Benefits administration
The AI Office for benefits administrators.
New PBM disclosure obligations landed in February. The data assembly they require is recurring, and it is not going away.
Four hard filing dates a year — 1095-C on 2 March, e-file 31 March, RxDC 1 June, gag-clause attestation 31 December — each needing data pulled together from every carrier and PBM you work with.
If any of this sounds familiar
We would start by looking at your claims platform, and whatever middleware moves the 834s and 837s.
- Eligibility files arriving from nine carriers in nine formats, reconciled by hand every cycle
- Census variance chased down manually before every renewal
- Claims data discrepancies found late, by the client rather than by you
- Invoice accuracy dependent on one person who knows where the exceptions live
What we have delivered
In this industry, not an adjacent one
- 14
- sequential engagements since 2020 for one benefits-administration client
- $1.5M
- saved, from visibility into high-cost claims, duplicates and billing errors
- 3,200
- hours a year returned on census reconciliation alone
- 90%
- less manual invoice handling; a hundred invoices in under three minutes
- 12 mo → 2
- months to stand up a new point solution on vendor data
- Weekly
- operational alerting on the platform we still run today
This is the vertical we know best. There is no analogy to draw — we have been doing exactly this work, for a benefits administrator, across fourteen engagements.
Where we would start
One workflow. Four to six weeks. Fixed fee.
Reconciliation exception reporting. Counts and categories only — we do not need to see a single member record to scope it, and no PHI moves anywhere.
Before we start, we agree in writing the number the build has to hit. If it does not hit it, we keep working at no additional cost until it does.
$6,000
credited in full against month one of any retainer started within 30 days
Or go straight to a retainer from $2,500/month. Month to month, 30 days’ notice.
The build order
Ranked by what a wrong output costs
We start where mistakes are cheap and visible, and earn the right to touch money. If you ask us to begin at the bottom of this ladder — and people often do — we will explain the sequencing rather than agree to it.
A wrong output costs someone ten seconds.
Weekly operational alerting and exception digests · internal reporting consolidation · service-desk triage, routing and draft replies
A wrong output creates rework, caught inside the same cycle.
Document extraction into a review queue · data-quality management across incoming feeds · eligibility and census reconciliation as an exception queue
A wrong output has a clock and a counterparty.
Pre-certification and prior-authorization orchestration · vendor invoice reconciliation and fee validation
Every output is money leaving a plan asset account.
Level-funding settlement and stop-loss reporting · claims payment accuracy and repricing validation
The question you are about to ask
“You would need access to our member data.”
No. Error counts and categories — "400 rejected member records per cycle across nine carriers" — contain no PHI and are exactly what sizes the work. When an engagement does require PHI, a BAA comes first, and everything is built inside your own tenant with sensitive data masked in non-production.
Your data
Your data never leaves your tenant.
We do not hold your data, because we do not build on our infrastructure. We build inside yours.
- Built inside your own Microsoft tenant
- Entra ID role-based access through security groups
- No static or local accounts
- MFA enforced
- SFTP with IP whitelisting for partner feeds
- Sensitive data masked in every non-production environment
Continuity
One client has renewed us fourteen times since 2020.
A benefits administrator has brought us back for fourteen sequential engagements since 2020 — eligibility reconciliation, invoice automation three separate times as the requirement changed, pre-certification workflows, a data-quality programme — and we still operate their platform today, with alerting, weekly. Every one of those fourteen ended with them asking for the next thing. That is the part worth weighing: fourteen engagements is not one relationship, it is thirteen separate decisions to keep us, each made by someone who could have stopped. Six years is the honest answer to the question behind every retainer decision — will you still be here in year three.
Twenty minutes, and you will know.
We ask what your team spends its week on. If there is nothing here worth doing, we will tell you that.