The Payer AI Platform

The Operating System for the Modern Health Plan.

AI-driven decisions across the front, middle, and back office of every health plan. Built on the Payer Ontology. Composed of 160+ agents. Designed to operate across your core systems.

Payer AI
Platform

Benefits Lifecycle

Claims Operations

Customer Experience

Performance Insights

Provider Operations

70+

Health Plan Clients

IDC MarketScape Leader

18+

Years of Expertise

One Platform

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.

The Platform

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.

10 root entities 200+ sub-entities Expert agents 5 domains

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

Customer Success

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 Everett

Manager 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

Why Simplify Healthcare

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.

Financial Times & Statista — The Americas’ Fastest Growing Companies 2026

Get Started

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

Five Domains. One Unified Operating System.