How AI is helping to make health care feel more personal

Instead of expecting members to understand a fragmented health care system on their own, AI is working behind the scenes to better meet employees and their families where they are in their health care journeys. This shows up at the very start of health plan enrollment — when members need to get up to speed on their benefits and coverage.

Avery, the AI companion from UnitedHealthcare, is designed to provide 24/7 on-demand support to respond to member questions. Avery delivers real-time, conversational support by offering clear information. This can help members understand their coverage, learn about potential next steps and navigate the health system more easily. Avery learns from every interaction and adapts to the individual user. In fact, Avery can help members resolve their inquiries 90% of the time without needing a transfer to an Advocate.²

“Having a tool that allows members to ask simple questions and get answers, while also prompting next-best actions, removes barriers like uncertainty or not even knowing what to ask,” says Amy Jordan, vice president of consumer engagement for UnitedHealthcare Employer & Individual.

One of the earliest interactions a member has with their benefits typically starts with searching for a provider. After setting up their profile in the UnitedHealthcare® app and myuhc.com, members can add their personal preferences. Whether they use Avery or search directly, members receive prioritized search results with a Smart Choice score based on 4 evaluation factors: quality, benefits, convenience and personal fit. This experience aims to help employees and their families to make more informed provider selection decisions.

In fact, members using the UnitedHealthcare AI-powered search tool to compare care based on Smart Choice scores were 18.8% more likely to choose a provider from their prioritized search results.³

Once a selection has been made, Avery can assist in scheduling an appointment with that provider on the member’s behalf. Using AI technology, a voice scheduling tool will contact the provider’s office to coordinate an appointment based on communicated member preferences and availability.

The provider connectivity that supports appointment scheduling can also help simplify the check-in process through Smart Pass, a new digital capability. Smart Pass can help prepare a pre-visit checklist, automate pre-visit forms and verify coverage based on the individual member's profile. This may reduce time spent in the office on paperwork and help minimize potential inaccuracies from manual entry.

Throughout the plan year, there may also be times when an employee or their family member has a more complex health issue that leaves them wondering where to go or what to do next. Avery is there to help route them appropriately or connect the member to a UnitedHealthcare Advocate if an extra human layer of support is needed.

But AI's role doesn't stop there. It can also serve as a support function for the UnitedHealthcare Advocate by summarizing recent chat history and interactions, proactively flagging potential barriers and providing real-time information that may be relevant during the live conversation with the member.

AI can also help serve up relevant next-steps that can help unlock additional value by encouraging employees to get the most out of what’s available to them. That can include benefits and programs their employer has invested in. It may also include additional health, well-being and lifestyle offerings available for purchase based on what is most relevant to an individual's health and well-being goals, life stage or the claims history of members with similar profiles.

When AI is embedded in the claims process, like it is with UnitedHealthcare Claims Assistant, it can help support members in submitting reimbursement requests by auto-populating medical field values from an uploaded photo. This can simplify the reimbursement process and reduce submission time: Claims Assistant cuts the time to submit out-of-network claims from 12–15 minutes to 3, nearly doubling completion rates.⁴

After receiving care, it’s important that employees understand the final cost of that care and how it impacts their deductibles and out-of-pocket costs. AI-powered Explanation of Benefits (EOB) summaries provide a recap of the care they received and surface important details like amount owed in language that employees can easily understand. This may help reduce post-care complexity and help employees better understand what their cost responsibility may be, and why.

UnitedHealthcare is also using AI-powered technologies to help smooth the member journey, which includes optimizing back-end processes as well as those at the forefront of member interactions..

For instance, Optum AI technology helps connect payers and providers, making it easier to share information and automate administrative tasks. That streamlined exchange of information can help simplify the health care experience for providers and, in turn, for members. It also gives providers greater visibility into a member’s benefits, coverage and cost-share, which can support more informed care recommendations. In addition, the technology can help identify when information may be missing, helping reduce processing issues, appeals, denials and care delays.

UnitedHealthcare Benefit Assist® uses an AI-enabled program to identify when members qualify for supplemental health payments and initiates 90% of supplemental health claims. It also prompts Advocates to inform members about potential benefits when claims are submitted.⁵

Stronger payer-provider connectivity and AI-enabled workflows are also allowing for major improvements and efficiencies in the prior authorization process. With the aim to reduce prior authorization requirements by 30% in 2026, UnitedHealthcare is committed to leaning into improving operational efficiencies, supporting more coordinated care and creating more seamless experiences across the entire health care ecosystem.