HSS and Ema's agentic AI cuts claims appeals from 45 to 5 minutes

The global healthcare sector faces a workforce crisis, with the WHO predicting a shortfall of 11 million workers by 2030. At Hospital for Special Surgery (HSS) in New York, agentic AI from Ema is delivering measurable results. The AI handles insurance claims end-to-end, processing 1,100 per month and reducing the appeals stage from 45 minutes to just five minutes. The success rate for those appeals jumped from 65% to 100% in nine months, allowing HSS to bring all claims work in-house and eliminate third-party contractors.

Building on that success, HSS launched a 24/7 AI triage and scheduling service in collaboration with Ema. The system uses conversational AI to ask patients about their condition, then books appointments with the most appropriate clinician based on location, insurance, and availability. It is trained on HSS's full knowledge base and protocols, with built-in safeguards to escalate complex or uncertain cases to human specialists. Every decision is auditable, and human staff can intervene at any point. This balance of automation and human oversight aims to reduce clinician burnout while improving patient access to world-class care.