AI-Native Decision Intelligence for Health Insurance

What I do

Most health insurance organizations are rich in data and poor in decision capabilities. Product, market, network, regulatory, and sales data sits fragmented across dashboards and portals — so the choices that matter most still take weeks of manual reconciliation. A chatbot on a dashboard doesn't fix that.

My work sits between executive strategy and implementation: defining which decisions AI should improve, the user and agent workflows behind them, the data and semantic model underneath, and the roadmap to get there — before you commit to a major build, a vendor, or another disconnected pilot. My depth is Medicare, with cross-line work spanning ACA/ICHRA, Medicaid, and Commercial.

Where it pays off

Health plans

Grow profitably; know where you win and where you're exposed.

Which markets and counties to enter, defend, or exit
Where benefits, rates, or network are losing to competitors

Healthcare vendors

Find, size, and win the right accounts.

Which accounts are ready now — and the triggers that say so
Where the whitespace and the largest opportunities sit

FMOs & sales agencies

Sell more, and sell defensibly.

Which markets, carriers, and plans to point agents at
Cross-line and cross-sell across Medicare and ACA/ICHRA

How I work

Engagements are fractional or short-term — typically a two-to-four-week Vision Sprint that defines what to build before you invest, supported by a network of delivery partners for execution.

The shift isn't a smarter dashboard. It's moving from a fixed set of pre-built reports to essentially limitless insight on demand — every answer grounded, explainable, and governed.

Read the point of view →

Not a replacement — and not a black box. The intelligence shows its evidence; your experts apply the judgment that makes the call.

Let's talk.

If your team is rethinking payer analytics, market intelligence, or agent enablement, I'd welcome a conversation.

Start a conversation

or email karl@froeseinsights.com