Healthcare Health Insurance & InsurTech

nexgile-pulseiq-hub

The Nexgile-PulseIQ Hub is a comprehensive digital ecosystem designed to revolutionize health insurance administration through intelligent automation, seamless integration, and enhanced stakeholder engagement. It serves as a unified hub connecting insurers, healthcare providers, members, brokers, and corporate partners.

Explore Digital Workers View Capabilities

System Status

Operational

3 Digital Workers

22 AI Agents

44 + Capabilities

AI Powered

Portal ID: nexgile-pulseiq-hub

Platform Overview

Comprehensive enterprise solution

The platform provides end-to-end lifecycle management from quotation to claims settlement, featuring intelligent quote generation with real-time eligibility checks, multi-plan comparison engines, and automated underwriting with configurable rules. Claims processing includes multi-channel submission (EDI, portal, mobile), AI-powered document extract... The platform provides end-to-end lifecycle management from quotation to claims settlement, featuring intelligent quote generation with real-time eligibility checks, multi-plan comparison engines, and automated underwriting with configurable rules. Claims processing includes multi-channel submission (EDI, portal, mobile), AI-powered document extraction, and auto-adjudication for routine claims achieving 80%+ straight-through processing. Members access a consumer-grade digital experience with secure single sign-on, digital ID cards with mobile wallet integration, real-time claims tracking, benefit utilization dashboards showing deductible and out-of-pocket progress, spending account management (HSA, FSA, HRA), prescription management with formulary search, and provider directory with geolocation-based search and quality ratings. Healthcare providers access real-time eligibility verification, prior authorization submission with status tracking, claim submission portals, and electronic remittance advice, with comprehensive credentialing workflows, contract management with fee schedule configuration, provider performance scoring across trust, quality of care, and patient-centricity metrics, and network adequacy analytics. Insurance brokers manage their book of business through dedicated dashboards featuring commission tracking, quote generation, enrollment management, renewal workflows, and marketing material access, providing complete client portfolio visibility with performance metrics. The platform integrates population health management with risk stratification, chronic disease management programs, care gap identification, and wellness program administration. Executive dashboards provide real-time KPIs including membership trends, premium revenue, medical loss ratio, and claims expense analysis. A comprehensive RESTful API suite enables ecosystem connectivity with standard EDI transactions (834, 837, 835, 270/271, 276/277, 278), HL7/FHIR healthcare interoperability, and third-party integrations with pharmacy benefit managers, telemedicine platforms, and enterprise systems.

Platform Screenshots 4 images

Policy Admin - Quotes Page

Analytics Dashboard - Real-time KPIs and Performance Metrics

Provider Directory - Comprehensive provider search with geolocation-based filtering and quality ratings

Broker Portal Overview - Dashboard displaying comprehensive broker analytics and management tools

AI-Powered Automation

Digital Workers

Autonomous AI systems orchestrating multi-agent workflows

3 Workers

22 Agents

24/7 Uptime

Digital Worker

FraudGuard AI - Healthcare Claims Fraud Detection System

Healthcare fraud costs the industry billions annually through billing manipulation, phantom billing, upcoding, unbundling, and kickback schemes. Traditional rule-based systems miss sophisticated fraud patterns while generating excessive false positives, leading to payment delays and operational inefficiency. Manual review processes are slow, inconsistent, and unable to scale with claims volume.

AI Agents

Orchestrator Agent ACTIVE

Data Extraction Agent ACTIVE

+ 6 more

8 Agents View Details

Digital Worker

AI Care Orchestrator - Population Health Management System

Care management programs struggle with member identification, risk stratification, and personalized intervention planning. Manual care planning is time-consuming, inconsistent, and often reactive rather than proactive. Care managers lack real-time clinical intelligence and evidence-based guidelines, leading to suboptimal outcomes and high readmission rates.

