Agentic AI is transforming the healthcare experience for members and providers from confusion to clarity

Despite unprecedented access to information, healthcare remains one of the most difficult experiences for consumers to understand and navigate.

For millions, navigating healthcare can feel like traveling a road filled with uncertainty. From enrollment and benefits questions to prior authorizations, claims, explanations of benefits (EOBs) and appeals, the healthcare journey is often fragmented, confusing, and difficult to navigate. The result is an "understanding gap" that creates frustration for members, unnecessary costs for payers, and avoidable workloads for customer service organizations. 

The data provides clear evidence of the problem. More than half of health plan members contact their insurer at least once a year seeking answers, with a significant portion of interactions stemming from confusion or the inability to easily find information, according to The Kaiser Family Foundation. 

This is where agentic AI is poised to fundamentally reshape the healthcare experience. Unlike traditional chatbots that simply retrieve information, agentic AI is designed to understand context, guide conversations, take action and help consumers achieve desired outcomes. It transforms healthcare interactions from one-way communications into intelligent, personalized, two-way conversations using easy to understand, empathetic natural language.

Imagine receiving an explanation of benefits. For many consumers, an EOB is one of the most misunderstood documents in healthcare. Questions immediately arise:

• What happened?
• What does this mean?
• What do I owe?
• What should I do next?

Historically, those questions often resulted in a phone call to a customer service center. Agentic AI changes that dynamic. Instead of forcing members to interpret complex healthcare language on their own, an AI companion can explain information in plain language, provide personalized context, answer follow-up questions, and guide the member toward the next appropriate action.

This shift is about more than automation. The most effective agentic AI solutions serve three important roles:

1. They interpret. Translating complex healthcare terminology into language people can easily understand.
2. They take action. Helping members complete tasks, resolve issues, and move forward without unnecessary friction.
3. They guide. Creating a seamless experience that empowers consumers throughout their healthcare journey.

The result is a healthcare experience that feels more contextual, easier to understand, more empowering and ultimately more human.

For healthcare organizations, members gain clarity earlier in the journey, customer service interactions become more efficient, unnecessary calls are reduced and human agents can focus on higher-value, more complex cases.

Real-world results demonstrate impact: 

• 86% of inquiries resolved without a human agent
• 900% increase in engagement on member platforms
• 21% reduction in live-agent interactions
• 24% reduction in average handle time (AHT)
• 8% to 14% reduction in total healthcare costs 

The future of healthcare experience is about helping people better engage with their providers.

That vision was recently recognized when Conduent was named the winner of the 2026 UnitedHealthcare + Optum Global Innovation Challenge. The winning concept from Conduent demonstrated how a personalized, agentic AI navigator can transform fragmented healthcare journeys into guided, two-way conversations that deliver clarity, confidence, and better outcomes. 

As healthcare organizations continue to seek ways to improve member experience, agentic AI represents an opportunity to close the understanding gap and create a future where every healthcare interaction is more intuitive, supportive, and action-oriented.