AI Benefit Guides Agent

How Cassidy automates benefit questions using AI

Step 1: Ingest and index your benefit documents

Cassidy's Knowledge Base ingests your Open Enrollment guides, SPDs, SBCs, EOCs, and plan summaries—extracting key fields like deductibles, copays, eligibility rules, and effective dates. Each document is tagged by plan year, audience, and compliance domain so retrieval stays precise.

Step 2: Trigger on employee question

The Workflow activates when an employee asks a benefits question in Slack, Teams, or your internal portal—capturing the query and the employee's identity attributes from your HRIS or SSO.

Step 3: Resolve plan context and scope retrieval

Cassidy maps the employee's eligibility class, location, and plan enrollment to scope retrieval to the correct documents. During Open Enrollment, the Agent distinguishes between current-year and future-year plan details.

Step 4: Retrieve and cite authoritative passages

The Agent pulls the most relevant passages from your governing documents—attaching citations with document title, plan year, page, and section. Glossary terms from the Uniform Glossary are surfaced when benefits jargon appears.

Step 5: Draft a guardrailed, plain-language answer

Cassidy generates a response strictly from retrieved evidence, summarizing in plain language while preserving required regulatory wording. Hallucination controls refuse answers beyond source evidence and flag uncertainty.

Step 6: Escalate or deliver with Human-in-the-Loop

For ambiguous questions, PHI-linked inquiries, or medical necessity determinations, the Workflow escalates to your benefits team with full transcript and citations. Routine answers are delivered instantly—with audit logs capturing every interaction for HIPAA compliance.