Long-horizon AI agents for health plan operations.
Health plans run document- and policy-heavy work across adjudication, prior authorization, appeals, provider data, and group underwriting. Layerup deploys one long-horizon agent per function inside your core admin and UM systems: the claims operations agent works each case from eligibility through adjudication support and appeals preparation, and the group underwriting agent takes each submission from census extraction to pricing-ready — single continuous runs that last hours or days.
One long-horizon agent per health plans function.
Each agent below owns every step of its function and runs uninterrupted for hours or days — inside your existing systems, until the work is finished and staged for human approval.
The claims operations agent
One agent carries each case across payer operations. It verifies member eligibility and coverage, applies plan policy and edits, supports adjudication and prior authorization review against medical policy, coordinates benefits, and assembles appeals and grievance packets with citations to plan documents and clinical evidence — working the case uninterrupted for hours or days until it is reviewer-ready.
The group underwriting agent
One agent takes each group submission end to end. It extracts census and enrollment data, reviews loss experience and utilization, preps stop-loss and reinsurance inputs, and stages pricing inputs — running continuously until new-business or renewal review is decision-ready.
Claims and underwriting workflows in health plans.
Every step below belongs to one agent's single continuous run — one long-horizon agent per function, working uninterrupted until the work is finished.
Claims workflows.
Every step below is automated by the single health plans claims agent in one continuous run — intake, summarization, file preparation, and routing 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.
The health plans underwriting agent carries each submission through every step below in a single uninterrupted run — intake, extraction, risk summarization, and quote and referral preparation.
- 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 long-horizon 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 runs critical workflows across the insurance and financial services lines below.
Deploy long-horizon AI agents in your health plans operation.
Start with one function's agent. Prove the operational lift. Then expand by line of business or by department.