Associate Data Solutions Analyst - Medicaid Operations

Highmark Wholecare and Fortuna Health introduce state's first AI-enabled Medicaid renewal support. - New conversational phone-based support is designed to help eligible members navigate renewals, reduce administrative barriers, and maintain access to coverage. PITTSBURGH (October 7, 2026) - Highmark Wholecare and Fortuna Health today announced plans to expand Fortuna's Medicaid renewal support program in Pennsylvania to include AI-powered voice capabilities designed to help Wholecare members complete time-sensitive renewal steps and stay connected to Medicaid coverage. The expanded collaboration builds upon Highmark Wholecare's work with Fortuna to provide members with added support throughout the Medicaid renewal process. Fortuna's platform helps identify members with upcoming renewal actions, reaches them through targeted reminders, and provides step-by-step guidance in plain language. When members need additional help, Fortuna connects them with live navigators. The new AI-enabled phone support is intended to add another access point for members who may miss mailed notices, face long wait times on phone calls, have limited internet access or need help understanding what action is required. The conversational phone agent can remind members that their Medicaid renewal is due, explain deadlines and next steps, answer common renewal questions and route complex plan member cases to a live person. The expansion comes as health plans, states and community partners prepare for federal Medicaid changes on Jan. 1, 2027. These changes will include more frequent eligibility checks as well as new work or community engagement requirements for beneficiaries enrolled in the Medicaid expansion program, raising the risk that eligible members lose coverage for administrative reasons. The federal government estimates that roughly 15% of all adults in the Medicaid expansion population may lose health coverage once the new rule is in effect, the majority of whom are people who can't prove they meet the new eligibility requirements, or don't return their Medicaid renewal forms in time. "With Medicaid renewals, our focus is on access and making it easier for our members to understand what they need to do, when they need to do it and where to get help," said Victor Fields, president, Highmark Wholecare. "By expanding our work with Fortuna and introducing responsible AI-enabled outreach, we can support members earlier and in ways that are more accessible to their daily lives." In Pennsylvania, Medicaid renewals are administered by the commonwealth's Department of Human Services. Members receive renewal packets when it's time to renew and may lose coverage if they do not complete and return required information by the due date. The Highmark Wholecare-Fortuna program complements these state processes by helping members recognize, understand, and act on their respective renewal requirements. Fortuna's AI-powered phone agent is not a robocall or automated voicemail. It's designed to hold a responsive conversation, provide bilingual support, and hand off to human navigators when needed. The tool does not make eligibility decisions; it provides education, reminders, and navigation support under human oversight and with secure privacy safeguards for personal health information. Measuring the results of thousands of renewals with AI-enabled contact support versus human contact support, Fortuna saw members who received AI-enabled support renew at a 9 percentage-point higher rate than those who only received human contact support. "The members most likely to lose coverage are often those with the greatest burdens on their time. A father who works evening shifts, the caregiver of a disabled child," said Nikita Singareddy, co-founder and CEO of Fortuna Health. "We're proud to expand our digital support with Voice AI and meet members, at more hours, in the language of their choice. Our aim is to provide guided support through the renewal process and decrease member burden, and we're proud to bring this work to more Pennsylvanians with Highmark Wholecare." About Highmark Wholecare Highmark Inc. believe in caring for the whole person in all communities where the need is greatest. Highmark Inc. see a future in which everyone has equal opportunity to achieve their best health. Through its leading Medicaid and Medicare programs, Highmark Inc. is coordinating health care that goes beyond doctors and medicine that helps members achieve not just physical health but also delivers whole person care. Its team members are helping to drive this new kind of health care for its 325,000 Medicaid and Medicare members in collaboration with a network of 29,000 primary care physicians, specialists, hospitals, and other ancillary providers. Highmark Inc. is also committed to supporting its neighbors through its many community outreach and engagement programs. About Fortuna Health Fortuna Health is a consumer-first Medicaid navigation platform - "TurboTax(R) for Medicaid" - enabling guided support across eligibility, enrollment, renewal, and transitions off the program. Fortuna partners with health plans, managed care organizations and health systems across more than 21 markets to deliver member-first navigation that drives timely and accurate enrollment and renewals for the 80 million Americans who rely on Medicaid. Fortuna Health is backed by Andreessen Horowitz, BoxGroup, and Y Combinator. For more information, visit fortunahealth.com.

