

$400

Savings PPPY in data management costs

What if more claims could be resolved automatically at first touch?

Too many claims require manual review, creating delays, rework, and unnecessary costs. Our AI-driven approach automates eligible claims and intelligently prioritizes the rest, improving accuracy, efficiency, and outcomes.

Explore Claims Operations ›

Meet Intelligent Claims Orchestration.

Faster decisions. Smarter reviews. Less manual effort.

$2.3M

Reduction in denial and rework costs

$230K

Reduction in manual processing costs

$390K

In claims adjustment avoidance

Estimated for a midsize health plan

What if every stakeholder received the same accurate answer across every channel?

Disconnected systems create inconsistent experiences. Our AI-powered CX platform unifies data, workflows, and engagement, so members, providers, and service teams always get accurate, consistent answers.

Explore Customer Experience ›

Meet Unified CX.

Consistent answers. Better experiences. Lower cost to serve.

98%

Benefit quote accuracy across channels

65%

Of inquiries resolved through self-service

2–3 pt

Increase in CAHPS scores within 12 months

What if you could understand the health of your business in real time?

Most health plans rely on delayed reporting and manual reconciliation to measure performance. Our AI-driven intelligence layer connects operational data across the enterprise, providing continuous visibility, actionable insights, and faster decisions.

Explore Performance Intelligence ›

Meet Unified Operational Intelligence.

See your business as it runs, in real time.

Unified intelligence layer across the enterprise

Real-time

Visibility across core operations

10x

Faster access to performance insights

root entities

200+

sub-entities

Expert

agents

domains

DATA, DECISIONS, AND OPERATIONS UNIFIED IN ONE SYSTEM.

Point solutions often require expensive integrations. Business intelligence tools provide insights but cannot act, workflow engines execute tasks but lack reasoning, and core systems store information but do not make decisions. Our platform integrates data, decision, and operational layers across your existing systems to address these gaps.

The Ontology

Our platform includes a pre-built ontology and a dynamic digital model of the U.S. health plan, featuring 10 root entities and more than 200 sub-entities. Each entity contains its data, relationships, and defined actions.

Explore Context1™ ›

The Domains

We support five operational domains, each with established decision logic. Configure once to operate seamlessly across all areas. Rules are applied when outcomes are clear, while agents provide judgment where needed. All actions are audit-ready.

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The Agents

Expert agents execute multi-step actions across all operational areas. Each action is based on the Ontology, tracked for accountability, and includes human oversight if adverse outcomes occur.

Explore Foundry1™ ›

THE PLATFORM PAYERS TRUST
FOR REAL OUTCOMES.

Leading health plans rely on the Payer AI Platform to unify operations across all business functions, eliminating disconnected systems and manual processes. The result: faster decisions, reliable data, and measurable performance improvements enterprise-wide.

Our partnership with Simplify has been a tremendous success, and we have met or exceeded all our goals. We have gained significant efficiencies while eliminating costly manual errors. We cut the end-to-end group setup time by 64% and there have been zero claims processing errors from plan setup.

Director of OperationsNortheast Regional Health Plan

Simplify Healthcare has truly been a business partner for us. We generate 100+ documents across all our plans and we've been able to get those documents out to our population a lot quicker than we ever had in the past. Production timelines are reduced by 33%.

Manager of Government ProductsIndependent Health

Based on all the challenges we faced, we wanted a single source of truth to provide everything we needed for SBC integration. We teamed up with the Simplify Healthcare Team to create not only the SBCs but the Metadata and .csv files needed to move the SBC internally. This streamlined our whole process.

Senior Technical Business ConsultantCentral PA Health Plan

ENTERPRISE-GRADE SECURITY.
INDUSTRY-PROVEN TRUST.

Eighteen years of payer expertise, an enterprise-grade security posture, and a platform validated by the industry's most recognized certifications and awards.

THE PAYER
AI PLATFORM