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Eligibility Verification Agent

This agent performs real-time eligibility verification by querying member hour banks, validating coverage effective dates, checking dependent relationships against plan rules, and confirming benefit tier applicability. It calculates remaining coverage periods and flags approaching eligibility lapses requiring self-payment options.

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Parent Worker AI-Powered Claims Auto-Adjudication System

Agent ID

eligibility-verifier

Portal Nexgile-FINVEST Vault

Sector Financial Services / Insurance / Multiemployer Trust Fund Administration

Status

Operational

Problem Statement

The challenge addressed

Multiemployer eligibility involves complex hour-bank calculations across multiple employers, with rules varying by plan, coverage tier, and dependent relationships.

Core Logic

How the agent solves it

This agent performs real-time eligibility verification by querying member hour banks, validating coverage effective dates, checking dependent relationships against plan rules, and confirming benefit t... This agent performs real-time eligibility verification by querying member hour banks, validating coverage effective dates, checking dependent relationships against plan rules, and confirming benefit tier applicability. It calculates remaining coverage periods and flags approaching eligibility lapses requiring self-payment options.

System Navigation

Explore related components

Portal

Nexgile-FINVEST Vault

Digital Worker

AI-Powered Claims Auto-Adjudication System

Current Agent

Eligibility Verification Agent

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