AI Retiree Benefits Administration Agent

How Cassidy automates this using AI

Step 1: Trigger on retirement event

The Workflow activates when your HRIS sends a retirement event, automatically transitioning the employee from active coverage to retiree status and stopping payroll deductions.

Step 2: Generate retiree plan options and eligibility files

Cassidy pulls the retiree's demographic data, applies your eligibility rules (age/service formulas, pre-65 vs Medicare-eligible status), and generates the appropriate plan options. EDI 834 files are automatically created and transmitted to carriers.

Step 3: Provide Medicare decision support

For Medicare-eligible retirees, Cassidy's Agent answers questions about Part A/B enrollment, compares MA/MAPD vs Medigap + PDP options based on the retiree's doctors and prescriptions, and guides them through AEP/SEP timing reducing call center volume.

Step 4: Activate direct billing

Cassidy automatically issues the welcome packet and first invoice, configures the retiree's payment method (ACH, credit card, or lockbox), and establishes the dunning schedule in your AR subledger.

Step 5: Process payments and manage collections

The Workflow applies incoming payments, clears suspense items, sends grace period notices, and escalates to termination for non-payment per your plan rules with automatic reinstatement logic when arrears are cured.

Step 6: Reconcile carrier invoices and CMS submissions

Cassidy compares carrier bills to system enrollment by tier and effective date, flags variances for review, and for EGWP/RDS programs, manages Covered Retiree Lists and post-plan-year reconciliation with CMS.

Step 7: Generate compliance artifacts and reports

The Workflow produces AR aging reports, cash posting summaries, carrier variance explanations, and audit-ready documentation plus automated Creditable Coverage notices before the October 15 deadline.