Agentic artificial intelligence for health plan claims operations startup Alaffia Health Inc. announced today that it has raised $55 million in new funding to accelerate growth, launch new AI agents and increase research and development.

Founded in 2020, Alaffia is focused on reducing administrative waste and improving accuracy across health plan claims operations. The company was created to address growing cost pressures that are faced by payers, such as payment integrity, utilization management and appeals, where manual processes and fragmented data can often lead to inefficiency, delays and inconsistent outcomes.

Alaffia provides an agentic artificial intelligence platform that supports clinical review across the entire claims lifecycle, with the technology able to forensically evaluate medical claims against complete patient medical records. The result allows health plan providers to identify billing errors, inappropriate charges and missed clinical context.

Under the hood, Alaffia uses a hybrid model approach that pairs expert clinicians with AI-driven analysis. The AI extracts and structures clinical facts while human reviewers validate findings and ensure decisions are defensible and compliant with regulatory and provider-relations requirements. Alaffia says that combination enables faster turnaround times, improved consistency in reviews and outcomes that health plans can clearly explain to providers and regulators.

“Health plans are under immense pressure to reduce administrative costs and drive affordability for their members and like many industries, they’re starting to see the value of emerging AI solutions,” said co-founder and Chief Executive TJ Ademiluyi.

The company’s solutions are being used by regional and national health plans to scale clinical review capacity and drive measurable cost savings. The platform has delivered millions of dollars in medical cost savings, reduced review cycles from weeks to days and generated more than 20% average savings on high-cost facility claims.

The Series B round was led by Transformation Capital, with FirstMark Capital, Tau Ventures and Twine Ventures also participating.

“Payment integrity is one of the most untapped opportunities in healthcare, in part because payers are harder to build for due to their complex and diverse rule sets,” said Todd Cozzens, managing partner at Transformation Capital. “Alaffia has built a core clinical review platform that is already delivering millions in savings and can scale beyond payment integrity to become foundational infrastructure for health plans. By reducing administrative waste and improving accuracy across claims operations, Alaffia ultimately helps lower costs for health plans — creating a more affordable healthcare system for consumers.”

The new funding takes the total raised by Alaffia to more than $73 million.

Image: Alaffia Health