Technical Deep Dive
The technology Actually Works
The technology behind AI-powered enrollment — from Monte Carlo simulations to real-time voice counseling.
Technical Deep Dive
The technology behind AI-powered enrollment — from Monte Carlo simulations to real-time voice counseling.
PlanMatch AI
We run 1,000 simulated healthcare years for each plan, using your employee's actual claims data, family composition, age, and the answers they give during enrollment. Every simulation produces a cost distribution — not a single estimate.
Distribution of 1,000 simulated healthcare-year costs for Silver PPO
Cost Efficiency
Total expected cost across all scenarios (premium + OOP)
Plan-Profile Fit
How well plan design matches this person's specific utilization pattern
Predictability
Variance of outcomes — low deductible plans score higher for risk-averse employees
Coverage Adequacy
Does the plan cover the services this person actually needs?
Network
Provider access, specialist availability, and geographic match
Worked example
Sarah is enrolled as Employee + Spouse. During the discovery questionnaire, she indicates she's planning back surgery this year. The simulation immediately reruns 1,000 scenarios that include a major surgical event — hospital stay, anesthesia, surgeon fees, physical therapy, and post-op imaging.
The Gold PPO scores 94 because the $500 deductible and $3,000 out-of-pocket max cap the damage. The Bronze HSA drops to 45 because the $6,000 family deductible hits before insurance kicks in — and the simulation shows Sarah paying $8,200+ out-of-pocket in 73% of scenarios.
Scores update in real-time as employees answer questions. Every answer changes the math.
Live scoring demo
Toggle the scenario and watch scores recalculate
For a healthy year, the Silver PPO balances cost and coverage. The Bronze HSA's low premium and tax-advantaged savings make it competitive.
Ben Voice AI
Ben is a real-time AI voice coach that doesn't just answer questions — he navigates the enrollment UI, selects plans, and completes elections on screen while the employee watches.
Employee speaks
Natural voice input captured via microphone
Speech converted
Voice-to-text transcription in ~200ms
AI analyzes
Decision engine processes with full plan context and employee profile
UI navigated
AI calls tools to control the enrollment screen in real time
Response spoken
Text-to-speech delivers a natural voice reply as the UI updates
This is what makes Ben different. The voice coach, the AI decision engine, and the enrollment screen aren't separate tools — they're one integrated experience. Here's what it looks like in practice:
The coach greets them by name, verifies their identity, and moves the screen to the verification step. The employee sees the screen change in real time — the AI is driving.
"Are you taking any regular medications?" "Anything big coming up — surgery, having a baby?" Each answer feeds into the AI scoring engine. The employee just talks naturally.
Based on the employee's age, family, salary, claims history, and discovery answers, the AI simulates a thousand different healthcare years for each plan. Scores update in real time on screen.
"Based on everything you've told me, I'd go with the Silver PPO. Here's why..." The coach eliminates the worst-fit plan first, then compares the remaining two using a scenario with the employee's actual family members.
The employee says "yeah, let's go with that." The AI selects the plan on the enrollment screen, and the employee watches it happen. No clicking required.
The coach walks through each benefit line — educating along the way. "Accident insurance pays you cash directly if someone breaks a bone — four bucks a paycheck."
The coach walks through the final summary: what they chose, how it hits their paycheck, what their employer pays, and how it compares to last year. The employee signs electronically.
The AI doesn't just talk — it takes action. It has direct control over the enrollment interface, so the employee never has to click a button.
Moves from medical → dental → vision → review automatically as the conversation progresses. The screen follows the conversation.
When the employee agrees to a recommendation, the AI selects it on screen immediately. The employee watches the plan highlight in real time.
"Want to add accident insurance?" "Yeah." Done — toggled on screen instantly. Premium updates automatically.
After every selection, the AI calculates the per-paycheck cost and tells the employee: "So far you're at about two thirty-two per paycheck."
Ben's conversational approach is modeled on how the best human benefits coachs actually work — informed by pioneering research in behavioral decision support.
Eliminate, then compare
Remove plans that are clearly wrong before diving into details. Reduces cognitive load from 5 plans to 2-3 finalists.
Personalized scenarios
Uses first names and real family details. "If Michael needs his asthma inhaler refilled 12 times this year..."
Two numbers max
Never presents more than 2 financial figures in a single response. Complex comparisons are broken into digestible pieces.
Normalize confusion
"Most people find this part confusing — let me explain coinsurance in plain terms." Reduces anxiety and increases engagement.
HIPAA-safe by design
Voice AI never touches PHI. Social Security numbers are entered on encrypted screen fields only — never spoken aloud or transmitted through the voice pipeline.
The Living Agent
Most platforms ship and stop. Ben ships and starts learning — from every conversation, every pause, every question.
