Solutions / Health funds

AI running member journeys for Australian health funds

Onboarding, win-backs, product guidance, claims protection and contact centre execution - live in production across national health funds, with every action governed and audited.

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In production - national health fund

Member onboarding and win-back journeys run through Covalent, with a live data operations pipeline covering every policyholder.

In production - industry fund group

Australia’s largest industry-specific health fund group delivers rewards and engagement to more than 600,000 members on the platform.

Why now

Every April the whole industry churns. The funds that act early keep the member.

Lapse risk is visible months before the cancellation call: extras going unused, a quote started on a comparison site, a premium-rise notice opened and never actioned. Most funds see these signals in the monthly lapse report. By then the member has already switched.

Covalent turns those signals into same-day action: lapse-propensity models scoring every policyholder in real time, warehouse signals streamed into the decision path, and save journeys firing across app, email and contact centre the moment a threshold trips - every offer tested against holdouts so the response sharpens with each cycle, all inside approval and audit guardrails.

See
Extras non-utilisation · quote abandonment · premium-rise sensitivity · claims friction · age-bracket risk windows - surfacing in your warehouse weeks ahead of lapse.
Act
Timed save offers · downgrade-not-cancel paths · extras activation nudges · contact centre prompts with full member context - written back to your CRM, approved and audited.
Members drift quietly DRIFT → DETECT → RECOVER

The member lifecycle, end to end

Four stages decide whether the book grows or shrinks. Covalent runs all four from one decision spine.

HLT 01 · Acquire

Win switchers when they are switching

Rate-rise season campaigns, quote-abandonment follow-up and timed offers for the moments the market is in motion - lifetime health cover deadlines, tax-time surcharge decisions, first-job cover.

HLT 02 · Onboard

Make the first 90 days count

Onboarding journeys that get extras activated, digital claiming set up and waiting periods understood - because a member who uses their cover in the first quarter is a member who renews. In production with a national health fund.

HLT 03 · Deepen

Turn utilisation into loyalty

Extras reminders before benefits reset, preventive-health nudges and rewards that keep the fund in the member's week, not just their payroll - running today for more than 600,000 members.

HLT 04 · Retain

Save the member before the call

Lapse prediction, April premium-rise save journeys, downgrade-not-cancel options and automated win-backs - triggered in real time, routed with full context, written back to your CRM.

What Covalent runs for health funds

01

Product guidance & policy support

Cover explanations, waiting-period logic and product comparisons grounded in your actual policy documents - not the internet.

02

Claims protection & fraud detection

Anomaly detection across claims flows with human-in-the-loop review - high-risk claims route to the right person before anything is paid.

03

Member retention & win-backs

Lapse prediction, personalised interventions and automated win-back journeys - triggered in real time from your warehouse, written back to your CRM.

04

Contact centre execution

Live member briefs, governed actions across member, policy and claims journeys, and escalation to humans with full context.

AI - decides
Lapse models · next-best-action · claims anomaly detection · member copilots
Covalent - governs
Context · policy · approvals · idempotent write queues · audit · rollback
Your fund - executes
Member administration · claims engine · CRM · contact centre · marketing platforms

No model ever writes directly to your claims engine or member admin. Every action passes through the control plane.

Under the hood

Governed workflow execution

Every journey above runs on the same machinery: queued, idempotent, reversible actions in CRM and member systems, with approvals and an immutable audit trail at every step.

For your teams

Private AI for internal teams

Frontier-model access inside your control environment - Australian data residency, SSO, full audit. See CoWork.

See it against your member journeys

A working session, not a demo. Bring your architecture and your constraints.

Book a working session