Partnership combines the ServiceNow AI Platform and Healthcare and Life Sciences Service Management with Simplify Group™’s 17 years of payer domain expertise and purpose-built solutions to help health plans move from manual operations to managed, measurable outcomes.
AURORA, Ill.–(BUSINESS WIRE)–#AI—Simplify Alpha™, the Solutions-as-a-Service (SolaaS) arm of Simplify Group™, today announced a partnership with ServiceNow, the AI control tower for business reinvention, to modernize health plan operations at scale.
By combining the ServiceNow AI Platform, including Healthcare and Life Sciences (HCLS) Management, agentic AI capabilities, and enterprise workflow orchestration with Simplify Group™’s deep payer domain expertise, honed across 70+ U.S. health plan engagements over 17 years on all major packaged and custom payer Core-Admin platforms, the partnership aims to help payer organizations tackle the $300 billion administrative burden and margin pressures with production-ready solutions that are driving impact at scale; not pilots.
Partnership Focus
The partnership will initially target five operational domains where payers continue to face persistent challenges, the areas that most directly drive a plan’s admin cost ratio, Star Ratings, and member retention:
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Claims Operations: End-to-end inventory management, AI-assisted adjudication, and SLA-aware routing, powered by the ServiceNow AI Platform and unified by Simplify Healthcare®’s Claims1™ and Foundry1™ (powered by SimplifyX®) domain logic.
Outcome: up to 40% reduction in claims cycle time and measurable drop in rework rates. -
Appeals and Grievances: Automated intake, intelligent routing, deadline tracking, and audit-ready documentation on a single ServiceNow-powered layer, driven by Foundry1™, turning a compliance liability into a competitive advantage.
Outcome: Up to 35% improvement in appeals processing time and near-elimination of missed regulatory deadlines. -
Provider Network Operations: Unified provider data management, contracting, credentialing, network adequacy, and directory accuracy on a single ServiceNow-powered layer.
Outcome: up to 60% reduction in provider data discrepancies and fewer directory-related member complaints. -
Sales Operations (Broker/Agent Enablement): Healthcare-native broker management, proposal generation, and enrollment processing on ServiceNow’s Sales and Order Management modules, powered by Benefits1™.
Outcome: Up to 50% faster proposal-to-enrollment cycle time and reduction in enrollment fallout. -
Member and Provider Experience: Omnichannel service management integrating claims, benefits, eligibility, and prior authorization into ServiceNow’s Agent Workspace, powered by Xperience1™, and Context1™.
Outcome: up to 30% improvement in first-call resolution, call elimination, and measurable gains in member satisfaction scores.
Each domain is delivered through ServiceNow’s Now Create methodology, augmented by Simplify Alpha™’s ALPHA operating model and pre-built solutions from Simplify Healthcare® and SimplifyX®. Engagements begin with a 4-week Discovery Sprint tied to real business KPIs, followed by modular 12-to-16-week deployment cycles with human oversight checkpoints throughout. All engagements operate within ServiceNow’s FedRAMP-authorized and SOC 2 Type II compliant infrastructure, ensuring enterprise-grade security and regulatory alignment from day one.
Why This, Why Now
The timing reflects three converging forces.
- Regulatory pressure is intensifying: CMS-0057-F is raising the bar on data exchange.
- Star Ratings methodology changes are penalizing operational inefficiency, and DOJ fraud enforcement hit record levels in 2025.
- Cost pressure continues to build: admin expense ratios for large commercial plans hover above 15%, representing real margin on the table.
The technology has matured: ServiceNow’s agentic AI and HCLS data model are now production-grade for health-plan-scale automation, and that platform capability reaches its full potential when paired with deep domain intelligence. That domain layer is what Simplify Group has spent 17 years building into products, AI models, and operational playbooks.
Leadership Perspective
“Strong ecosystem partnerships are essential to solving the complex challenges facing healthcare payer organizations today. What makes this partnership with Simplify Alpha™ distinctive is the depth of operational knowledge they bring, not just platform expertise, but the ability to translate payer domain complexity into production-ready AI-native workflows on ServiceNow. Combined with our AI-powered orchestration and HCLS data model, this is how we help health plans move past point-solution fatigue into real, scalable transformation.”— Milind Shah, Head of Healthcare Payer, ServiceNow.
“Health plans don’t have a technology problem. They have an orchestration problem. ServiceNow gives us the AI platform and enterprise workflow engine. What Simplify Group™ brings is the domain intelligence earned across 70+ health plans and 17 years of operating inside the complexity: the benefit configuration traps, the pend code edge cases, the provider data cascades that only surface during peak enrollment. And critically, we bring purpose-built solutions like Claims1™, Benefits1™, Provider1™, Xperience1™, Insights1™, and Context1™ that encode that knowledge into deployable engines, not slide decks. Together with ServiceNow, we can deliver what the market has been asking for: managed outcomes with measurable results, not another integration project.”— Venkatgiri (Giri) Vandali, Co-Founder & CEO, Simplify Alpha™.
About Simplify Alpha
Simplify Alpha™ is the Solutions-as-a-Service (SolaaS) arm of Simplify Group™, delivering managed outcomes across payer operations — powered by a connected AI platform, agentic automation, and deep payer domain expertise. Simplify Alpha™ operates on the ALPHA model: AI solutions, Human Oversight, Precision Payer Ops, High Fidelity Intelligence, and Adaptive Learning Loop. It is backed by Simplify Group™’s 17-year payer heritage across 70+ health plans on all major packaged and proprietary payer claims-processing platforms, Simplify Healthcare®’s connected AI platform with five domain platforms, two foundation platforms, and Simplify Docs™ document services, and Foundry1™’s agentic automation and platform-intelligence engine. Simplify Group™ is a technology holding company that builds and operates businesses focused on simplifying complex operational challenges through domain expertise and emerging technologies, including artificial intelligence. Headquartered in Aurora, IL, with delivery centers in Pune, India.
For more information, visit simplifyalpha.com.
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Contacts
Simplify Alpha
Phone: (844) 720-6678
Email: [email protected]
