About Us

CareInsight is an AI-native healthcare intelligence company purpose-built to transform how health plans operate. Our platform replaces fragmented, manual workflows with intelligent AI agents that automate operations end-to-end from member outreach and care plan generation to claims resolution and appeals adjudication while maintaining full regulatory compliance, clinical accuracy, and audit readiness.
We serve Medicare Advantage plans, Medicaid managed care organizations (MCOs), Special Needs Plans (D-SNPs, C-SNPs, I-SNPs) navigating the growing complexity of value-based care. Our customers range from regional health plans managing tens of thousands of lives to large payers scaling across multiple lines of business.
Our platform is anchored by Health3D.ai, a FHIR-native data aggregation engine that unifies claims, EMR, HIE, pharmacy, lab, and unstructured clinical data into a single longitudinal member view. On this foundation, CareAssistant.ai deploys 12+ bespoke AI agents across five operational domains Care Management, Utilization Management, Appeals & Grievance, Claims and Administrative Operations. CareWallet.ai extends the platform to members and caregivers through a mobile app that drives engagement, care gap closure, and HEDIS/Star performance.
What sets CareInsight apart is our regulatory-first design. Every agent is built around the specific CFR mandates, CMS timelines, and NCQA standards our customers are held to from the 90-day HRA completion requirement under 42 CFR §422.101(f) to the 72-hour expedited appeal deadline under §438.408. Our AI recommends; clinicians decide. Every interaction is logged, timestamped, and audit-trail complete.
The results are measurable and fast. Our primary customer achieved a 40% reduction in operational costs within the first 90 days of deployment. Across our agent suite, we deliver 75–95% cost savings on intake, outreach, and administrative workflows with zero rip-and-replace. We plug into the systems health plans already run QNXT, Facets, TriZetto, and beyond and go live in weeks, not years.
CareInsight exists because healthcare operations are broken at scale. Clinical staff are buried in administrative tasks. Compliance deadlines are missed. Member outreach is manual, expensive, and inconsistent. We believe AI should handle the work machines do best data assembly, pattern recognition, outreach at scale, and workflow orchestration so that clinicians, care managers, and medical directors can focus on what only humans can do: make clinical judgments, build trust with members, and deliver better outcomes.

Vision

A future where technology seamlessly personalizes care, enhancing every individual’s journey towards optimal health and well-being.

Vision

A future where technology seamlessly personalizes care, enhancing every individual’s journey towards optimal health and well-being.