Using AI for eligibility file management

Technologies like fuzzy matching and approximate string matching can be used to process eligibility files with little or no human interaction and give quicker results. (Photo: Shutterstock)

When a company decides to offer a health care administration platform to its employees, they’ll need to provide a certain level of information to give members the best possible experience. As a general rule, the more information a service provider about an employee’s benefits package, the better a member’s experience will be. Essential information includes name, contact information – such as email or phone number, medical plan information. Additional information could be voluntary benefits like 401K, long-term disability, short-term disability, etc. These files–which rarely come in a single file–are what the industry calls eligibility files.

c Although there are some standards in the space, they are limited and not universally used. A single typo can cause a benefits system to fail, requiring hours of detective work to find the problem. Older systems can be outdated and result in compatibility issues, especially when multiple benefit partners are in the mix.