Behind each health insurance claim are millions of combinations of variables that take into account a mixture of rules relating to regulations, contracts, and common industry practices among other factors. When a doctor has a question about a particularly complex claim, they contact one of Oscar’s claim specialists, who interprets the claims system’s output. It’s a complex and labor intensive process for health insurers.

GPT enables new types of automation through Campaign Builder. This allows Oscar and +Oscar clients to deliver relevant interventions and intelligently monitor for signals to better serve members’ and patients’ clinical needs.

With AI, we’re exploring ways to automate the translation of provider contracts into highly accurate claims configurations.

In our member services operations, we ask members to rate their interactions with us on member satisfaction (MSAT, general satisfaction with Oscar) and agent satisfaction (ASAT, their satisfaction with the care guide who helped them). How good is GPT-4 at estimating those two ratings from member services transcripts?

A bot is trained to understand system logs and PDFs, breaking down the cost of procedures and identifying how insurance logic was applied in each case.

An AI-generated clinical documentation system that automatically summarizes and documents conversations between our medical team and patients.