Alaffia Health

Alaffia Health, based in New York, builds agentic AI for health plan claims operations, pairing autonomous software agents with expert clinicians to cut the administrative waste that drives up the cost of care. Founded in 2020 by siblings TJ Ademiluyi, its chief executive, and Adun Akanni, its chief operating officer, who grew up in a family revenue cycle management business, it raised a fifty five million dollar Series B in February 2026 led by Transformation Capital, bringing total funding to more than seventy three million dollars. The company reports saving health plans more than one hundred twenty million dollars while reducing review cycles from weeks to days.

The platform supports the full claims lifecycle across payment integrity, utilization management, and appeals. Proprietary optical character recognition digitizes unstructured itemized bills and medical records, agents then extract and structure clinical facts and cross reference a claim against the complete patient record, clinical criteria, and policy guidelines, automating routine cases and prioritizing the most valuable claims for human review. A generative AI assistant helps reviewers summarize medical records, source clinical guidelines, and draft determination responses. Crucially, the model is hybrid and transparent: every recommendation carries a clear clinical rationale and traceable citations, and licensed clinicians remain at the helm for validation and signoff, which is what makes findings defensible to providers and regulators. Agents are configured to each plan's data, policies, and processes, and the company reports getting live in about thirty days with integration into existing claims systems and no disruption to workflows.

Alaffia is built for the compliance realities of payers, upholding SOC 2 Type II, HIPAA, and HITRUST standards, and it deliberately avoids the black box denial algorithms drawing regulatory backlash by grounding every insight in verifiable record data with a clinician checkpoint. It runs as a cloud service or a fully managed offering, uses its own models rather than a choice of provider, and is not a browser automation tool or a general agent builder. For a regional or national health plan that wants to scale clinical review capacity with defensible, traceable savings, Alaffia is a strong and purpose built fit; a payer seeking a self serve, model flexible platform, or an organization outside claims operations, will find it specialized for the payer.