This isn't a slide deck. It's a working AI agent that handles member inquiries about claims, benefits, pharmacy coverage, prior authorizations, and account services for AZ Blue members.
Ask it anything about claims, benefits and coverage, pharmacy, prior authorizations, or your member account. It has real knowledge, real workflows, and real guardrails.
Built around real member scenarios that AZ Blue's support team handles every day.
Checks claim status, explains EOBs in plain language, walks members through the dispute process, and clarifies what they owe and why.
Answers "is this covered?" questions, explains deductibles and copays in plain language, and helps members find in-network providers.
Explains drug tiers, directs to the formulary and Price a Drug tool, guides mail-order pharmacy setup, and clarifies step therapy requirements.
Explains which services require pre-approval, provides status check guidance, walks through the appeal process, and handles urgent timelines.
Handles ID card replacements, portal access issues, premium payments, address changes, and tax document requests.
Detects medical emergencies and directs to 911, prevents medical advice, and protects member health information with HIPAA-aware safeguards.
This demo was built from scratch for AZ Blue. Real logic for real member scenarios.
Pulled AZ Blue's member resources, plan details, claims processes, and pharmacy benefits into the AI's knowledge base.
Created member-specific workflows for claims, benefits, pharmacy, prior auth, and account management with smart routing.
Configured safety guardrails for medical emergencies, medical advice prevention, and PHI protection.
Ran 250 simulated member conversations across claims, benefits, pharmacy, prior auth, and account scenarios at ~83% resolution.
Connected to your actual member data. Handling your real support volume. This sandbox is just the start.
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