AI agents for health plan operations.
Health plans run document- and policy-heavy workflows across adjudication, prior authorization, appeals, provider data, and group underwriting. Layerup agents work inside your core admin and UM systems to intake claims, verify eligibility, support adjudication and appeals, and on the new-business side, intake group submissions, parse census and experience data, and prepare pricing inputs.
AI agent use-cases for health plans.
The agent surfaces Layerup deploys today for health plans. Each runs inside your existing systems and routes exceptions for human approval.
Adjudication support agent
Verifies member eligibility and coverage, applies plan policy and edits, and stages clean claims for adjudication.
Prior authorization agent
Reviews PA requests against medical policy and clinical criteria, assembles the case file, and routes to the right reviewer.
Appeals & grievance agent
Assembles complete appeals packets with citations to plan documents, prior decisions, and clinical evidence.
Group new-business agent
Intakes group submissions, extracts census, prior experience, and stop-loss data, and prepares pricing inputs.
Claims and underwriting workflows in health plans.
The complete set of workflow surfaces Layerup agents handle in this line of business today.
Claims workflows.
AI agents that intake, summarize, prepare, and route health plans claims for examiner approval inside your existing systems.
- 01Claim intake & adjudication support
- 02Prior authorization review
- 03Member eligibility & coverage verification
- 04Provider data extraction
- 05Appeals & grievance preparation
- 06Coordination of benefits
- 07Payment integrity & overpayment recovery
Underwriting workflows.
AI agents that intake submissions, extract data, summarize risk, and prepare quote and referral packages for health plans underwriters.
- 01Group submission intake
- 02Census & enrollment data extraction
- 03Loss experience & utilization review
- 04Stop-loss & reinsurance prep
- 05Pricing input prep
- 06Renewal review
How Layerup deploys here.
Operational details that matter when deploying AI agents inside health plans operations.
- 01Commercial, Medicare Advantage, Medicaid, and ACA business supported.
- 02Designed with PHI handling, retention, and audit obligations for health plan operations.
- 03Configurable approval gates per claim type, dollar threshold, and provider relationship.
Explore other lines of business.
Layerup supports both claims and underwriting across the lines below.
Deploy AI agents in your health plans operation.
Start with one workflow. Prove the operational lift. Then expand by line of business or by department.