Service Users
👤 Member
🤝 Broker
🎧 Call Center Agent
Direct service delivery to insured members and their agents. Front-line of the platform.
Operations and Clinical
📊 CC Manager
⚙️ Ops Manager
🔬 Clinical Reviewer
Oversight, analytics, and clinical decision authority. The intelligence layer of the platform.
Platform Administration
🏢 Client Admin
🔧 IT Admin
💻 Developer Admin
Configuration, integration, and platform governance. The control surface of the platform.
👤
Member
The insured individual. Primary end-user of all self-service workflows.
- ▸Medical history in full context
- ▸Policy coverage and benefit limits
- ▸Claims history and active claims
- ▸Authorization history and pending preauths
- ▸Network and provider data
- ▸Bilingual EN/AR experience
Core Capabilities
Chat Copilot
Authorization Status
Claim Inquiry
Reimbursement Submission
Provider Search
Policy Explanation
Rejection Clarity
Document Upload
Escalation Request
Provider Rating
The member experience is the most complete self-service channel in the platform. A member can move from inquiry to action, submit a document, initiate a preauth, and request a callback without leaving the chat interface. All responses are grounded in the member's actual policy, claims, and care history. No generative guessing.
🤝
Broker
Manages a portfolio of client accounts and member cases across groups.
- ▸Client portfolio view (scoped)
- ▸Member inquiry context
- ▸Case history across clients
- ▸Claim and document access
Core Capabilities
Chat Copilot
Case Management
Claim Reference
Document Access
Portfolio Reports
Member Inquiry Support
Brokers operate in a dedicated service channel with portfolio-level visibility. The broker interface shows only the clients and members within the broker's assigned scope, with no cross-client data exposure. Case submissions on behalf of members and policy reference tools are built in.
🎧
Call Center Agent
Assisted service operator handling escalated and complex member cases.
- ▸Full member context pre-loaded
- ▸AI-suggested responses
- ▸Case conversation transcript
- ▸Queue assignment and routing
Core Capabilities
Agent Workspace
Work Queue
Case Creation
Member Context Panel
AI-Suggested Responses
Document Access
Escalation Tools
Agents receive cases from the escalation queue with full conversation transcript and member context pre-loaded. AI response suggestions reduce handle time without removing agent judgment. All agent actions are auditable and attributed. The agent workspace is where human and AI service converge.
📊
Call Center Manager
Supervises call center performance, team capacity, and escalation patterns.
- ▸Team performance metrics
- ▸Queue analytics
- ▸Escalation monitoring
Core Capabilities
Supervisor Dashboard
Queue Monitoring
Team Analytics
Approval Workflows
Agent Performance
Escalation Trends
The manager view provides real-time queue visibility, agent workload distribution, and escalation pattern analysis. Approval workflows for sensitive case dispositions are built in. The supervisor can see where service is concentrated and where agents need support.
⚙️
Operations Manager
Strategic oversight of service delivery, KPIs, and platform health.
- ▸Service KPIs and benchmarks
- ▸Workflow health monitoring
- ▸Provider utilisation trends
- ▸Phase analytics and distribution
Core Capabilities
Analytics Dashboard
KPI Tracking
Operations Overview
Provider Analytics
Reporting
Trend Analysis
Operations managers see across the full service delivery picture: inquiry volumes, resolution rates, escalation drivers, provider utilisation patterns, and phase analytics. AI-generated insight signals surface automatically. Reports are exportable and configurable for board-level and executive review.
🔬
Clinical Reviewer
Reviews preauthorisation requests and complex clinical decisions.
- ▸Clinical evidence access
- ▸Member medical history
- ▸Policy clinical rules
- ▸Auditable decision recording
Core Capabilities
Reviewer Workspace
Preauth Review
Clinical Evidence Panel
Decision Recording
Member History
Document Access
The reviewer workspace is structured for clinical decision-making, presenting the request, the member's relevant medical history, supporting documents, and applicable policy rules in one consolidated view. Decision recording is auditable and timestamped. Every review is traceable end-to-end.
🏢
Client Admin
Insurer or TPA configuration authority. Controls the white-label surface.
Core Capabilities
Branding Config
Insurance Policy Rules
User Management
Role Assignment
Analytics Access
Content Management
The client admin configures the platform for their deployment: applying brand identity, defining insurance policy rules, managing users and role assignments, and accessing analytics dashboards. In managed cloud and client cloud deployments, this is the primary white-label control surface accessible to the insurer.
🔧
Client IT Admin
Integration and system operations authority for the client technical team.
Core Capabilities
Control Tower
Integration Management
Data Sync Config
System Diagnostics
Webhook Config
The IT admin manages the technical integration between HealthCopilot and the client's source systems: data sync schedules, webhook endpoint configuration, integration health monitoring, and system diagnostics. This role is the bridge between the insurer's IT infrastructure and the HealthCopilot platform layer.
💻
Developer Admin
Platform-level multi-tenant administration. Innovestor-operated in managed deployments.
Core Capabilities
Tenant Management
AI Engine Config
AI Routing Rules
Prompt Templates
System Diagnostics
The developer admin has platform-wide scope across all tenants: managing AI routing rules, engine configurations, prompt template libraries, and multi-client operational oversight. In managed cloud deployments, this role is operated by Innovestor on behalf of all clients. In on-premises deployments, it transfers to the client's technical team.