Payors are under more pressure than ever to do two things at once: deliver a better member experience and control rising administrative costs. At the same time, the medical cost ratio (MCR) has reached historic highs, and Medicare Advantage reimbursement rates will remain flat for 2027. 

Until now the systems supporting member services haven’t meaningfully evolved in decades, which is why we’re excited to announce the launch of our Agentic AI Member Services Suite. It’s designed specifically to transform payor member communications across inbound and outbound calls, as well as across the entire member journey.

What it is, and why it’s needed

This suite of agentic AI tools drives three critical outcomes for payors: it reduces costs of serving members; improves member engagement and satisfaction through personalization; and helps drive better outcomes by proactively engaging with members, guiding them to next best actions for preventive care, scheduling appointments, and managing chronic conditions.

Specifically, the suite enables health plans to leverage agentic AI for:

  • Member onboarding: AI agents proactively orient new members, introducing themselves as ongoing personal resources available 24/7 by voice or text. At the beginning of the member journey, they capture members’ communication preferences; explain plan basics, access to care and prescriptions, key benefits, and next steps; conduct health risk assessments (HRAs), and more.  
  • Intelligent triage: replace legacy interactive voice response (IVR) on inbound member calls with agentic IVR that asks “how can I help you?” ensuring members seamlessly reach the help that they need.
  • Administrative self-service: AI agents field calls from members asking questions like “is this drug/procedure covered?” “is this doctor in network?” or “what’s the status of my claim?” –  containing these calls without requiring human intervention. 
  • Care navigation: AI agents continuously engage members, and remember them, proactively reaching out to close common care gaps (e.g., scheduling annual wellness exams or next best actions for managing chronic conditions), as well as supporting adherence and capturing experience data. 

Payors using Infinitus already see strong performance, with voice AI agents outperforming human benchmarks by more than 18% in certain functions and over 90% of members rating their AI call experience positively. Infinitus’ AI agents operate within strict clinical, operational, and compliance guardrails, allowing them to take action on behalf of the health plan while protecting PHI and meeting enterprise safety standards.

Member services, reimagined

“Our Agentic AI Member Services Suite ushers in a new era for health plans, one where every member interaction becomes an opportunity to deliver personalized support and remove barriers to care,” said Ankit Jain, CEO and co-founder of Infinitus. “It allows care teams to focus their expertise where it matters most, while transforming member services from a cost center into a strategic differentiator.”

Are you ready to see what agentic AI can do for your member services organization? We invite you to request a demo to explore how Infinitus helps payors improve member engagement, reduce costs, and scale with confidence.