Simplifying healthcare
Rubraik gives US healthcare payers a clear, confident, controllable path to AI in member operations. Built on deep payer expertise. Designed for the realities of your organization, across every population you serve.
Healthcare complexity is real. For everyone.
Members need clear answers. Providers need certainty. Advocates need context fast. But with new benefits, rising volumes, shifting rules, and more edge cases, healthcare service keeps getting harder.
That complexity reaches the contact center quickly: members leave confused, advocates start behind, calls run longer, escalations rise, and teams take longer to ramp.
Most AI speeds up individual tasks. Rubraik improves the service operation behind them—bringing together healthcare expertise, operational insight, and accountable AI for regulated environments.
Built by operators who know healthcare firsthand, Rubraik removes friction at the source—so advocates move faster, members get clearer answers, and every interaction stands up to scrutiny.
Where a single interaction moves the outcome
Benefits and Eligibility
Most member contacts start with benefits questions. Getting answers right the first time reduces callbacks and builds trust.
Fewer callbacks • greater trust • lower cost-to-serve
AEP & OEP Seasonal Support
Annual enrollment demands speed and precision. Accurate, compliant enrollment during peak demand protects member retention and regulatory standing.
Compliance confidence • member retention • audit-ready
STARS & Care Gap Closure
Consistent outreach drives preventive care, medication adherence, and care gap closure. The right message at the right time improves quality measures and member outcomes.
Higher STAR scores • better outcomes • bonus eligibility
Grievances and Appeals
Grievances and appeals require accuracy, empathy, and compliance. Getting them right protects members, reduces escalation, and strengthens trust.
Regulatory confidence • reduced escalation • member retention
The goal is simple - make healthcare easier to navigate, for agents, members, providers, and operations leaders alike.
AI built for what matters most
Every regulated enterprise faces the same tension: the need to move faster with AI, and the responsibility to never compromise on trust. Rubraik was born from that tension — designed not just to perform, but to prove it.
Augment
It starts with people.
Rubraik helps healthcare payer teams handle complex member interactions with more speed, accuracy, and confidence without losing the judgment these moments require.
- Real-time guidance for member support and complex service workflows
- Next-best-action guidance that supports accuracy, compliance, and consistency
- AI simulation that helps teams get up to speed faster in complex workflows
- Quality oversight where consistency, accuracy, and judgment matter most
Automate
Then it scales.
Rubraik removes repetitive work from complex payer workflows, helping plans improve productivity, consistency, and control across high-volume member operations.
- Intelligent automation for claims, appeals, and case management workflows
- AI-powered self-service for routine member questions and status updates
- Voice and digital AI support for high-volume interactions that still need oversight
- Workflow support that reduces manual effort and improves turnaround times
Anticipate
And it looks ahead.
Rubraik helps plans spot emerging issues sooner, understand risk earlier, and act before small problems become bigger member issues.
- Interaction analytics that surface friction, risk, and quality issues in real time
- Complaint and escalation analytics that help uncover systemic issues earlier
- Signals that help plans identify member friction and service breakdowns sooner
- Insights that help teams act earlier and shorten resolution cycles
We put the AI where the work happens
A member’s issue rarely lives in a single moment. It starts before anyone picks up, it plays out in the conversation, and it resolves somewhere after. Rubraik works in all three, because that is where complexity actually costs the plan and the member.
The agent is holding the system together
Primary Pressure Points
· Disconnected systems and outdated knowledge bases
· Cognitive load driving errors and escalations
· Prior authorization accuracy and turnaround
· Time lost to searching instead of serving
RubrAIk in the journey
In the performance — Before the member ever calls
Targeted practice and coaching prepare agents for real-world scenarios before demand hits.
In the conversation — While the member is on the line
Real-time guidance helps agents resolve issues faster and stay focused on the member.
In the interaction — Across the full case
Rubraik maintains continuity, automates follow-through, and turns every interaction into performance insight.
Live Program Outcomes
15–20 %
AHT improvement via Agent Assist
100 %
Interactions monitored, not a sample
30–50 %
QA cost reduction via automation
25–40 %
Cost-to-serve reduction
Confusion, ambiguity, and the annual reset
Primary Pressure Points
· Benefit confusion and the annual reset
· Provider uncertainty on authorizations by plan and state
· Avoidable call volume and complaints
· Directory accuracy and 90-day SEP disenrollment exposure
RUBRAIK IN THE JOURNEY
In the performance — When the member wants a person
Well-trained, well-prepared agents deliver accurate answers and empathetic service from the first interaction.
