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Pricing Audit Agent

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Parent Worker AI-Powered Claims Auto-Adjudication System

Agent ID pricing-auditor

Portal Nexgile-FINVEST Vault

Sector Financial Services / Insurance / Multiemployer Trust Fund Administration

Status Operational

Problem Statement

The challenge addressed

Claims pricing involves multiple fee schedules, contracted rates, COB calculations, and deductible/copay applications—errors result in overpayments or provider disputes.

Core Logic

How the agent solves it

The Pricing Auditor Agent validates billed amounts against contracted fee schedules, applies appropriate pricing methodologies (fee schedule, UCR, DRG), calculates member cost-sharing, coordinates ben... The Pricing Auditor Agent validates billed amounts against contracted fee schedules, applies appropriate pricing methodologies (fee schedule, UCR, DRG), calculates member cost-sharing, coordinates benefits with other coverage, and ensures accurate fund allocation across health, dental, and vision plans.

System Navigation

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Portal

Nexgile-FINVEST Vault

Digital Worker

AI-Powered Claims Auto-Adjudication System

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Pricing Audit Agent

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