For Employee Benefits

AI transformation for employee benefits

Medical, dental, vision, disability, hospital, worksite, and voluntary plans — enrollment, carrier integrations, and discrepancy management rebuilt on Employee Navigator, Ease, and the HCM/HRIS/payroll systems you already run. Layer-first. Migration-capable. Audit-ready.

How it works

The Problem

Benefits ops break when humans are the integration layer

Open enrollment, carrier connectivity, and premium billing all depend on data that never quite matches across systems.

Census never matches carrier files

HRIS census, ben-admin records, and carrier 834 files disagree every enrollment cycle. Discrepancies surface after premium runs — not before.

Open enrollment is a manual reconciliation event

Every year, enrollment coordinators reconcile medical, dental, and vision elections across Workday, Employee Navigator, Ease, and carrier systems by hand. The window is tight and the error rate is not.

HRIS → ben-admin → carrier is held together by spreadsheets

Member data flows through HCM, HRIS, payroll, and benefits admin platforms — but humans are still the integration layer between every handoff.

Carrier integrations don't scale

Every new medical, dental, or vision carrier appointment is a bespoke EDI, API, or file-drop project. Documentation lags behind production, and onboarding takes quarters.

Where We Transform

Employee benefits workflows we rebuild end to end

Open enrollment & census sync

Medical, dental, vision, disability, hospital, worksite, and voluntary plans — census validation, eligibility verification, and election sync across ben-admin, HCM/HRIS/payroll, and carrier systems.

Carrier integrations

Standardize 834 EDI, API, and file-drop integrations across medical, dental, vision, disability, hospital, worksite, and voluntary carriers — on Employee Navigator, Ease, Benefitfocus, and custom platforms. New carrier appointments onboard in days, not quarters.

Discrepancy management

Flag enrollment exceptions, census-to-carrier mismatches, premium billing deltas, and eligibility conflicts — every flag traces back to its source with a full audit trail.

Member services & COBRA

Eligibility inquiries, coverage questions, COBRA processing, and enrollment exception handling rebuilt as auditable AI workflows with human-in-the-loop sign-off.

Integrations

Layer-first on your ben-admin and HCM stack

Most engagements start as a layer on Employee Navigator, Ease, Benefitfocus, or your custom platform. When the platform is the bottleneck, we migrate or build custom — same audit, same compliance trail.

Employee Navigator
Ease
Benefitfocus
Workday
ADP
Paylocity
UKG
Carrier APIs
834 / 837 EDI
Custom ben-admin

Outcomes

Transformation, not a pilot

6–12 wks

From audit to production deployment

Days

New carrier integration timeline

Proactive

Discrepancy detection before premium runs

Layer-first

On your ben-admin — migrate when needed

Built For Benefits Operations

"Employee benefits teams spend open enrollment reconciling census files that should have matched on day one. AI transformation is how enrollment, carrier connectivity, and discrepancy management stop being separate manual workflows."

SOC 2 Type II · HIPAA · BAAs with major model providers

Transform one benefits workflow.

Two weeks. One enrollment, carrier integration, or discrepancy workflow. A scoped architecture for what AI transformation looks like inside your ben-admin stack.