AI Front Office for Health Payers. The AI receptionist for health plans and TPAs
Zanus AI is an AI receptionist for health plans, third-party administrators and benefits administrators that answers the member line, the provider line, the website chat and the service inboxes day and night, in each caller's language. It answers from your plan documents, files requests and passes coverage, claims and eligibility to your people.
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7 days free · per company, never per seat · nothing to install
Easy setup
Answers & books
You talk. Lisa sets it up.
You“Appeals, eligibility and claim status go to a person; answer the rest from our documents.”
Lisa“I'm sending appeals, eligibility and claim status questions to your teams and answering the rest from your documents. Apply?”
Any setting, in any module · applied only on your yes
Start with the one thing you need. Add more anytime by asking Lisa.
The whole Front Office › · All industries ›
Who reaches you
Who the AI answers for Health Payers
- Members asking where their ID card is or how a deductible works
- Spouses and adult children calling about a family member's plan
- Provider offices and billing services asking where a corrected claim goes
- Brokers and general agents with a small-group renewal on the desk
- Employer HR teams adding a new hire or a newborn to the plan
- Members of self-funded employer plans served by a TPA
The member front desk
What an AI receptionist for health plans answers
One front office takes the member line, the provider line, the website chat and the service inboxes. It answers the frequently asked questions from what your plan approved, so you let the AI receptionist handle the calls your team would otherwise put on hold.
Benefit terms in plain words
What a deductible is, how a copay differs from coinsurance, how to file an appeal: answered from your plan documents in the member's own words.
ID cards and address changes
A member who lost a card or moved is asked what your rule needs, and the request is filed as a ticket for your enrollment team.
Provider office questions
Where to send a corrected claim, the timely filing window, the fax for a records request: answered from the provider manual you loaded.
Broker and employer calls
A broker's renewal question or an HR manager adding a new hire reaches the right team, with the group name and the reason written down.
Routing by reason and language
Callers say what they need in natural language, in the language they speak, and the AI sends them to member services, provider services, enrollment or appeals.
Every conversation written down
Each call is saved with its transcript and summary, so the representative who takes the next call reads what was said instead of asking again.
The plan year
After-hours answering for health plans, from open enrollment to January
A payer knows its busiest weeks a year ahead. In those weeks the AI answers every call on the member line, so the call volume of open enrollment brings no missed calls and no longer hold queue.
Open enrollment
Shoppers compare next year's plans and members ask what changes; answers come from your approved summaries, and appointment scheduling with an enrollment advisor happens in the same call.
The first week of January
New cards, a deductible that starts again, a pharmacy asking for the new plan details: the repeated questions are answered and the requests filed.
Evenings and weekends
A member calling at 9 PM, outside business hours, after an urgent care visit is answered like all after-hours calls, and the request waits for your team in the morning.
Provider office mornings
A medical office or a billing service calls as soon as office hours begin; the provider line takes them all at once instead of stacking them in a queue.
Employer renewal season
Brokers and HR teams with a renewal date ask for documents and meetings; the AI books the account manager, sends the appointment reminders and files the request for the group.
Closures and holidays
When the office closes for a holiday or a storm, callers hear the message you wrote for that day, and plan questions are still answered.
Real screens
Inside the AI receptionist for health payers, screen by screen
Real Zanus AI screens with demo data, framed for a health plan's member and provider services.
Compared
An AI contact center solution for health insurance companies, compared
Most plans weigh three ways to answer more calls: more staff in the queue, an outsourced center, or a recorded menu and voicemail, sometimes with an answering service that only takes messages. Here is how the AI front office compares on the jobs a member line does each day.
| What a member line needs | Your staffed queue | An outsourced call center | A phone menu and voicemail | Zanus AI |
|---|---|---|---|---|
| A call at 8 PM | Closed until morning | Agents still learning your plans | A recording | Answered: from your approved plan answers, in the caller's language |
| January call volume | Longer hold times | More agent hours billed | A full mailbox | Every caller answered: on your own number, with no hold queue |
| A coverage or claim decision | Your representative | Escalated back to your team | Not possible | Passed to your people: with the reason told to them before the call connects |
| A question in Spanish or Vietnamese | Waits for a bilingual colleague | Depends on who is on shift | One recorded language | Answered in that language: or routed to the colleague who speaks it |
| What is written down | What someone had time to type | Notes in another company's system | A voice message | Every conversation: with its transcript and summary on the caller's record |
Guardrails
What the AI hands to your representatives
Who is covered
The AI never tells a caller whether someone is covered; eligibility questions from members or a hospital's patient access team go to your people.
What a member owes
Balances, cost estimates and what a member will pay for a service are passed to your people, never worked out by the AI.
Claims and prior authorizations
The AI never decides, pays or denies a claim and never decides a prior authorization; it explains how to submit one, from your manual.
Appeals and grievances
A member who disputes a decision is passed to appeals and grievances, and the ticket carries the member's own words for the reviewer.