In the conversation — While the member or provider is with us
Real-time support delivers accurate answers across voice and digital channels, helping members and providers get the information they need without barriers.
In the interaction — Wherever the member or provider chooses to start
Members and providers get answers through self-service or assisted channels, with context carried forward so no one has to start over.
Live Program Outcomes
15–20 %
CSAT / NPS uplift via analytics-led intervention
25-40 %
Cost-to-serve reduction across member journeys
Proactive
Outbound education before predictable call spikes
Multi
Language clarity for LEP member populations
Running a compliant operation on incomplete evidence
Primary Pressure Points
· Quality reviewed by sample rather than in full
· Root cause analysis that lags the problem
· Forecasting and capacity planning under seasonal and regulatory volatility
· Cost to serve rising faster than the levers to control it
RUBRAIK IN THE JOURNEY
In the performance — The efficiency of a workforce that is ready
Targeted coaching builds competency faster, improves retention, and keeps the operation audit-ready.
In the conversation — The efficiency of getting it right the first time
Real-time guidance drives faster resolution, fewer transfers, and stronger compliance.
In the interaction — The efficiency of automating the work itself
Automation handles routine work, leaving people to focus on high-value decisions.
Live Program Outcomes
~1 wk
Reduced training time per agent
5 %
Training-period attrition reduction
Wider
Supervisor coaching spans of control
Seasonal
Scale without classroom-only training
A simpler way to navigate healthcare.
Less friction. Better outcomes.
Rubraik brings together AI and domain expertise to reduce friction across every interaction and every workflow — solving for the people doing the work, not extracting cost from them.
Built for healthcare complexity
Built for healthcare complexity
Focused on simplification, not just optimization
Focused on simplification, not just optimization
Grounded in operator expertise
Grounded in operator expertise
Driven by outcomes
Driven by outcomes
Leader in Everest Group's Healthcare CXM Intelligent Operations PEAK Matrix® 2026
As healthcare CXM evolves toward outcome-driven, technology-enabled operations, service providers must demonstrate the ability to integrate domain expertise with scalable digital capabilities. ResultsCX is well positioned through its broad healthcare value chain coverage, strong payer-centric and growing provider portfolio, and diversified global delivery model — contributing to its positioning as a Leader in Everest Group's Healthcare CXM Intelligent Operations PEAK Matrix® Assessment 2026.
Outcomes that speak for themselves
These are not projections. Every number below is a delivered result from an active client engagement.
Supplemental benefits
Medicare benefits & rewards provider — 22% gain in agent proficiency through AI-powered bots
Knowledge Management. AI Chatbots
22 %
Improvement in speed to proficiency for newly hired agents
14 %
Improvement in average handle time versus the year before implementation
5.15 %
Improvement in quality across member support interactions
Annual enrollment
Fortune 500 health plan — 12% CSAT improvement with conversational AI during Annual Enrollment
Conversational AI. Speed to proficiency
15 %
Higher accuracy scores while hitting the speed-to-proficiency target in the first month
12 %
Greater customer satisfaction in month one, with further gains in months two and three
1 min
Reduction in average handle time in the first month, with added gains in the months after
Medicare Advantage
Fortune 50 health plan — 2.8x more member appointments and 70% lower cost in two years
Omnichannel engagement. Care gap closure
2.8 x
Increase in Medicare members’ scheduled care appointments
70 %
Lower cost per scheduled appointment than the industry standard
20 %
YoY increase in inbound calls, directly attributable to omnichannel engagement strategies​
See how accountable AI operates inside regulated healthcare payer operations
- SCOPE One regulated workflow, agreed with you
- WINDOW Ninety days, start to measured result
- MEASURE Outcome verified independently
- TERMS Our fee tied to the result
Pick one workflow. Give us 90 days. We will show you what changed.
Request a Rubraik briefing
Less friction in the conversation. Less friction in the operation. Better outcomes for everyone involved. See how Rubraik operates inside healthcare payer programs like yours.