Administer groups, adjudicate claims and prove fair treatment — at member scale.
Group onboarding and list billing, disability and health claims with document intelligence for medical records, member-level service views, and complaints and conduct monitoring that stands up to regulator scrutiny.
Group Benefits Center
LiveMembers administered
3.4M
Claims STP rate
71%
↑+9ptsAvg claim cycle
3.2d
↓-1.9dComplaints per 10k
1.8
↓-0.4Claims processed per week, last 8 weeks (k)
AegisNow serves health, disability and group benefits carriers with group and member administration, list billing with employer self-service, claims automation with medical-record document intelligence and fraud detection, and a Customer 360 that gives service and conduct teams member-level context. HIPAA-conscious data handling and complaint/TCF monitoring run across the whole lifecycle.
Document intelligence extracts and classifies medical records, cutting manual keying and review.
Illustrative, capability-framed outcome — your results depend on your data, scope and configuration.
The pressures that define health & group benefits
Every health & group benefits programme answers to a distinct set of loss modes and regulators. AegisNow maps both onto one governed core — so a single filing artifact can satisfy many regimes.
Claims cost trend
and adjudication consistency at volume
Medical-record handling, PHI protection
and HIPAA exposure
Group renewal pricing on stale experience data
Enrollment and eligibility errors flowing into claims disputes
Complaint volumes
and fair-treatment scrutiny
Provider and claimant fraud
across high claim volumes
Mapped to one filing library
Obligations from each regime auto-map to shared artifacts, so evidence collected once satisfies many regimes at exam time.
- HIPAA
- State DOIs / prompt-pay rules
- ERISA (group plans)
- ACA market rules
- Unfair Claims Practices
Built for health & group benefits, on one governed core
Each module is composable and shares the same data fabric, Cortex AI brain and evidence ledger — so coverage compounds across the vertical instead of fragmenting.
Smart Claims
Every decision on the file has an author, a rule and a record.
Policy Administration
Service the book, launch products and run MGA programs on one core.
Billing & Collections
Collect every premium, settle every commission, on time.
Customer 360
One view of every policyholder, household and interaction.
Underwriting Workbench
Rate, decide and refer on one governed underwriting desktop.
Actuarial Platform
Every assumption versioned, every run reproducible, every sign-off logged — and uncertified data refused.
Our examiners used to be data-entry clerks with clinical judgement. Now the documents read themselves and the judgement is what we pay for.
92%
of medical documents processed straight-through
The challenge. A group disability and health carrier keyed medical records and bills by hand across high claim volumes, adjudication consistency varied by examiner, and eligibility mismatches between enrollment, billing and claims surfaced as member disputes and complaint volume the conduct team could not get ahead of.With AegisNow. The carrier deployed Smart Claims with document intelligence for medical records and AI triage at intake, list billing reconciled against eligibility on the same fabric, and Customer 360 with complaint workflows and outcome monitoring so service and conduct teams work from one member-level view.
Illustrative scenario; the organisation is described by sector only. No fabricated names, logos or certifications.
Health & Group Benefits operations, clarified
The questions health & group benefits underwriting, claims and finance leaders ask most.
Resilience built for health & group benefits
See AegisNow mapped to your health & group benefits regulators, lines and workflows in a working environment — in one session.