HCIactive has disclosed plans to introduce the new Predictive Administrative Intelligence (PAI) framework.
It leverages AI to identify potential administrative problems before they occur, allowing carriers, third-party administrators (TPAs), employers, and brokers to act proactively.
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The framework builds on HCIactive’s existing AI-based platforms, such as VIRA Audit, AI Agency Manager, SmartBenefits.ai and VIRA Communicator.
The addition of predictive functions is intended to improve the ability of industry participants to address operational concerns at an earlier stage.
A central feature of PAI is Predictive Eligibility Tracking, which uses AI to analyse census file alterations, employment status changes, timing of plan rule shifts, and contribution mismatches.
This process is designed to help brokers and employers recognise eligibility issues before they disrupt operations.
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By GlobalDataPAI also includes Forecasted Claims & Accumulator Behaviour, identifying deductible or out-of-pocket inconsistencies, possible claim misalignments, coverage conflict triggers, and outlier events.
These insights allow TPAs and carriers to respond to claims-related risks early in the process.
Predictive Remittance & Commission Oversight is another aspect of the system.
Through forecasts of missing employer payments, commission discrepancies, incorrect group set-ups and contribution mismatches, this function aims to strengthen financial reliability across organisations.
The Member Experience Forecasting component uses SmartBenefits.ai to predict areas where members may get confused, increases in HR or TPA inquiries, changes in claims or benefits, and patterns in benefit usage.
This forecasting intends to reduce member uncertainty and ease pressure on support services.
The PAI framework also features integrated predictive dashboards that highlight risk zones, expected discrepancies, likely operational challenges, and suggest interventions.
They are designed to provide stakeholders with a clearer view of possible issues before they develop.
According to HCIactive, the PAI system will be introduced in phases from 2025 through 2026.
HCIactive CEO Henry Cha said: “Our next phase is predictive. We are moving from automating today’s workflows to anticipating tomorrow’s issues. Predictive Administrative Intelligence is the foundation for a new generation of accuracy and clarity.”
