Simplify1™

THE PAYER
AI PLATFORM

Know your enterprise. Connect your systems. Act across every workflow. Built on the systems you already run and governed by the rules you already trust.

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Benefits Lifecycle Provider
Operations Claims
Operations Customer
Experience Performance
Intelligence

30%Operational Cost Savings

80+Health Plan Clients

18+Years of Experience

News

Simplify Healthcare® Names Kamal Ahuja Chief Growth Officer to Accelerate Expansion of Its Payer AI Platform

AI-Ready Solutions for Modern Health Plans

Built on Simplify1™, our solutions give payers AI-ready data, systems, and controls needed to streamline operations, scale with confidence, and deliver the health plan of tomorrow, today.

What if the benefits you sell, file, pay, and deliver were always aligned?

Disconnected systems create inconsistencies across sales materials, CMS filings, claims, and member communications. Our AI-driven platform unifies benefits management with a single source of truth, keeping every plan, filing, configuration, and document synchronized.

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Meet Unified Benefits.

What you sell, file, pay, and deliver finally aligns.

80%

Reduction in plan year build cycle

Zero

Filing defects from configuration drift

70%

Reduction in sales quoting turnaround time

What if your provider data existed in one trusted source?

Fragmented provider data drives inefficiency, inaccuracies, and administrative burden. Our AI-driven platform creates a continuously synchronized provider record that powers credentialing, directories, contracting, and pricing from a single source of truth.

Explore Provider Operations ›

Meet the Provider Data Advantage.

One provider record. Unified workflows. Simplified operations.

84%

Reduction in onboarding time

90%

Reduction in manual tasks

$400

Savings PPPY in data management costs

What if more claims could be resolved automatically at first touch?

Too many claims require manual review, creating delays, rework, and unnecessary costs. Our AI-driven approach automates eligible claims and intelligently prioritizes the rest, improving accuracy, efficiency, and outcomes.

Explore Claims Operations ›

Meet Intelligent Claims Orchestration.

Faster decisions. Smarter reviews. Less manual effort.

$2.3M

Reduction in denial and rework costs

$230K

Reduction in manual processing costs

$390K

In claims adjustment avoidance

Estimated for a midsize health plan

What if every stakeholder received the same accurate answer across every channel?

Disconnected systems create inconsistent experiences. Our AI-powered CX platform unifies data, workflows, and engagement, so members, providers, and service teams always get accurate, consistent answers.

Explore Customer Experience ›

Meet Unified CX.

Consistent answers. Better experiences. Lower cost to serve.

98%

Benefit quote accuracy across channels

65%

Of inquiries resolved through self-service

2–3 pt

Increase in CAHPS scores within 12 months

What if you could understand the health of your business in real time?

Most health plans rely on delayed reporting and manual reconciliation to measure performance. Our AI-driven intelligence layer connects operational data across the enterprise, providing continuous visibility, actionable insights, and faster decisions.

Explore Performance Intelligence ›

Meet Unified Operational Intelligence.

See your business as it runs, in real time.

Unified intelligence layer across the enterprise

Real-time

Visibility across core operations

10x

Faster access to performance insights

root entities

200+

sub-entities

Expert

agents

domains

Where Trusted AI Meets Payer Operations

Business intelligence tools provide insights. Workflow engines automate tasks. Core systems manage transactions. Simplify1™ brings these capabilities together in a single platform built for payers that understands your business, connects your ecosystem, and enables governed AI actions across the enterprise.

Know Your Business

Payer Ontology

A payer-specific model connects business concepts to the data and systems you already use.

Connect Systems

Action Registry

Governed actions connect AI to existing systems while preserving their rules and validations.

Act with Confidence

Agent Studio

Pre-built or custom agents that complete payer workflows using shared, governed business context.

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THE PLATFORM PAYERS TRUST
FOR REAL OUTCOMES.

Leading health plans rely on the Payer AI Platform to unify operations across all business functions, eliminating disconnected systems and manual processes. The result: faster decisions, reliable data, and measurable performance improvements enterprise-wide.

From project kickoff through implementation, the experience with Simplify Healthcare was seamless. The team was exceptionally responsive, proactive in addressing requirements, and consistently delivered effective solutions. Their professionalism, collaboration, and commitment to our success have made them a trusted partner.

Operations LeaderNational Pharmacy Benefits Organization

Our partnership with Simplify has been a tremendous success, and we have met or exceeded all our goals. We have gained significant efficiencies while eliminating costly manual errors. We cut the end-to-end group setup time by 64%, and there have been zero claims-processing errors during plan setup.

Director of OperationsNortheast Regional Health Plan

The Simplify Healthcare team took the time to understand the unique aspects of our Medicare business processes and worked with us to identify areas and opportunities where we could streamline work and utilize technology.

Vice President, Medicare ProgramsWestern New York Health Plan

Working with Simplify Healthcare helped us dramatically improve the quality of claims configuration while maintaining consistent operational throughput. Through stronger process controls, workflow enhancements, and automation, we achieved measurable quality improvements and greater confidence in our delivery operations.

Operations ExecutiveCentral PA Health Plan

Improving the experience for providers is a top priority for us, and Simplify Healthcare has helped us do just that. Their team was highly collaborative throughout implementation, and the results exceeded expectations. We've already seen how the platform can improve operational efficiency while giving our teams the tools they need to do their jobs more effectively and with less frustration.

Vice President, OperationsMA Health Plan

Ensuring our members receive accurate and timely benefits information is essential to their experience. The platform helped us create a single, reliable place for all our benefits content, making things more consistent across the board. This led to a smoother experience for our members, whether they were shopping for plans or using the self-service portal.

Vice President, Medicare Product StrategyNational Health Plan

ENTERPRISE-GRADE SECURITY.
INDUSTRY-PROVEN TRUST.

Eighteen years of payer expertise, trusted partnerships, an enterprise-grade security posture, and a platform validated by the industry's most recognized certifications and awards.

THE PAYER
AI PLATFORM