AI Employee Benefits Audit Agent

How Cassidy automates this using AI

Step 1: Ingest and normalize audit data

The Workflow pulls enrollment snapshots, carrier invoices, HRIS records, and 834 EDI files into Cassidy's Knowledge Base. Data is standardized across plans, coverage tiers, and effective dates to create a single source of truth for the audit.

Step 2: Apply eligibility and billing rules

Cassidy matches each dependent and member record against configured eligibility rules waiting periods, dependent definitions, documentation requirements, and carrier retro windows. Billing logic compares expected premiums to actual invoices, flagging variances and ATC discrepancies.

Step 3: Validate DEV documentation

When dependent verification documents are uploaded, Cassidy extracts key data via OCR, validates name/DOB matches, checks relationship proofs against the documentation matrix, and routes exceptions to specialists for review.

Step 4: Generate compliance determinations

For ACA, Cassidy tracks hours and applies measurement/stability periods, tests affordability using the selected safe harbor, and assigns Line 14/15/16 codes for each employee-month building the foundation for accurate 1094-C/1095-C forms.

Step 5: Surface exceptions with Human-in-the-Loop review

Complex cases QMCSO, disabled adult dependents, out-of-window retro items, or affordability edge cases are routed to consultants for final determination. Cassidy presents the relevant context and recommended action, keeping humans in the driver's seat.

Step 6: Execute remediation and reporting

Approved actions flow back through the Workflow: carrier tickets for credits and corrections, 834 updates, COBRA notices for newly ineligible dependents, and consolidated audit reports showing savings, recovered premiums, and compliance status ready for client delivery.