CONSHOHOCKEN, PA — Opyn’s artificial intelligence technology has reduced provider call center costs by 40% at health plan administrator Marpai, automating most routine inquiries while allowing the company to expand service capacity without hiring additional staff.
The Conshohocken-based healthcare technology company reported that its Opyn Agents platform now handles the initial contact for all inbound provider calls at Marpai, a national third-party administrator serving self-funded employer health plans.
After several months of operation, the system fully resolves 70% of provider inquiries without human intervention, according to Opyn.
The deployment targets a significant operating expense for third-party administrators, which manage eligibility verification, claims processing and other services for employer-sponsored health plans.
Provider inquiries frequently involve coverage eligibility, benefit details, claim status and prior authorization requirements. Handling those requests traditionally requires call center personnel to retrieve information from multiple administrative systems.
Opyn’s platform uses AI-powered voice agents and a web portal to respond to inquiries around the clock, drawing information from authorized member records, plan documents and administrative rules.
The system handles eligibility and provider verification, benefit quotations based on individual plan documents, claim inquiries, network guidance and prior authorization routing.
Rather than replacing Marpai’s existing administrative technology, Opyn Agents operates alongside its established systems and workflows.
The platform also maintains records of each interaction, including transcripts, audio recordings and AI-generated summaries.
When an inquiry requires human intervention, the system transfers the case to an appropriate representative along with the information collected during the automated interaction.
That process is intended to reduce repeated questioning and allow service personnel to concentrate on cases requiring additional review or judgment.
“Most TPAs can’t simply hire their way out of growing call volume,” Mike Nigels, Opyn’s chief information officer, stated.
The company describes its system as operating within a HIPAA-compliant environment, with responses generated from authorized healthcare and administrative records rather than public information sources.
Opyn also provides reporting tools that allow administrators to monitor automated resolution rates, escalations and operating costs.
Marpai Director of Customer Service Angela Williams attributed the technology’s deployment to the company’s ability to manage increased service demand.
“With their help, we’ve been able to support the significant growth we’ve seen this year,” Williams stated.
The results reflect Marpai’s ongoing use of the platform rather than a limited demonstration, with all incoming provider calls entering the automated system and approximately three in 10 inquiries requiring further assistance.
For Opyn, the deployment provides an operating example of how third-party administrators can use AI to reduce service costs and increase capacity while retaining human representatives for more complex provider issues.
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