AI Enrollment Reconciliation Agent
Automating Benefits Enrollment Reconciliation with AI
Detect Variances Across Every Line of Coverage
The agent matches enrollment records against carrier invoices at the member-plan-period level, surfacing missing terms, tier mismatches, rate discrepancies, and COBRA timing issues before lookback windows expire.
Accelerate Root-Cause Analysis and Remediation
Automated classification pinpoints whether each exception stems from an HRIS error, EDI processing gap, or carrier billing mistake then generates corrected 834 transactions or carrier case documentation with supporting evidence.
Tie Out Payroll and Recover Premium Leakage
The system reconciles employee deductions and employer contributions to expected premiums across 24/26/27 pay-period calendars, flagging arrears and catch-up gaps while tracking recovered dollars at the client and worksite level.
How Cassidy automates this using AI
Step 1: Ingest enrollment and invoice data
The Workflow triggers on your reconciliation schedule monthly or per billing cycle pulling enrollment snapshots from your HRIS or ben-admin system, EDI 834 files, carrier invoices (PDF or structured), payroll registers, and COBRA TPA remittance reports into Cassidy's Knowledge Base.
Step 2: Normalize and map plan data
Cassidy standardizes member IDs, harmonizes carrier plan codes to internal identifiers, aligns tier structures (composite vs. age-banded), and applies effective date logic and waiting-period rules to create a unified person-plan-period ledger.
Step 3: Run eligibility hygiene checks
Before invoice comparison, the Workflow validates enrollment data checking effective date rules, dependent age-outs, EOI status for volume-based coverages, salary updates for STD/LTD/Vol Life, and COBRA grace windows.
Step 4: Match and classify variances
Cassidy performs deterministic and fuzzy matching across members, plans, tiers, and premiums, then categorizes each discrepancy: missing term, missing add, tier mismatch, rate mismatch, salary/volume variance, COBRA misalignment, or duplicate charge.
Step 5: Generate remediation actions
For each exception, Cassidy determines the remedy path producing corrected 834 transactions with appropriate Maintenance Type Codes and effective dates, drafting carrier case templates with evidence, or flagging payroll deduction corrections.
Step 6: Route for approval with Human-in-the-Loop
The Workflow sends a Discrepancy Identification Report and Payment Approval Packet to your benefits and finance teams for review. Analysts approve carrier credits, 834 resends, and payment adjustments before execution.
Step 7: Track resolution and close the cycle
Cassidy monitors EDI acknowledgments (999/277CA), ages open carrier cases against lookback deadlines, and maintains an audit trail of all actions. A KPI dashboard surfaces PEPM recovered, exception rates, and premium leakage trends for continuous improvement.
Implement it inside your company
- Hands-on onboarding and support
- Self-paced training for your team
- Dedicated implementation experts
- Ongoing use case discovery
- ROI tracking & analytics dashboards
- Proven playbooks to get started fast
