nexgile-riskmind-platform
Nexgile-RiskMind Platform supports Taft-Hartley multi-employer benefit fund administration. Its stakeholder portals connect fund administrators, trustees, contributing employers and healthcare providers around benefit-plan operations and member services.
Enterprise solution scope
Platform Overview
Digital Workers
Defined business processes supported by coordinated AI agents
AI Claims Adjudication Digital Worker
Manual claims processing is slow, error-prone, and inconsistent. Human adjusters struggle with complex medical coding rules, miss fraud patterns, and cannot efficiently cross-reference provider histories across 220+ funds. This leads to overpayments, compliance violations, and delayed member reimbursements.
AI Agents
Multi-Agent Eligibility Intelligence Digital Worker
Multi-employer fund members work variable hours across multiple employers, making eligibility determination complex. Coverage gaps threaten families, especially those with special needs dependents. Manual eligibility reviews cannot predict risks, analyze scenarios, or provide personalized recommendations at scale.
AI Agents
Trustee Decision Intelligence Digital Worker
Fund trustees face complex financial decisions requiring analysis of fund health, contribution trends, claims patterns, vendor performance, market conditions, and regulatory compliance. Manual analysis is slow, siloed, and cannot provide real-time predictive insights or what-if scenario modeling.
AI Agents
Platform at a Glance
Review documented capabilities, operational stakeholders and business objectives
Enterprise Capabilities
45 core functions
Real-time eligibility status tracking based on hours worked
Comprehensive claims management with detailed Explanation of Benefits (EOB) views
Digital ID cards with Apple Wallet and Google Pay integration
Dependent and beneficiary management
Pension account dashboards with retirement planning calculators
+ 40 more
Operational Stakeholders
7 stakeholder groups
Union members and beneficiaries
Contributing employers
Fund trustees
Healthcare providers
Fund office staff and administrators
+ 2 more
Solution Highlights
8 key differentiators
Comprehensive digital ecosystem serving over 220 funds across the United States
Five specialized portals for distinct stakeholder groups
Personalized benefits hub for union members
85%+ auto-adjudication rates through intelligent rules-based processing
Advanced AI agentic workflows with multi-agent orchestration
+ 3 more
Business Objectives
9 key benefits
Addresses unique challenges of Taft-Hartley fund administration
Prevents fraud, waste, and abuse through clinical code editing
Delivers real-time recommendations and risk scoring
Ensures regulatory compliance monitoring for ERISA, HIPAA, and ACA
Provides field environment accessibility through mobile applications
+ 4 more