Alaffia Health

Alaffia Health develops an AI-powered healthcare claims management platform purpose-built for health plans, delivering deeper insights, smarter automation, and consistently better outcomes across the entire claims lifecycle. The platform serves payment integrity, utilization management, appeals, special investigations, and case management teams. Alaffia's AI agents automate routine clinical case reviews by cross-referencing medical records against clinical criteria and policy guidelines, automating routine cases and prioritizing the most valuable claims for human review. The platform's four-step workflow includes configuration (integrating plan-specific data, policies, and processes), data extraction (normalizing medical records into pre-built clinical facts annotated by clinicians for accuracy), clinical analysis and triage (automating routine cases and flagging high-value claims), and human validation (providing clear clinical rationale and traceable citations for defensibility). Every recommendation includes a clear clinical rationale and traceable citations, with human clinicians always at the helm for overview and signoff. The platform achieves a 20x increase in throughput, 97%+ accuracy rate, and 5x ROI, with implementation in just 30 days. Alaffia differentiates itself through its combination of expert clinicians and transparent AI, its focus on defensibility with traceable citations, and its enterprise-grade security including SOC-II Type II, HIPAA, and HITRUST compliance. Founded in 2020 and headquartered in New York City, United States, Alaffia Health has raised approximately $72 million in a Series B round backed by Anthemis Group, 1984 Ventures, Aperture Venture Capital, Tau Ventures, Plug and Play Tech Center, Entrepreneurs Roundtable Accelerator, Twine Ventures, GingerBread Capital, FirstMark, Remarkable Ventures, Transformation Capital, Alex and Bart's Angel Fund, Tale VP, and Hustle Fund.

GRC Software > Risk Management > Industry > Finance > Insurance,

Banking Tech > RegTech > Risk Management > Third Party Risk,

RegTech > Fraud Detection > Insurance,

Insurance IT > Insurance Policy Solutions > RegTech > Fraud Detection > Health,

Healthcare IT > Provider > Administrative Solutions > Finance Management > Patient Centric Payments > Financial Assistance,

Healthcare Payer Tech > Claims Management > Diversified