Fortuna enters West Virginia market with Highmark Health Options. Parkersburg, W.Va. (October. 6, 2026) - In anticipation of changing Medicaid eligibility guidelines through the implementation of new federal rules, Highmark Health Options West Virginia (HHO) has introduced Fortuna, a consumer-first navigation platform that simplifies the Medicaid renewal process and helps members impacted by the upcoming changes address eligibility requirements to maintain health coverage if eligible. Fortuna is one of several companies currently working with the federal government on the technical requirements for the new law. The federal government estimates that roughly 15% of all adults in the Medicaid expansion population may lose health coverage once new federal Medicaid changes take effect on Jan. 1, 2027, the majority from people who can't show they meet the new eligibility requirements, and a meaningful share simply because of missed deadlines or documentation gaps. Fortuna's work with HHO builds on a model designed to reduce preventable coverage loss by meeting members where they are. The platform combines timely outreach by text, email and phone; plain-language guidance; multilingual support; document and notice assistance; and access to live navigators. The service is designed to help members understand renewal notices, know when action is due and complete the appropriate steps with confidence. Fortuna's approach addresses common renewal barriers, including confusing notices, missed deadlines, language access needs and uncertainty about required documentation. "As Medicaid programs across the country prepare for more frequent eligibility checks and community-engagement requirements for certain adults, member communication and navigation will play an increasingly important role in helping eligible people avoid unnecessary gaps in coverage," said Jason Landers, president and CEO, Highmark Health Options. "It's our job, as a leading managed care organization, to help the state communicate the upcoming changes and provide the tools and support to maintain coverage if eligible for members impacted by the new requirements." Fortuna and HHO, the state's first Blue Cross Blue Shield-branded managed care organization, are working in alignment with West Virginia's Medicaid renewal process and under the oversight of the West Virginia Bureau for Medical Services. West Virginia Medicaid members are already being encouraged to prepare for upcoming federal changes by keeping contact information current, reading state communications and watching for future notices about required actions. As of June, there were nearly 390,000 Medicaid beneficiaries in the state of West Virginia. "As new requirements take effect, we're proud to expand our partnership with Highmark Health Options to bring technology and navigation support to Medicaid members in West Virginia," said Nikita Singareddy, co-founder and CEO of Fortuna Health. "We're also grateful to the Bureau for Medical Services for their commitment to effective, member-first outreach and engagement, and we're proud to support West Virginians maintaining their coverage and connecting to work and community engagement opportunities." Fortuna estimates that 77% of all Medicaid expansion beneficiaries are uncertain of when they need to take action to maintain eligibility. According to a 2024 survey by the National Association of Community Health Centers, 85% of enrollees don't understand how to read their coverage notices and 63% try more than once to renew coverage. The program is intended to support eligible members through the administrative steps required to keep coverage active, while ensuring that eligibility decisions remain with the appropriate state authorities. A similar pilot program with Highmark's Medicaid population in Pennsylvania has yielded strong results. On average, Fortuna's managed care customers see an approximate 10% increase in monthly renewal rates over baseline. About Highmark Health Options West Virginia Highmark Health Options West Virginia is a managed care organization serving West Virginians who qualify for Medicaid. Highmark Inc. help each of its members receive the care and services they need to live healthier and more independent lives, and Highmark Inc. collaborate with providers and regulators to improve health outcomes, simplify the health care experience, and ensure affordability. Highmark Health Options West Virginia members include individuals and families with low income or complex health and social needs, expectant mothers, children, and people with disabilities. Learn more at https://www.highmark.com/health-options-wv About Fortuna Health Fortuna Health is a consumer-first Medicaid navigation platform - "TurboTax(R) for Medicaid" - enabling guided renewal support across eligibility, enrollment, renewal, and transitions off the program. Fortuna partners with managed care plans to deliver simplified, member-first navigation that drives higher enrollment, faster renewals, and stronger long-term retention for the 80 million Americans who rely on Medicaid.