AI governance for health insurance plans
Adopt AI with confidence. Govern it with control.
AI is becoming part of everyday health plan operations, from claims and fraud detection to utilization management, prior authorization, and member services. As adoption grows, it becomes harder to keep track of where AI is being used, what member data it can access, and whether the right safeguards are in place.
At the same time, AI is only one part of a wider risk picture. Health plans still need to manage cyber exposure, third-party access, compliance obligations, and the operational risks that come with a highly connected environment.
AI governance for health insurance helps bring that into view, so you can expand AI use while keeping member data protected, risk under control, and oversight consistent across the organization.
Solution Synergy helps you build that governance so AI can grow across your organization without risk growing with it.
Know where AI is being used
Gain visibility into AI tools, applications, and use across your organization.
Govern AI responsibly
Put policies, oversight, and accountability around how AI is adopted and used.
Protect member data
Reduce the cyber and data risks surrounding AI, systems, providers, and vendors.
Be ready to demonstrate compliance
Build the governance and evidence needed for audits and evolving AI requirements.
AI is spreading fast. So are the risks around it.
- AI usage is expanding faster than governance can keep up.
Different teams are adopting AI tools, while existing platforms and vendors are adding their own AI capabilities. It can quickly become difficult to know what’s being used, where it’s operating, and what data it can access. - You can't govern what you can't see.
Many health plans are discovering that AI capabilities arrive through vendor updates, cloud applications, business-unit initiatives, and platforms already used across the organization. Effective governance starts with visibility. - And there’s more sensitive information at stake.
Health plans manage enormous amounts of member, claims, provider, and financial data. As more AI tools connect to that information, organizations need confidence that access is appropriate and properly controlled. - But the risk doesn’t stop at your own organization.
Providers, TPAs, business associates, cloud platforms, and technology vendors all connect to your environment, adding AI, cybersecurity, and compliance risks to manage. - On top of that, regulatory expectations are getting tougher.
HIPAA, HITECH, CMS requirements, HEDIS reporting obligations, and state privacy laws already place significant demands on health plans. Emerging AI guidance is also raising expectations around oversight, accountability, transparency, and AI-supported decisions.
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Governance. Visibility. Control.
Strengthen AI governance, cybersecurity, and compliance across your health plan
Build governance around how AI is being used
AI increasingly supports claims operations, fraud investigations, utilization management, prior authorization, and member services. As adoption grows, health plans need visibility into where AI is being used, what data sources it can access, and how decisions are being governed.
Give third parties access without expanding your attack surface
TPAs, business associates, providers, and technology partners need access to get work done. But they don’t need direct network access or broad permissions. Excessive, outdated, or unmanaged access can create additional pathways for attackers.
Xona allows health plans to control exactly what third parties can access while keeping critical systems isolated from direct exposure. Sessions can be monitored, controlled, and audited without granting broader access to the environment.
Know what’s connected, exposed, and creating risk
As AI adoption expands, more applications, systems, cloud services, vendor connections, and data sources require oversight. Risk can develop in places teams don’t realize exist until it becomes a security or compliance issue.
EAGLEi + Armis Centrix help health plans discover assets, understand cyber exposure, identify unmanaged risk, and prioritize the issues most likely to affect member data, operations, and compliance.
Prevent outages that disrupt member and provider services
Member portals, provider portals, APIs, and other digital health plan services depend on certificates working correctly behind the scenes. When certificates expire unexpectedly, critical services can go offline and disrupt member, provider, or business operations.
AppViewX helps health plans discover and track certificates and automate their lifecycle, so expirations can be addressed before they disrupt member, provider, or business operations.
Connect AI governance, cybersecurity and compliance into one strategy
Scale AI across your health plan with confidence
Expand adoption without losing visibility, oversight, or control as more teams and functions start working with AI.
Build greater trust in AI-supported decisions
Demonstrate accountability and responsible use of AI to members, regulators, and leadership.
Take the pressure out of audits and regulatory reviews
Make it easier to show how your health plan is managing AI, cybersecurity, and compliance risk.
Manage risk consistently across the entire health plan
Give teams a common framework for identifying, prioritizing, and addressing risk across your health plan.
Protect the experience your members, providers and brokers depend on
Reduce the security and technology issues that can interrupt access to important health plan services.
AI governance
Cybersecurity
Compliance
Operational resilience
Third-party access
Make AI easier to adopt and risk easier to manage
Sound familiar? This is how risk shows up across a health plan.
Your fraud team starts using AI to review cases
An AI tool is helping staff investigate potential fraud cases faster, but can you explain how it reached a recommendation, what member data it accessed, and whether it aligns with your governance policies?
Clear oversight makes AI-supported decisions easier to explain and defend, helping teams move faster without creating compliance or member trust issues.
Your claims platform adds a new AI feature
A routine update to your claims administration platform introduces new AI capabilities. The platform is already part of everyday work, but its new AI functionality changes how member and claims information is used.
Assessing new AI features quickly lets teams keep working without introducing unmanaged risk.
A TPA needs access to your claims system
A third-party administrator needs access to resolve claims issues, but broad permissions could expose more systems and information than the job requires.
Limiting access to exactly what’s needed reduces risk and restricts how far an attacker can move if a third-party account is compromised.
A firewall port is open and exposed to the internet
A firewall port that should have been closed remains open. No one is actively monitoring it, creating an unnecessary entry point for attackers.
Continuous exposure monitoring helps security teams find overlooked internet-facing risks, close vulnerabilities faster, and remove entry points before they put member data or operations at risk.
A Single TLS Certificate expires, and provider services go down
A TLS certificate expires unexpectedly, breaking trusted connections and taking provider-facing services offline.
Finding and renewing certificates before they expire helps keep provider and broker connections — and the services that depend on them — running without interruption.
Solutions built for the challenges facing modern health insurance plans
When you need to …
Solution
Establish oversight and governance for AI initiatives
Identify, reduce & control cyber risk across a complex payer environment
Improve compliance and prepare for audits and regulatory reviews
Control how TPAs, business associates, and vendors access your systems
Keep certificates from expiring and disrupting health plan operations