AI-powered interaction intelligence and specialized healthcare support aim to improve operational efficiency, protect revenue and manage enrollment surges

iQor, a global customer experience business process outsourcing provider, is expanding its healthcare customer experience (CX) capabilities to help providers, payers and life sciences companies address operational challenges related to claim denials, prior authorization delays, staffing shortages and fluctuating enrollment.

Healthcare organizations face growing financial and compliance pressures as administrative workloads increase and patients encounter barriers to care. According to the American Hospital Association, hospitals spent an estimated $43 billion in 2025 attempting to collect insurer payments for care already delivered, including nearly $18 billion to overturn claim denials.

Patients and health plan members are also experiencing rising costs and access challenges. KFF reported that insurers offering plans through the Affordable Care Act Marketplace proposed a median premium increase of 18% for 2026, compared with 7% the previous year. A January 2026 poll by KFF also found that two-thirds of insured adults considered delays and denials by health insurers a major problem, while one-third reported having a claim denied within the previous two years.

These challenges create additional administrative work for healthcare teams and increase uncertainty for patients and members navigating coverage, treatment and billing.

Identifying Root Causes of Healthcare Delays

iQor is using interaction analytics to help healthcare organizations identify recurring operational issues before they generate additional contacts or disrupt service delivery.

“ A denied claim or a missed prior authorization is rarely just an isolated issue. It can be a sign of a workflow problem somewhere upstream,” said Ben Roberts, executive vice president of operations at iQor. He added that identifying patterns earlier can help clients address root causes rather than continually managing the downstream volume they create.

The company's healthcare CX programs combine AI-powered automation, real-time interaction analytics and specially trained healthcare specialists to help resolve complex patient and member needs while maintaining compliance.

Combining AI Automation With Human Expertise

iQor's healthcare offering brings together three capabilities designed to support different stages of customer interaction and issue resolution:

• Insights iQ: Analyzes 100% of interactions to identify recurring issues involving eligibility, authorization, claims, scheduling and billing, helping organizations detect potential workflow breakdowns earlier.

• Agentic iQ: Automates high-volume, routine tasks to reduce manual workloads and support operational efficiency.

• Human iQ: Provides specialist support for complex or sensitive interactions that require human judgment, empathy and contextual understanding.

Together, these capabilities are intended to help healthcare organizations reduce avoidable contacts, improve resolution processes and protect revenue without compromising regulatory requirements.

Scaling Support During Demand Surges

iQor supports 29 healthcare clients across provider, payer and life sciences organizations. According to the company, its healthcare programs have achieved 96% of client key performance indicators and scaled staffing to 500% of baseline levels during demand surges.

The company also reports that its HIPAA-trained teams can become operational in as few as 30 days, providing organizations with additional capacity to respond to changing service demands.

Preparing for Regulatory and Enrollment Changes

Healthcare organizations are preparing for continued membership retention volatility, evolving eligibility requirements and increasing pressure to deliver cost-effective, compliant support. Medicaid eligibility redetermination processes are also expected to include additional work-requirement verification beginning in 2027.

In response, iQor continues to expand its healthcare CX capabilities across nearshore and offshore delivery markets, combining technology-driven insights with specialized operational support.