Ben
core
Every conversation
captured
Nightly AI
extraction
Lessons reviewed
& approved
Future Ben
smarter
“Most platforms ship and stop.
Ben ships and starts learning.”
The difference · every single day
Nightly
runs
Zero
prompts
100%
automatic
ClaimsIQ
When claims data is available, predictions are parameterized from actual utilization history — not generic assumptions. The simulation uses real PCP visit frequency, specialist counts, Rx fills, ER visits, and inpatient days.
Data pipeline
Claims Import
EDI 837 / CSV
Utilization Profile
Per-member
Monte Carlo Params
Distribution fitting
Cost Distribution
1,000 scenarios
Plan Score
0-100
Real PCP visit frequency (e.g., 4.2 visits/year)
Actual specialist utilization by type
Prescription fill counts and drug tiers
ER visit history and inpatient days
Historical out-of-pocket spending
Chronic condition continuity patterns
Questionnaire-derived utilization estimates
Age/sex demographic benchmarks (MEPS data)
Self-reported chronic conditions
Planned procedures and life events
Family size and dependent age factors
Conservative confidence intervals
Enrollment Flow
Every step adapts. If there's only one dental plan, we skip the comparison. If the employee is a 55-year-old male, we don't ask about pregnancy. The flow is driven by plan configuration, employee demographics, and prior answers.
Average completion time: 8 minutes with Ben's voice guidance
Verify
Confirm identity, employment status, and eligibility window
Dependents
Add/remove dependents with SSN enforcement and relationship validation
Discovery
Adaptive health questionnaire that adjusts based on age, sex, and family composition
Claims Review
When ClaimsIQ data is available, review prior-year utilization and confirm major events
Medical
Eliminate obvious mismatches, compare 2-3 finalists side-by-side, recommend with rationale
Dental
Skip comparison if only one plan. Score based on orthodontic needs and expected procedures
Vision
Factor in contact lens usage, eye exam frequency, and dependent vision needs
Ancillary
Educate on life, disability, accident, critical illness. Show paycheck impact
Review
Complete summary with e-signature. SHA-256 hash of elections for tamper-evident audit
Complete
Generate ID cards, trigger EDI 834 carrier files, and confirm next steps
Prior Year Intelligence
Ben shows employees what they had last year, what it cost, and why this year's recommendation might be different. Anchoring to familiar data builds trust and speeds decisions.
Prior year vs. recommendation
2025 election
Silver PPO 1500
Employee + Spouse
$210/paycheck
$5,460/year premium
2026 recommendation
Gold PPO 500
Employee + Spouse + Child
$310/paycheck
$8,060/year premium
Why the change:With a new baby, the Gold PPO's lower deductible and pediatric coverage saves an estimated $2,400 in out-of-pocket costs — more than offsetting the $100/paycheck premium increase.
HSA Intelligence
If an employee has an existing HSA balance, Ben factors that into the recommendation. A $5,000 HSA balance changes the calculus — the Bronze HSA deductible is less scary when you already have funds to cover it.
The triple tax advantage — tax-free contributions, tax-free growth, tax-free withdrawals for medical expenses — makes HSAs the most powerful savings vehicle in the tax code. Ben quantifies this for every employee.
HSA growth calculator
See the triple tax advantage in action
Projected HSA value
$20,563
*Tax-free withdrawals for qualified medical expenses. After age 65, non-medical withdrawals taxed as income (no penalty).
Security & Compliance
Benefits data is some of the most sensitive information in an organization. Ben AI is built with healthcare-grade security at every layer.
PHI encrypted at rest and in transit
Voice AI isolated from PHI pipeline
Minimum necessary access principle
BAAs being signed with covered subprocessors
Data encrypted at rest (AES-256-GCM)
TLS 1.3 in transit
Field-level encryption for SSNs
Key rotation every 90 days
Legally binding e-signatures
SHA-256 hash of election data
Tamper-evident audit trail
Complete consent documentation
Control framework being implemented
Continuous monitoring
Incident response playbook
Penetration testing planned
State-specific mandate tracking
Automatic plan design validation
Regulatory change monitoring
Multi-jurisdiction support
Every PHI access logged
Immutable audit trail
User action attribution
90-day retention minimum
For Brokers
Book management, white-labeling, renewal workflows, commission tracking, stop-loss monitoring, and network intelligence.
Explore broker toolsFor HR Teams
Employee enrollment, benefits administration, compliance management, and real-time reporting for HR professionals.
Explore HR toolsFor Carriers
AI-powered plan onboarding, real-time enrollment data, market intelligence, and distribution to brokers and employers.
Explore carrier platformBilling Intelligence
Automated carrier invoice auditing that catches terminated employees, tier mismatches, and rate variances — included at no extra cost.
See how it worksThe best way to understand Ben is to meet him. Book a technical demo or explore the platform yourself.