Improving Healthcare outcomes with
Trusted AI

Our AI Applications improve patient outcomes while lowering operating costs through predictive, proactive and personalized care.

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Healthcare Applications

CognitiveScale’s Artificial Intelligence Applications include Healthcare-specific products that accelerate Member and Patient engagement in areas like care optimization (e.g. cost of care, Star Rating Improvement) and service experience.  Process improvement Applications in Healthcare improve claims and program integrity (fraud, waste and abuse) processes.

Service Experience

  • Chatbot
  • Self Service
  • Agent Assist
  • Intelligent Call Routing

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Care Optimization

  • High Cost Claims
  • Care Interventions
  • Star Rating Improvements

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Claims Transformation

  • Claims Exception Automation 
  • Real-time Adjudication
  • Fraud, Waste & Abuse

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Sales Acceleration

  • Intelligent Lead Gen
  • Plan Match
  • Medicare Conversion

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Inclusion Advocacy

  • Care Inclusion
  • Coverage Inclusion
  • Collections Inclusion

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Healthcare Artificial Intelligence solutions leveraging patient, member, provider, and claim profiles

CognitiveScale’s Profile of One is a 360-degree, temporal, longitudinal view of key entities (Patients, Members, Providers, Agents, Claims, etc.). Profiles form a key foundation for personalized insights and proactive interventions. These profiles are built out leveraging Healthcare-specific accelerators like data connectivity (e.g. APIs) and schemas common in the payer and provider segments.

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