Case studies
Insurance
Insurance – Group Benefits MGA: Enrollment & Eligibility AI
Timeline: Build: 8 weeks. Deploy: employer cohorts. Optimization: 9 weeks carrier maps.
Business overview
Industry: group benefits MGA. Complexity: employer churn, QLE volume.
Common pain points
Manual census, QLE backlog, EDI errors.
Full AI automation system (PrimeAxiom solution)
Census Agent, Eligibility Agent, QLE Agent, EDI Agent.
Automation workflow (detailed system flow)
1. Census upload. 2. AI normalizes rows. 3. Eligibility checks. 4. QLE events routed. 5. 834 generated. 6. Compare ACK/ERR. 7. Fix loops.
AI agents & logic
Parse Agent, Rules Agent, Reconciliation Agent.
Technical architecture
HIPAA-aligned, EDI expertise, LLM for messy spreadsheets.
Tools & integrations
Benefit admin platform, carrier APIs, PostgreSQL, OpenAI
Results
Enrollment error rate −74%; QLE turnaround −52%; carrier rejection rate −68%; broker support tickets −44%.
Timeline
Build: 8 weeks. Deploy: employer cohorts. Optimization: 9 weeks carrier maps.