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Auditable AI for healthcare

Rubraik brings auditable, accountable, governed AI to healthcare service operations. Every consequential action human-owned. Every outcome measured.

 
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See what your members experience

100%

Of interactions reviewed for compliance and quality. Not a sample.

99%

Quality pass rate on a governed review workflow

50+

Compliance rules enforced in-workflow, human approval retained

20+ yrs

Operating inside regulated healthcare environments

Every number sourced. Every result proven in live operations.

Accountable AI for complex Healthcare operations

Healthcare is too complex for one-size-fits-all AI. Coverage rules shift by plan and by state, benefits redesign every January, and the answer that was right last quarter is only partly right now. Payers, providers, pharmacy benefit services and direct-to-consumer health run different operating models, but all four need the same thing: an accurate answer, fast, that still holds up when someone checks it.

Rubraik is built for the friction underneath that — the long calls, the escalations, the slow ramp, the service moment that goes one way on Monday and another way on Tuesday — not just the individual tasks sitting on top of it. It was designed by people who have run regulated healthcare operations, so every capability maps to a specific breakdown in the experience rather than a general claim about productivity.

The result is less friction across care, coverage, access and support — and a record of how each answer was reached, for whoever asks later.

That’s the promise. Everything after this is proof, and it starts with a single call.

In healthcare, a wrong answer doesn't stay small

The consequences show up differently across healthcare, but they all stem from the same problem: decisions that can’t be explained, traced, or trusted.

If you're a payer

An audit finding you can’t explain. A Star rating that slips half a point and takes revenue with it. A complaint that turns out, on review, to have been a pattern for months.

If you're a provider

Your front door is a phone line, and it’s where the revenue actually leaks. Registration errors that surface as denials months later. Patients who gave up somewhere between the second call and the third.

If you run pharmacy benefit

Turnaround breaches that start as a queue and end as a notice. Adherence gaps. Therapy abandoned at the counter because nobody could answer in time.

If you're direct-to-consumer

Trust lost in a single interaction, and churn that never tells you why it left.

When the consequences are real, accountability can’t be optional.

These are not projections

Every number below is a delivered result from a live client engagement, not a model output or a pilot extrapolation.

 

2.8x

More member appointments scheduled, at 70% lower cost per appointment

Fortune 50 health plan · Medicare Advantage · Sustained two years

 

12%

CSAT improvement in month one, with AHT down and accuracy up through the AEP window

Fortune 500 health plan · Annual Enrollment

 

22%

Gain in associate proficiency, with new hires reaching standard faster

Medicare benefits provider · Supplemental

 

2.8x

More member appointments scheduled, at 70% lower cost per appointment

Fortune 50 health plan · Medicare Advantage · Sustained two years

12% CSAT improvement in month one, with AHT down and accuracy up through the AEP window

Fortune 500 health plan · Annual Enrollment

22% Gain in associate proficiency, with new hires reaching standard faster

Medicare benefits provider · Supplemental

— Everest Group Healthcare CXM Intelligent Operations PEAK Matrix® 2026

Independent validation from the industry’s most watched benchmark

ResultsCX has been named a Leader in Everest Group’s Healthcare CXM Intelligent Operations PEAK Matrix® Assessment 2026. More important than the accolade itself is what it represents: independent confirmation that accountable AI, deep healthcare domain expertise, disciplined execution, and operational rigor are already working together in live environments.

Different healthcare journeys.
The same operational friction.

Whether you’re a payer, provider, pharmacy benefit manager, or direct-to-consumer health organization, the barriers to faster, more accurate service tend to emerge in the same critical places.

Your associates are searching, not resolving

They're the human layer navigating healthcare on everyone else's behalf, across systems that were never built to talk to each other. Every minute spent searching is a minute not spent resolving — and it's where your errors, escalations and quality misses start.

WHAT CHANGES WITH RUBRAIK

Your members are asking about a plan that changed in January

Benefits redesign every year. Auth rules shift by plan and by state. When clarity is missing, the gap fills with call volume, complaints, provider abrasion and disenrollment — with special enrollment exposure when directory data is off.

WHAT CHANGES WITH RUBRAIK

Your best people take three months to build, and you need them in six weeks

Hundreds of associates needed inside the AEP window. Redetermination cycles that surge on a schedule. Last year's expertise partially obsolete every January. You cannot classroom-train your way to seasonal scale.

WHAT CHANGES WITH RUBRAIK
Associate working at desk

Your associates are searching, not resolving

They're the human layer navigating healthcare on everyone else's behalf, across systems that were never built to talk to each other. Every minute spent searching is a minute not spent resolving — and it's where your errors, escalations and quality misses start.

Customer Service Representative Dashboard

Your members are asking about a plan that changed in January

Benefits redesign every year. Auth rules shift by plan and by state. When clarity is missing, the gap fills with call volume, complaints, provider abrasion and disenrollment — with special enrollment exposure when directory data is off.

Customer Service Representative Dashboard

Your best people take three months to build, and you need them in six weeks

Hundreds of associates needed inside the AEP window. Redetermination cycles that surge on a schedule. Last year's expertise partially obsolete every January. You cannot classroom-train your way to seasonal scale.

Associate working at desk

Your associates are searching, not resolving

They're the human layer navigating healthcare on everyone else's behalf, across systems that were never built to talk to each other. Every minute spent searching is a minute not spent resolving — and it's where your errors, escalations and quality misses start.

Customer Service Representative Dashboard

Your members are asking about a plan that changed in January

Benefits redesign every year. Auth rules shift by plan and by state. When clarity is missing, the gap fills with call volume, complaints, provider abrasion and disenrollment — with special enrollment exposure when directory data is off.

Customer Service Representative Dashboard

Your best people take three months to build, and you need them in six weeks

Hundreds of associates needed inside the AEP window. Redetermination cycles that surge on a schedule. Last year's expertise partially obsolete every January. You cannot classroom-train your way to seasonal scale.

Different operating models. The same friction. The same standard of proof.

The compliance questions every AI solution should answer

Because in healthcare, every decision may need to be explained, defended, and audited.

" Is it certified for our environment?

  • Independently audited against the standards your security review already runs on, and configured to your control framework from day one.

" Can you show me how it reached that?

  • Not just logged. The inputs, the rule applied, the approver and the reason — assembled into a record a reviewer can follow without our help.

" What if the associate forgets the rule?

  • Requirements are encoded as rules the workflow enforces, not guidance someone is expected to recall under seasonal volume.

" Where does our PHI go?

  • Your security model, your PHI boundaries and your retention rules, from day one. Models trained on live regulated casework, not a generic corpus.

Independently certified — organization-wide

HITRUST r2

Certified — the healthcare-specific assurance standard

ISO 27001:2022

Information security management

AICPA SOC

Service organisation controls

PCI DSS

Payment card data security

When AI acts, you should still know who approved it and why.

Two modules do most of the work

Rubraik Audit

Automated compliance and quality intelligence across 100% of interactions — the evidence layer underneath everything else.

Rubraik Assist

The right answer in your associate’s flow, with real-time guidance, compliance-aware next-best-action and conversation summarisation.

Eight further capabilities cover automation, analytics, learning, multilingual access, voice and advisory. Explore Rubraik →

 

See how accountable AI operates inside regulated healthcare environments.

BOOK WITH WORKING SESSION
  • 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.