Resolve provider claim inquiries faster with a subagent that answers natural-language questions. Deflect routine payer calls to a voice agent that verifies callers, handles common questions, and logs cases. Give reps a unified AI-generated summary of member, claim, and clinical details so they engage with context in seconds.
- Summarize Provider Claims on Demand in Payer Contact Center
Resolve provider claim inquiries faster with the enhanced Claims Service Assistance subagent. Reps can now ask the payer contact center agent about provider claims by using natural language. The subagent retrieves and summarizes claims by the provider's National Provider Identifier (NPI), claim ID, or service date range. Reps can quickly access details such as payment status, amounts, and processing errors via a formatted summary card, helping them focus on callers instead of searching for records. - Start Every Interaction with an AI-Generated Summary
Help your reps quickly understand who they're speaking with and why they're calling. New AI-generated summaries pull data in parallel from Agentforce Health objects and Data 360 to create a unified view of member plan details, claims, clinical information, and provider data. Every conversation starts with full context, so reps spend their time helping, not hunting through tabs and systems. - Automate Payer Contact Center Call Deflection, Wrap-Up, and Case Creation
Deflect low-risk payer calls to a voice agent that works around the clock. It verifies callers, resolves common questions about claim status, denials, prior authorization, and eligibility so your reps can focus on more complex issues. Every call ends with a consistent case record, giving you complete, reliable data for reporting and follow-ups. - Give Members Self-Service Answers to Drug Coverage Questions
Reduce contact center volume and expand self-service by configuring Agentforce for Formulary Data Queries. Provide members verified answers to common questions regarding drug coverage, cost tiers, authorization requirements, quantity limits, and lower-cost alternatives. Powered by PDex FHIR-aligned, CMS-compliant APIs, the Drug Coverage Inquiry subagent queries plan-scoped formulary data without requiring member authentication or session keys. - Process Document Extractions Directly from Amazon S3 Folders
Accelerate document processing and expand storage flexibility by adding Amazon S3 as a supported file source in Document AI for Health. When creating a Document Extraction Request, select files directly from an S3 folder in addition to standard content files. Document AI for Health scans the designated folder, retrieves the eligible files, and completes the extraction seamlessly, without requiring manual file transfers to Salesforce. - Identify the Correct Template for Document Extraction
Reduce processing overhead and simplify document extraction with template auto-identification. Save time and improve template selection accuracy as the system selects the best match from multiple similar templates. For batch files, the system uses folder timestamps to associate each file with the correct template when multiple active templates share a source folder. It processes each file only once and creates a single Document Extraction Record (DER), which prevents duplicate requests and reduces extraction costs. If no template matches, the system creates a DER in an unidentified state so users can review the document, assign the correct template, and retry extraction without losing track of the file.