Zanus AI for Health Payers. Every member answered. Every appeal on its deadline.
Front OfficeMembers asking about ID cards, deductibles and in-network doctors, provider offices checking eligibility and claim status, and brokers asking for group quotes, answered by phone, chat and e-mail from your plan documents; enrollment meetings booked.
Back OfficePrior-auth requests, claims, appeals, provider correspondence and plan documents filed on the right member or provider record; every appeal and grievance deadline on the calendar, every determination left to your clinical reviewers.
Zanus AI Front Office
Front Office for Health Payers With your members, provider offices and brokers
Who reaches youMembers and the spouse who manages the family's coverageAdult children calling for a parent on a senior planProvider offices and billing companies checking eligibility and claimsSmall-group brokers, general agencies and benefits consultantsEmployer HR and benefits administrators adding or terminating employeesMembers of self-funded employers served by a TPA
Answers & books
AI PhoneMember and provider lines answered from the first ring.AI BookingCallbacks, broker appointments and enrollment meetings booked in the call.AI ChatNetwork, ID-card and deductible questions answered on your website.AI E-mailThe member-services inbox answered from your plan documents.AI Web FormsQuote requests and enrollment forms worked the hour they arrive.AI AvatarA face that explains the plan to new members.Sells
AI CRMMembers, groups, brokers and provider offices on one record.AI QuotingSmall-group quotes from your approved rate tables.AI Follow-upMissing census fields and unsigned forms chased until complete.AI MarketingOpen-enrollment and renewal campaigns in each member's language.AI Auto-CallID cards mailed, deadlines near, members called.AI DemoYour plan lineup presented to groups and brokers on demand.AI MeetingsVirtual open-enrollment sessions with notes and follow-ups.AI Partner PortalBrokers sign up, refer groups and see their own book.Zanus AI Back Office
Back Office for Health Payers Inside your health plan or TPA
Create unlimited AI automations just by talking to the AI. Prior-auth requests, claims, appeals, provider correspondence and plan documents filed on the right member or provider record; every appeal and grievance deadline on the calendar, every determination left to your clinical reviewers.
Automates
AI AutomationsDescribe the intake once: every appeal is logged, dated and sent to a reviewer.AI TasksMember letters, provider notices and call summaries drafted in your format.AI ApprovalsNo letter goes to a member or a provider without your OK.AI DashboardToday’s open appeals, aging prior auths and due dates on the first screen.Knows your company
AI AssistantAnswers your staff from your plan documents and desk procedures, with the source.AI AnalysisReads a member’s claims history and reports the findings and open items.AI ArchiveEvery EOB, ID card, benefit booklet and provider contract, found in seconds.AI VectorstoreEach member’s health information kept private and found by meaning.AI LibraryLearns your benefit documents, medical policies, state mandates and desk manuals.AI TranscriptsMember calls and appeal hearings transcribed and summed up for the file.AI MailroomEvery medical record and provider letter filed on the right claim or appeal.Runs your business
AI CustomersMembers, dependents, groups and their coverage history on one private record.AI CasesEach appeal and grievance handled on its own records and deadlines.AI ProjectsGroup renewals and new-group installs run as projects, with owners and dates.AI DesignMember guides, ID-card layouts and enrollment flyers revised from your words.AI SuppliersPrint-and-mail houses, ID-card printers and review vendors at hand.AI InventoryYour plan lineup, benefit options and riders, always current.AI MarketingRenewal reminders and preventive-care notices sent to the right members.Your team
AI TeamworkIntake staff, nurse reviewers and appeals coordinators share each file.AI TrainingNew claims and appeals staff trained from your own procedures.AI IntegrationsAdds AI to the claims system and the member portal you keep.AI Apps & RobotsApps and robots built for your claims and enrollment routines.Privacy & auditHIPAA compatible: member files open only to the roles you allow.Live Demos
See it working for your health plan.
Tell us what you want to see. We build an interactive AI demo for your company from your website, and the link and the documentation arrive in your inbox in about 2 minutes.
Questions & answers
Zanus AI for Health Payers: questions & answers
Can an AI answer a health plan's member services line?
Yes. AI Phone answers the number printed on the ID card from the first ring, verifies the caller by your rules and answers from your plan documents, benefit summaries and directory data. It files ID-card and address requests, reads back the claim status your system returns where you authorize it, and transfers everything else to the right team.
Does the AI decide whether a claim or a service is covered?
No. The AI makes no coverage, eligibility, medical-necessity, prior-authorization or appeal decisions and gives no medical advice. It answers from approved plan information, reads back status only as your systems return it, and never says whether something will be covered. Those calls go to claims, appeals and grievances or the nurse advice line with the transcript attached.
How does the AI handle the open enrollment and January call surge?
It answers every caller at once instead of queuing them. In the fall it explains plan options from your approved summaries and books advisor callbacks. In January it takes the ID-card, deductible-reset and 'is my doctor still in network' calls that pile up when the new plan year starts.
Can provider offices check eligibility and claim status with the AI?
Yes, where you authorize it through Connectors. The provider line answers between patients, reads back eligibility on file and claim status as your system returns them, and quotes timely-filing rules and claim-submission addresses from your provider manual. Denied-claim disputes, credentialing and contract questions go to provider relations with the context attached.
Can the Back Office track appeal and grievance deadlines?
Yes. It reads the received date on each appeal or grievance, puts the response deadline from your rules on the calendar with an owner, and tells the coordinator before a date is missed. The decision itself stays with your licensed reviewers.
Can the Back Office prepare a prior-auth file for a nurse reviewer?
Yes. It gathers the request, the medical records received and the matching medical policy into one file, lists what is missing and cites the clause it matched, so the reviewer starts with everything in one place. The determination is always the reviewer’s.
How do the Front Office and the Back Office work together for a health plan?
The Front Office answers the member or the provider office, finds out what the caller needs and books the callback or the enrollment meeting; the lead, the call transcript and the booking land on the member’s record in the Back Office, where the claim files, the appeal dates and your reviewers’ work take over.
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