HCIactive has disclosed plans to introduce the new Predictive Administrative Intelligence (PAI) framework.
It leverages AI to identify potential administrative issues before they arise, enabling carriers, third-party administrators (TPAs), employers and brokers to act proactively.
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 features aims to improve the ability of industry players to address operational concerns earlier.
A core feature of PAI is predictive eligibility tracking, which uses AI to analyze changes to census files, changes in employment status, the timing of plan rule changes, and contribution mismatches.
This process is designed to help brokers and employers recognize eligibility issues before they disrupt operations.
PAI also understands expected claims and accumulator behavior, identifying deductible or out-of-pocket inconsistencies, possible claims misalignments, coverage conflict triggers, and outlier events.
This information allows TPAs and insurers to respond to claims risks early in the process.
Predictive monitoring of remittances and commissions is another aspect of the system.
By predicting missing employer payments, commission gaps, incorrect group configurations and contribution asymmetries, this feature aims to strengthen the financial reliability of organizations.
The Member Experience Forecasting component uses SmartBenefits.ai to predict areas where members may be confused, increases in HR or TPA inquiries, changes in claims or benefits, and benefit usage patterns.
These forecasts aim to reduce member uncertainty and ease pressure on support services.
The PAI framework also includes built-in predictive dashboards that highlight risk areas, expected gaps, likely operational challenges and suggest interventions.
They are designed to provide stakeholders with a clearer view of possible problems before they arise.
According to HCIactive, the PAI system will be introduced in phases from 2025 to 2026.
Henry Cha, CEO of HCIactive, said: “Our next phase is predictive. We are moving from automating today’s workflows to anticipating tomorrow’s problems. Predictive administrative intelligence is the foundation for a new generation of precision and clarity.”
“HCIactive to Release Predictive Administrative Intelligence Framework” was originally created and published by Life Insurance International, a brand owned by GlobalData.
The information on this website has been included in good faith for general information purposes only. It is not intended to constitute advice on which you should rely, and we make no representations, warranties, express or implied as to its accuracy or completeness. You should obtain professional or specialist advice before taking or refraining from any action on the basis of the content on our site.
