Alaffia Health builds an agentic AI platform that supercharges claims operations for health plans, TPAs, and cost-containment firms. Its AI agents (branded Auto Agents, formerly Autodor) forensically cross-reference medical records against clinical criteria and policy guidelines to catch improper payments, billing errors, and fraud, waste, and abuse across the claims lifecycle, including payment integrity, utilization management, appeals, special investigations, and case management. Human clinicians validate every AI recommendation, providing clinical rationale and traceable citations for defensibility. Founded in 2020 by siblings TJ Ademiluyi and Adun Akanni, Alaffia serves Medicaid, Medicare Advantage, and commercial health plans, reporting over 20% average savings on high-cost facility claims, 20x throughput increases, 97%+ accuracy, and 5x ROI for clients.
Unclaimed