AI Agents

OrchestrAI - Central Orchestrator Agent ACTIVE

DataMiner - Data Extraction Agent ACTIVE

+ 4 more

6 Agents View Details

Digital Worker

AuthorizAI - Prior Authorization Multi-Agent System

Prior authorization processes are slow, labor-intensive, and frustrating for providers and members. Average turnaround times exceed regulatory requirements. Manual clinical review is inconsistent and creates bottlenecks. Providers lack visibility into authorization status, leading to care delays and administrative burden.

AI Agents

Orchestrator Agent ACTIVE

Data Ingestion Agent ACTIVE

+ 6 more

8 Agents View Details

Business Overview

Platform at a Glance

Comprehensive overview of capabilities, audience, and value delivered

Enterprise Capabilities

44 core functions

End-to-end policy lifecycle management from quotation to claims settlement

Intelligent quote generation with real-time eligibility checks

Multi-plan comparison engines

Automated underwriting with configurable rules

Multi-channel claim submission (EDI, portal, mobile)

AI-powered document extraction

Auto-adjudication for routine claims

Comprehensive fraud detection using machine learning algorithms

Secure single sign-on authentication

Digital ID cards with mobile wallet integration

Real-time claims tracking

Benefit utilization dashboards showing deductible and out-of-pocket progress

Spending account management (HSA, FSA, HRA)

Prescription management with formulary search

Provider directory with geolocation-based search and quality ratings

Real-time eligibility verification for providers

Prior authorization submission with status tracking

Claim submission portals for providers

Electronic remittance advice

Comprehensive credentialing workflows

Contract management with fee schedule configuration

Provider performance scoring across trust, quality of care, and patient-centricity metrics

Network adequacy analytics

Commission tracking for brokers

Enrollment management

Renewal workflows

Marketing material access

Client portfolio visibility with performance metrics

Population health management with risk stratification

Chronic disease management programs

Care gap identification

Wellness program administration

Health challenges and activity tracking

Biometric results monitoring

Preventive care recommendations

Incentive rewards programs

Executive dashboards with real-time KPIs

Predictive analytics for fraud detection, risk assessment, member churn prediction, and healthcare cost forecasting

HEDIS reporting and regulatory compliance

Ad-hoc report generation with export capabilities

RESTful API suite (eligibility, claims, provider, authorization, member, billing, analytics)

Standard EDI transactions (834, 837, 835, 270/271, 276/277, 278)

HL7/FHIR healthcare interoperability

Third-party integrations with pharmacy benefit managers, telemedicine platforms, and enterprise systems

Target Audience

7 stakeholder groups

Health insurers and payers

Healthcare providers

Plan members and patients

Insurance brokers

Corporate partners and employers

Care management teams

Executive leadership and analysts

Competitive Edge

12 key differentiators

Comprehensive digital ecosystem revolutionizing health insurance administration

Intelligent automation with seamless integration

Unified hub connecting all stakeholders

Consumer-grade digital experience for members

80%+ straight-through processing for routine claims

Multi-tenant, multi-currency, and multi-branding capabilities for global operations

HIPAA compliance with AES-256 encryption

Role-based access control with comprehensive audit trails

SOC 2 Type II attestation

Modern cloud-native architecture

Rapid product launches and continuous innovation

99.9% uptime SLA

Value Proposition

15 key benefits

Revolutionized health insurance administration through intelligent automation

Enhanced stakeholder engagement across all user types

80%+ straight-through processing reducing manual intervention

Comprehensive fraud detection protecting against losses

Real-time visibility into membership trends, premium revenue, and medical loss ratio

Improved member experience with consumer-grade digital self-service

Streamlined provider interactions with real-time eligibility and authorization

Complete client portfolio visibility for brokers

Proactive population health management with risk stratification

Predictive analytics enabling member churn prediction and healthcare cost forecasting

Regulatory compliance with HEDIS reporting

Global scalability with multi-tenant, multi-currency capabilities

Enterprise-grade security with HIPAA compliance and SOC 2 Type II attestation

High availability with 99.9% uptime SLA

Ecosystem connectivity through comprehensive API suite and EDI support