THE PAYER
AI PLATFORM

The Operating System for the Modern Health Plan.

Take 30%+ of administrative cost out of payer operations. 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.

Payer AI Platform — Benefits Lifecycle, Provider Operations, Claims Operations, Customer Experience, Performance Insights

70+Health Plan Clients

3xIDC MarketScape Leader

18+Years of Expertise

FIVE DOMAINS.
ONE UNIFIED OPERATING SYSTEM.

Built on a single 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 scale.

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

Payers often manage benefits across disconnected systems, creating inconsistencies between sales materials, CMS filings, claims, and member communications. Our AI-driven approach unifies everything in a single Enterprise Product Catalog, so every plan, filing, configuration, and document is generated from one source of truth.

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Meet the Enterprise Product Catalog.

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

80%Reduction in plan year build cycle time

0Filing defects from configuration drift

70%Reduction in sales quoting turnaround time

What if your provider data wasn't fragmented across systems?

Payers have long relied on manual effort and point solutions to manage disconnected provider data. Our AI-driven approach unifies every update into a single, continuously synchronized golden record, powering directories, pricing, and credentialing from one reliable source.

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Meet the Provider Master.

Integrated workflow management, a golden provider record, and connected audit logging.

84%Reduction in onboarding time

90%Reduction in manual tasks

$400Cost savings PPPY in data management

What if 20–35% of claims resolved automatically at first touch?

Too many claims still require manual review — sitting in queues, assigned without context, and handled without prioritization. Our AI-driven approach flips the model: resolving eligible claims instantly, then prioritizing and routing the rest to the right examiners with full context and recommended next steps.

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Meet Intelligent Claims Orchestration.

Faster decisions. Smarter reviews. Less manual effort.

$2.3MCost savings in denial and rework reduction

$230KCost savings in configuration labor

$390KClaims adjustments avoidance

Estimated for a midsize health plan

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

Today, members, providers, CSRs, and brokers rely on disconnected systems — resulting in inconsistent information, frustration, and higher support costs. Our AI-driven CX platform unifies data, workflows, and agents across service, care, sales, and marketing to deliver consistent experiences from a single source of truth.

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Meet Unified CX.

Consistent answers. Better experiences. Lower cost to serve.

98%Benefit quote accuracy across all channels

65%Inquiries resolved through self-service

2–3 ptCAHPS score increase within 12 months

What if you had real-time visibility into your operations?

Most payers rely on delayed reports and manual reconciliation, limiting insight and slowing decisions. Our AI-driven approach connects your core entities in a unified ontology, making every data point versioned, queryable, and always up to date — so dashboards and insights are generated automatically.

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Meet Unified Operational Intelligence.

See your business as it runs, in real time.

1Unified ontology powering every dashboard

10xFaster insight cycle vs. traditional BI

Real timeContinuous visibility across all core entities

DATA, DECISIONS, AND
OPERATIONS UNIFIED
IN ONE SYSTEM.

Point solutions can lead to costly integrations. Business intelligence layers can view data but cannot act, workflow engines can act but lack reasoning, and core systems record information but cannot make decisions. Our platform addresses this by integrating the data, decision, and operating layers across your existing core systems.

10root entities

200+sub-entities

Expertagents

5domains

The Ontology

Our platform features a pre-built ontology with a live digital model of the U.S. health plan with 10 root entities and over 200 sub-entities. Each entity includes its data, relationships, and available actions.

Explore Context1™

The Domains

We support five operational domains, each with defined decision logic. Configure once and operate across all areas. Rules are applied where answers are clear, and agents are used where judgment is needed. Every action is audit-ready.

The Agents

Expert agents leverage the Ontology to perform multi-step actions across all operational areas. Actions are grounded in the Ontology, registered for accountability, and include human oversight for any adverse outcomes.

Explore Foundry1™

THE PLATFORM PAYERS TRUST FOR
REAL OUTCOMES.

From regional plans to national payers, operations teams run their front, middle, and back office on the Payer AI Platform, retiring fragmented point solutions for one system of record. The result is faster decisions, cleaner data, and measurable operational lift across every domain.

“

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 Operations,Northeast 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%.

Wade EverettManager of Government Products, Independent 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 Consultant,Central 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.

Experience a purpose-built
platform for payers.

Join 70+ health plans running their front, middle, and back office on one unified AI platform.

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THE PAYER
AI PLATFORM