Serve better without spending more.
AI agents that answer the member on the spot and take repetitive work out of the operation: from quoting to authorization within the regulator's deadline, from reimbursement to retention. With data confidentiality and a human in command of everything clinical.
On one side the cost goes up. On the other, so does what is expected.
Every interaction is at once an operating cost and a moment of truth with the member. Doing it well, on the spot and within the deadline, without inflating headcount, is what defines margin and satisfaction.
1 Overloaded call center
Hotline and app queuing on repetitive questions: invoices, member cards, network and waiting periods. High cost, poor experience.
2 Authorization past the deadline
A request that drags turns into dissatisfaction, a complaint and the risk of a regulator notice and a fine.
3 Avoidable emergency room visits
With no guidance to the right channel, the member goes to the ER for something primary care would resolve. The loss ratio goes up.
4 Members who cancel
No answer and a poor experience lead to cancellation, losing recurring revenue and the waiting period already served.
The member resolved on the spot, with the data protected.
The agent books, guides and issues the routine authorization, and hands over to a human when the decision is clinical or about coverage. Less call center, the same confidentiality.
14 agents, from sales to regulatory.
Answering well is only the start. Each agent steps into a point of the member's journey and moves both levers at once: less cost in the operation and more experience for whoever uses the plan.
Acquisition and enrollment
2 agentsQuoting and Qualification
Takes the sales enquiry, understands the profile and the number of lives, explains coverage and waiting periods and passes the qualified proposal to the commercial team.
Member Onboarding
Welcomes the member and explains waiting periods, the digital member card and the network: fewer repeated questions at the call center right at the start.
Relationship and network
2 agentsTier 1 Service (WhatsApp)
Resolves on the spot what fills the hotline today: duplicate invoices, member cards, coverage questions, authorization status and reimbursement status.
Network Search
Finds the right doctor, clinic or lab by specialty, region and plan, and offers to book it.
Booking and health navigation
2 agentsAppointment and Exam Booking
Books straight into the network's calendar, confirms, sends reminders and reschedules when the member needs it: fewer no-shows.
Health Navigation and Triage
Guides the member to the right point of care. At any sign of urgency, it brings in a health professional immediately: the clinical decision is always made by a human.
Authorization and regulation
2 agentsPrior Authorization
Reads the claim form in the TISS standard (the Brazilian health data exchange standard), checks eligibility and coverage and assembles the complete case for medical review, tracking the regulator's deadline. It neither approves nor denies on its own.
Implants and High-cost Items
Organizes the documentation and the quoting of the most complex requests, cutting the back and forth on exactly the most expensive cases.
Finance and back office
2 agentsPremium Collection and Retention
Sends the invoice before the due date and, once it is late, runs the negotiation so the member does not lose the plan to non-payment.
Reimbursement
Explains what to send, checks the documentation and tracks the status through to payment, keeping the member informed.
Quality, retention and regulatory
4 agentsOmbudsman and Customer Service
Logs, classifies and answers complaints within the deadlines, and monitors the regulator's notices so they are answered in time and no fine follows.
Retention and NPS
Runs the satisfaction survey, spots cancellation risk and triggers the retention action before the member leaves.
Chronic Care and Health Programs
Follows chronic patients and expectant mothers with reminders for exams, medication and appointments: continuous care that eases the loss ratio.
Fraud Prevention and Claims Audit
Cross-checks claim forms, requests and reimbursements to flag unusual patterns to the audit team. The decision to reject or deny is always human.
Health data demands another level of governance.
LGPD & health regulator
Flows designed for sensitive health data and for the sector's regulatory bar.
Data isolation
Runflow does not train models on your data. Per-client isolation, with self-host wherever confidentiality demands it.
Human-in-the-loop
Clinical and coverage decisions always with human approval.
Legacy integration
Our engineers connect TISS, ERPs and authorization systems.
From the assessment to production, with your team.
No months-long project. Our engineers step into your operation, put the first agent to work, and then hand over the baton.
Free assessment
We map where AI creates the most value in your business and prioritize the cases by ROI and feasibility.
Free · ~2 weeksFirst agent live
We build with your team, integrate with your systems and put the agent into operation.
In weeksProduction, scale and handoff
The agent runs 24/7, you measure the ROI and every solution becomes your own template. You stay in control.
You stay in control