Claims processing automation that scales

Automated claims ingestion and transformation from multiple insurance carriers, each with unique file formats and business rules—unified into a single processing pipeline.

• Multi-carrier support with carrier-specific schemas
• Flat file decoding and proprietary format conversion
• XML/JSON transformation and normalization
• Multi-group and multi-division claim routing
• SFTP and secure file transfer automation
• Duplicate detection and batch validation
• Paginated API extraction with state management
• Real-time processing status and audit trails

Automated enrollment delta processing and eligibility synchronization between benefits administration platforms, TPAs, and carrier systems.

• Delta change detection and transform pipelines
• Salesforce and CRM data synchronization
• Plan year management and activation rules
• Dependent add/remove automation
• Division and group change handling
• Enrollment resend and correction workflows
• Benefits platform connectivity
• Automated eligibility verification

Intelligent batch orchestration with automated review, error handling, and status management across the entire claims lifecycle.

• Scheduled batch processing (configurable intervals)
• Pending batch queue management
• Automated review and disposition workflows
• API error detection and alerting
• Duplicate claim identification and hold
• Batch status tracking and reporting
• Resubmission and retry automation
• Submission history and audit logging

Real-time monitoring with intelligent alerting to keep operations teams informed of processing status, errors, and exceptions requiring attention.

• Microsoft Teams channel notifications
• Email alerts with detailed context
• API error vs. logical error classification
• Batch-on-hold notifications
• Processing completion summaries
• Exception attachments and error details
• Priority-based alert routing
• Operations dashboard integration