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Simplifying healthcare with AI solutions

We help organizations optimize artificial intelligence (AI) to solve real-world problems for modern healthcare.

AI that makes healthcare better for everyone

Turn AI ambition into measurable results by combining deep healthcare expertise, differentiated data assets, market-ready technology and proven delivery. 

Optum has thousands of active use cases — including over 500 generative AI applications — in place today. Our workflow automation and responsible AI-based solutions help healthcare organizations harness the power of AI to improve:

  • Efficiency
  • Patient experiences 
  • Health outcomes  

We all win with a simpler healthcare system

97% real-time authorization rate

76% fewer medical necessity denials

15% reduction in health system technology footprint

96% patient estimate accuracy rate

Driving real-world outcomes with enterprise healthcare AI

Healthcare operations

Improve claims accuracy and speed with AI-driven validation, adjudication and exception handling. Automate decisions, reduce delays and denials, detect anomalies, strengthen coding and documentation and enhance customer interactions with real-time AI assistance.

Explore our offerings:

  • Claims
  • Contact Center
  • Payment Integrity
  • Prior Authorization
  • Risk & Quality

Digital operations

Optimize cloud and AI investments to improve performance, control costs and scale solutions. Transform unstructured content into actionable data, strengthen security with AI-driven protection, build reliable data pipelines and capture real-time clinical insights to reduce documentation burden.

Explore our offerings:

  • AI Data Engineering
  • AI for the CISO
  • Ambient Technology
  • Cloud Optimization
  • Document Intelligence

AI transformation & workforce

Scale AI adoption with governance, workforce enablement and embedded teams that accelerate deployment and outcomes. Enhance productivity with AI agents, build AI fluency across the workforce and improve execution through AI-assisted project management aligned to business priorities.

Explore our offerings:

  • Aegis Agentic PMO
  • Agentic Workforce Transformation
  • AI Learning & Development
  • AI Transformation Office
  • Zero-Distance AI Engineering

Analytics and insight

Uncover risks and root causes across claims, payments and clinical workflows with AI-driven analytics. Predict disruptions, improve system performance, enrich provider data for better decisions and identify high-impact process improvements through workflow intelligence.

Explore our offerings:

  • Forensics AI
  • Predictive Maintenance
  • Provider Data Intelligence
  • Task & Opportunity Mining

Life sciences

Accelerate life sciences innovation with AI-powered clinical trials, biomarker discovery, molecular design and predictive modeling. Improve engagement with real-world data, automate lab workflows to boost efficiency and enhance drug safety through AI-driven monitoring and case management.

Explore our offerings:

  • Clinical Trial Operations
  • Computational Science
  • Intelligent HCP Engagement
  • Laboratory Automation
  • Pharmacovigilance

Applying our healthcare AI expertise

Proven AI solutions enable real innovation, simplified operations and improved outcomes.

Expert-led AI integration

We deploy expert teams uniquely skilled in both healthcare and AI to lead every part of your AI transformation.

Connected solutions

Our integrated, tested AI solutions deliver results across thousands of use cases in our own care settings and at partner sites — at scale.

Responsible and human-first

We apply AI responsibly, using deep technical expertise and ethical frameworks, while prioritizing human control and decision-making.

Collaborative partnerships

We work together with you — from problem definition through activation — to deliver a custom solution that’s right for your organization.

Explore solutions powered by
Optum AI innovation

Clinical decision support solutions

Software

Case Advisor

Best for:
  • Health systems and hospitals
  • Providers

Artificial intelligence (AI) and evidence-based content are combined in this comprehensive utilization management (UM) workflow solution.

Software

InterQual Auth Accelerator

Best for:
  • Payers

Our evidence-based clinical decision support solution for payers, providers and government agencies helps ensure clinically appropriate medical utilization decisions.

Software

InterQual AutoReview

Best for:
  • Health systems and hospitals

This medical review automation solution increases utilization management (UM) efficiency and review accuracy.

Service

Hospital Case Management Optimization

Best for:
  • Health systems and hospitals

We offer real-time data and analytics, applied innovation, and expert guidance and investment in case management to optimize performance.

Data and analytics solutions

Research

Life sciences solutions

Best for:
  • Manufacturers

Drive results across the drug development lifecycle with real-world data, analytics and clinical expertise — helping you move from concept to impact faster.

Solution suite

Crimson AI

Best for:
  • Health systems and hospitals
  • Providers

Unlock healthcare data and transform it into robust business intelligence using AI-enabled feedback and suggested interventions.

Software

Crimson AI Provider Review

Best for:
  • Payers
  • Providers

Streamline physician review management and improve provider engagement with a unified AI-enabled workflow tool.

Software

Crimson AI Surgical Capacity

Best for:
  • Health systems and hospitals
  • Providers

Optimize surgical scheduling and operating room utilization with data-driven analysis and insights.

Software

Crimson AI Surgical Cost Module

Best for:
  • Health systems and hospitals

Enhance surgical service line profitability by utilizing data-driven insights to streamline costs and improve efficiency.

Financial solutions

Service

Claim Review

Best for:
  • Payers

Prevent improper payments, reduce medical spend and minimize provider abrasion with our comprehensive suite of pre- and post-pay solutions.

Service

Third-Party Liability

Best for:
  • Payers

Identify and validate primary policy coverage with accurate eligibility data.

Software

Optum Integrity One

Best for:
  • Health systems and hospitals
  • Payers
  • Providers

Unlock new levels of efficiency, accuracy and revenue integrity with our revolutionary end-to-end solution for the middle revenue cycle.

Service

Clinical Language Intelligence (CLI)

Best for:
  • Providers

Learn how Optum AI products use natural language processing (NLP) to make healthcare work smarter.

Operations and technology solutions

Solution suite

Change Healthcare Radiology Solutions

Best for:
  • Payers

Improve productivity with an AI-enabled enterprise radiology portfolio to streamline workflow.

Solution suite

Optum Real

Best for:
  • Health systems and hospitals
  • Payers

Improve transparency and administrative efficiency through real-time payer-provider connection.

Solution suite

Comprehensive coding solutions

Best for:
  • Payers

Explore a robust suite of AI-driven coding solutions with options to fit healthcare organizations of every size and structure.

Service

Retrieval Services

Best for:
  • Payers
  • Providers

Industry-leading chart retrieval services with a national footprint and continually expanding digital retrieval methods.

Pharmacy benefit management solutions

Solution suite

Smarter Pharmacy Benefits with AI

Best for:
  • Brokers and consultants
  • Employers
  • Health systems and hospitals
  • Payers
  • State governments

We’re using responsible artificial intelligence (AI) capabilities to supercharge pharmacy benefit experiences and drive meaningful results.

Related healthcare insights

Case study

AI advancements bridge the gap to dual eligibility enrollment

See how AI-powered technology and personalized member engagement are helping to identify and enroll more members into Medicaid programs.

White paper

5 AI use cases in payment integrity

A strategic blueprint to modernize your payment integrity program through intelligent, AI-driven health plan operations.

Article

Coding modernization: Leveraging the power of AI

Learn how Optum takes an innovative approach to smarter, more accurate healthcare coding.

White paper

AI and API integration for reduced denials

Transform claims with AI and API integration to reduce denials, strengthen transparency and drive more efficient, intelligent operations.

Learn how Optum can help solve your toughest challenges with AI

*First Case On-Time Start (FCOTS) rate measures the percentage of first-scheduled surgical cases in a day that begin exactly at the scheduled time.