AI Dental Plan Enrollment Optimization Agent

How Cassidy automates this using AI

Step 1: Ingest plan data and employee demographics

The Workflow pulls carrier plan designs (premiums, networks, waiting periods, annual maximums, ortho coverage) and employee data (demographics, employment class, dependents) from your HRIS and ben-admin systems into Cassidy's Knowledge Base.

Step 2: Generate personalized plan recommendations

Cassidy analyzes each employee's household profile, expected utilization, and current provider relationships to produce tailored plan comparisons surfacing total cost estimates, network fit scores, and key trade-offs between PPO and DHMO options.

Step 3: Deploy targeted behavioral nudges

Based on enrollment status and deadlines, Cassidy triggers personalized communications across email, SMS, and in-app channels reminding employees of pending actions, missing PCD selections, or approaching OE/QLE windows.

Step 4: Validate elections and calculate deductions

As elections come in, Cassidy validates each against eligibility rules, plan constraints, and required fields. It calculates payroll deductions by tier, applies pre-tax flags, and confirms effective dates before proceeding.

Step 5: Generate and transmit carrier-specific 834 files

Cassidy builds compliant X12 834 files mapped to each carrier's companion guide including proper INS, NM1, HD, and DTP segments and transmits via SFTP or AS2 on your configured cadence.

Step 6: Monitor acknowledgments and reconcile

The Workflow tracks TA1/999 acknowledgments, flags rejects for remediation, and runs periodic reconciliation against carrier eligibility backfeeds to keep your roster synchronized and audit-ready.