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Overview:
In this conversation with Healthcare IT Today's John Lynn, Ashish Desai (President, Benefits Lifecycle Solutions) and Jamie Hernandez (SVP, Product Engineering and Development) at Simplify Healthcare unpack why health plans still struggle to give members and providers a consistent answer about benefits, even after years of heavy investment in digital channels. The discussion traces the problem to its root: benefits data scattered across eight or nine source systems and coded differently in each one, which is why so many generative AI pilots produce inconsistent answers and never reach production. Ashish and Jamie lay out the approach that does work, starting with a clean data foundation and then applying AI built to return deterministic answers, and share outcomes from deployments live with customers today, including a large Blue plan on the East Coast that reduced average call handle time for benefit inquiries by more than 50% and cut CSR ramp-up from three to four months down to three to four weeks.

This session delivers real-world insights, proven outcomes, and practical steps to replicate success using AI-powered service solutions.

What You’ll Learn:

  • Why most generative AI benefit inquiry pilots stall at proof of concept, and what separates the ones that reach production.
  • How fragmented, inconsistently coded benefits data creates wrong answers, compliance exposure, and contact center attrition of 30% to 50%.
  • The difference between probabilistic and deterministic AI responses, and why accuracy decides whether a payer will go live.
  • How a payer ontology turns scattered enterprise data into a single source of truth for the organization, not the department.
  • What a well-governed approach looks like across digital and contact center channels: centralized data, traceability, and controlled content.
  • How one large Blue plan cut average call handle time by more than 50% and shortened CSR onboarding from months to weeks.
  • Why the benefits journey runs from pre-enrollment shopping through claims, appeals, and grievances, and what breaks when departments work in silos.
  • Why CRM platforms are the wrong tool for complex, payer-specific benefit processes.
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