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Clarity in Every Benefits Conversation

Intelligent Customer Experience: Inquiry automation (benefits, claims, member, provider, broker, employer), Portals, Member and Provider Communications, and Digital Engagement
Transform convoluted benefit details into clear, human-friendly benefits explanations.
From choosing plans to getting help – consistent answers for everyone, across every touchpoint.
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Why Traditional CX Fall Short

Health plans struggle with outdated, fragmented systems.
Challenges and Consequences

Challenges

High call volume from benefit inquiries
Disconnected data across systems
Poor shopping UX
Complex, unclear benefit details
Limited self-service
Inconsistent messaging

Consequences

Poor call center KPIs
Member frustration and churn
Low conversion rates
High CSR attrition
Negative STAR/MTM scores
Exception payments from misquotes

From Complexity to Clarity:
Reinventing the Customer Experience

Reduce Cost, boost growth, and retain members with smarter, AI-powered experiences
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Empower Every Customer

  • CSRs resolve issues faster, with clarity
  • Members receive answers across channels
  • Providers get quick, accurate responses
  • Brokers see fewer delays, more clarity
  • Real time Benefit lookup for all the users

Rapid Deployment, Quick ROI

  • Plug-and-play, no heavy lifting needed
  • AI trained on health literacy models
  • Prebuilt integrations with key systems
    • Core: TriZetto® Facets® and QNXT™, Benefits1™
    • CRM: Salesforce™, Pega™, MS Dynamics™

Elevate Omnichannel CX

  • Frictionless plan shopping and recommendations
  • Clear, human-friendly benefit explanations
  • Seamless experience across chat, voice, and web
  • Fewer escalations, higher compliance
  • AI driven high touch engagement

Proven Results with Leading Plans

Xperience1™ Core Capabilities

Data Aggregation and Transformation

Consolidates fragmented data into a unified view

Intelligent Content Management

Generates channel-specific, human-readable responses

Content Distribution Engine

Delivers answers by channel, intent, and business rules

Interactive AI framework

Plug into any channel for pre/post-enrollment use cases

Health Literacy Model

Adjusts messaging based on comprehension level

Quick Implementation

Fast setup with prebuilt integrations across major platforms

Ready to Rethink Benefits Inquiry?

Xperience1™ is helping leading health plans deliver fast, accurate, and compliant answers—every time, everywhere. Discover how you can elevate member and broker experiences while reducing operational load.
See It in Action

Experience the Power of a Connected Ecosystem

Xperience1™ is just the beginning. Seamlessly integrate with Simplify Healthcare’s full suite of intelligent solutions—spanning product, provider, claims, documents, and custom app development—to ensure accuracy, efficiency, and compliance at every stage of the product, benefits, and provider lifecycle.

Product and Benefits Lifecycle

Accelerate health plan operations with AI-powered sales enablement, configurable plan design, automated filings, and CMS-compliant document generation.

Explore Benefits1™ →

Provider Lifecycle

Streamline network adequacy, contracting, credentialing, roster files, data management, and claims config with an advanced, modular solution that delivers efficiency and effectiveness.

Explore Provider1™ →

Claims Lifecycle

Configure benefits and provider data directly into claims systems like TriZetto® Facets® and QNXT™ using intelligent automation.

Explore Claims1™→

Payer Performance

Track 14 operational modules and 80+ KPIs against CMS, NCQA, and industry benchmarks, with AI-surfaced root causes and recommended workflow actions.

Explore Insights1™ →

Payer Ontology & Data Activation

Turn fragmented data across 15+ payer systems into a governed payer ontology that powers every AI model, automation, and decision across your operations.

Explore Context1™ →

Agentic Automation and Platform Intelligence Engine

Manual coding of apps and agentic workflows slows delivery and consumes resources. Build problem-first solutions, agentic AI workflows, and platform extensions with Foundry1™.

Explore Foundry1™ →

Document Management

Auto-generate 150+ mandated and marketing documents with built-in 508-compliance, translations, and integrated print fulfillment.

Explore Simplify Docs™ →

Solutions as a Service

Stop buying software and services. Start buying managed outcomes. Gain-share economics, 8 to 16 week deployments, and success tied to yours.

Explore Simplify Alpha™ →

We don’t just deliver software—we work alongside your teams to guide implementations, simplify adoption, and ensure sustained success.

Explore HealthConsult

Frequently Asked Questions (FAQs)

What payers want to know before scaling benefit inquiry with Xperience1™

How does Xperience1™ improve consistency across channels?

It centralizes benefit content and scripting logic, so answers are generated from the same source—whether through a portal, chatbot, IVR, or call center.

Can we tailor responses by channel or user type?

Yes. Xperience1™ supports role-aware and channel-specific scripting—delivering human-friendly answers to CSRs, members, brokers, and bots.

How does it support health literacy and compliance?

Content is structured in plain language for member comprehension and built to ensure audit readiness, with full traceability and configurable review workflows.

Does it integrate with our existing tools and systems?

Yes. Xperience1™ integrates via API, ETL, and batch—connecting seamlessly to Facets®, QNXT™, Salesforce™, Pega™, and more.

Can we use it to power both assisted and self-service?

Absolutely. The same logic layer drives responses across live support, portals, mobile apps, and automated channels—ensuring consistency everywhere.

How is accuracy ensured over time?

With version-controlled content, AI validation rules, and real-time exception tracking, every response is monitored and logged for quality assurance.

How long does implementation take?

Xperience1™ deploys quickly with prebuilt connectors and low-code tools—typically delivering value within weeks, not months.

Can non-technical teams manage content and logic?

Yes. Business users can create, test, and update scripts without waiting on IT—using a no-code interface designed for fast iteration and control.