Medical questions
Symptoms and treatment questions get the wording you approved and a transfer to your nurse line or the clinical team you name.
Anything not written down
When your documents do not hold the answer, the AI says so and offers a person, and the question waits for your team to answer once.
Set-up
Member experience services for health plans, set up in 2 minutes
Forward the member line
Forward the number on your ID cards, and the provider line if you like, to the Front Office; nothing changes for members or offices.
Name your departments
Tell Lisa your teams, member services, provider services, enrollment, appeals and grievances, the AI voice each one answers with and when it can take a transfer.
Load the plan documents
Give Lisa the benefit summaries, the member handbook, the provider manual and your approved answers; she reads them and asks what she must never say.
Seven days on your own calls
Try the Front Office free for 7 days with no credit card, and read every member call it answered before you decide.
Questions & answers
Questions health plans and TPAs ask about an AI receptionist
What is an AI receptionist for health plans?
It is an AI that answers a health plan's phone lines, website chat and service inboxes the way a trained member services front desk would: it greets the caller, answers from your plan documents and approved answers, routes by reason and writes every conversation down. Zanus AI does this for health plans, TPAs and benefits administrators, and passes coverage, claims and eligibility to your people.
How is an AI receptionist for health plans different from an AI medical receptionist?
Most AI receptionists are built for a clinic's front desk: patient calls, patient intake and booking visits. A payer's lines carry other questions, from members, medical practices, brokers and employers, about benefits, claims and enrollment. Zanus AI answers those from your plan documents, routes each caller by reason, and leaves coverage and claim decisions to your people.
What is an insurance call center?
An insurance call center is the team that answers members, providers and brokers by phone: benefit questions, ID cards, claim questions, grievances and enrollment. A health plan usually runs a member line and a provider line, and both queue up in January and during open enrollment. Zanus AI answers both lines on your own numbers and sends the calls that need a representative to the right team.
What does a member services representative do for a health plan?
A representative explains benefits, helps a member find care, orders ID cards, takes address changes, explains a claim and records grievances. Many of those are common questions with the same answers in the plan documents. The AI takes the repeated questions and files the requests, so your representatives keep the calls that need a look at a member's account or a decision.
Does the AI decide whether a member is covered or a claim is paid?
No. The AI never says who is covered or what a member owes, and it never decides, pays or denies a claim or a prior authorization. Eligibility, claim status and a member's own benefits need your systems, so those questions go to your people with the transcript and the summary of the conversation attached.
How does outsourcing member services compare with an AI front office?
An outsourced center adds people who must learn your plans and work your queue from scripts you send them. An AI front office answers on your own numbers at once, in the caller's language, from the answers your team approved, and keeps every conversation on the record. Your own representatives remain the people members reach when a call needs judgment.
Can we keep the member services number printed on our ID cards?
Yes. You forward the number on the card to your Front Office line, and the AI receptionist answers calls on it from the next one, with no porting and no new phone system. The provider line and the broker line can be forwarded too, and the AI routes each caller by the reason they give.
Which languages can members and providers use?
Callers speak their own language and the AI answers in it, on the phone, in the chat and by e-mail; the website chat covers 40 languages. A member who speaks Spanish, Vietnamese or Chinese hears the same approved plan wording in that language, and calls can be routed by language to the colleague who speaks it.
Does it work for a TPA that serves many self-funded employers?
Yes. A TPA can give its larger employer groups a department of their own, and rules can be scoped to a department, so a member hears the wording written for that employer's plan. Questions the plan documents do not settle, and anything about a member's own claim, go to your administrators.
Is Zanus AI compatible with the privacy rules health plans follow?
It is built to be compatible with the privacy rules payers work under when your team sets it up that way. Call recording is off until you switch it on, recordings are kept only for the days you choose, and each person reads only the departments and drawers their rights allow. Your privacy officer decides the settings.
What happens when a member calls with a symptom or an emergency?
The AI gives no medical advice and does not judge symptoms. It says the words you approved for that moment, such as calling 911 in an emergency, and passes the caller to your nurse line or the team you name, telling your colleague who is calling and why before the call connects.
How much does an AI receptionist for a health plan cost?
Zanus AI is priced per company, never per seat or per representative, so every team on the member and provider lines shares one subscription. You choose the modules you need and add more later; the plans are on the pricing page, and the Front Office is free to try for 7 days with no credit card.
How long does it take to put the AI on a member line?
The first line answers in 2 minutes. You forward a number, tell Lisa your departments and hours, and give her the benefit summaries, the provider manual and the answers your team approved. She reads each change back to you, and nothing goes live before your yes.
Award-winning AI
Winner at CES 2026, ISE 2026 and TMCnet Enterprise AI Product of the Year.
REAL AI - the whole Front Office is AI, not old software with an AI button.
Awards & trade shows ›
Give Lisa your website.
She sets up your business in 2 minutes.
Other software makes you learn it. Zanus AI learns your business.
Try it free on your own business — no credit card, per company, never per seat.
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Or call +1 (954) 736-3939 — the AI answers.