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AI agent for benefits administrators

Benefits Enrollment Data Quality Agent

Consistent enrollment data before the deadline.

Benefits Enrollment Data Quality Agent: what goes in, what the agent does and what you get

What it does

Benefits enrollment forms often contain details that contradict each other, such as a dependant's birth date that differs between forms or a plan code that does not match the chosen coverage tier. This agent checks field consistency across all forms an employee submitted. When it finds a conflict, it drafts a specific clarification question rather than a generic request. When the corrected form comes back, it revalidates everything, because a fix in one field can create a new conflict elsewhere. It works through cases in order of the closest enrollment deadline. Benefits operations submits the enrollment; the agent never decides coverage. Edge case: an employee corrects a child's birth date, which makes the child too old for the selected dependant tier, so the agent asks a new question.

How it works

Follow the arrows from top to bottom. The orange dashed arrow is the loop: when a check fails, the agent goes back and tries again.

Start and resultWhat it doesA check on its own workWaits for your OKGoes back and retries
Yes, continueYes, continueApprovedNoNo 1 STARTS WHEN Forms submitted 2 USES A TOOL Check field consistency 3 CHECKS THE RESULT Are all fields consistent? If not: draft a targeted clarification. Back to step 2. 4 USES A TOOL Revalidate the corrected form 5 CHECKS THE RESULT Did the correction create a new conflict? If not: ask a new specific question. Back to step 3. 6 YOU APPROVE Benefits operations submits 7 RESULT Enrollment data-quality packet
Read the steps as a list
  1. Forms submitted
  2. Check field consistency
  3. Are all fields consistent?If not: draft a targeted clarification. Back to step 2.
  4. Revalidate the corrected form
  5. Did the correction create a new conflict?If not: ask a new specific question. Back to step 3.
  6. Benefits operations submitsThe agent waits here for your OK.
  7. Enrollment data-quality packet

How it decides

It checks inconsistent dates and dependent identifiers first and re-validates every correction.

  • Work cases in order of the closest deadline.
  • Revalidate the whole set after every correction.
  • Ask one specific question per conflict, never a generic request.
  • Coverage choices are never changed by the agent.

Make it yours

Every agent is a starting point. You choose these settings for your own situation.

  • Fields compared across forms (default dependants, dates, plan codes)
  • Enrollment deadline and how early to escalate (default 3 days before)
  • Tone and channel for clarification questions
  • Who submits to the carrier (default benefits operations)

What keeps you in control

It always asks you first

  • Coverage decisions
  • Enrollment submission

Hard limits

  • No coverage decisions.

It stops when

  • Done: consistent.

Set it up

We guide you through the set-up, step by step

Members get the full set-up guide for this agent. No technical skills needed: you copy, paste and upload.

10 minto set it up in your AI
5 AIsChatGPT, Claude, Copilot, Gemini, Grok
  • One set of instructions to paste into your AI, with the clicks for ChatGPT, Claude, Microsoft 365 Copilot, Gemini and Grok
  • The agent then walks you through connecting your own data, one source at a time
  • A downloadable copy with the flow chart, the rules and the full guide
Get access to this agent

An example run

What happensDuring open enrollment on November 4, the agent found Omar Diaz listed a spouse on the medical form but chose an employee-only plan code. It asked which was correct. Omar changed the plan to employee plus spouse, but the dental form still said employee only, so the recheck failed. The agent asked again, Omar fixed dental, and benefits operations submitted on November 6.

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