Alaffia Health Raises $55M to Fix Claims Waste with “Agentic AI”

HIT Consultant – Read More

What You Should Know

The Funding: Alaffia Health has raised a $55M Series B led by Transformation Capital, bringing its total funding to over $73M.
The Tech: The company uses “Agentic AI”—autonomous software paired with human clinicians—to forensically audit medical claims against patient records, targeting the estimated $570 billion in annual administrative waste.
The ROI: Unlike “black box” automated solutions, Alaffia’s transparent model has already saved health plans over $100M, delivering a reported 5x ROI and reducing claim turnaround times from weeks to days.

Beyond the “Black Box”

Payment integrity—the process of ensuring a medical bill is accurate before (or after) it is paid—has traditionally been a war of attrition. Health plans use rigid rules engines to deny claims, and providers use armies of staff to appeal them.

Alaffia, founded in 2020 by siblings TJ Ademiluyi and Adun Akanni, takes a different approach. They utilize “Agentic AI” to read the complete patient medical record and compare it against the claim. Crucially, they pair this AI with expert clinicians (human-in-the-loop) to verify the findings.

This hybrid model addresses the “trust gap” in AI. “Healthcare doesn’t need more automation that no one can explain—it needs AI that clinicians, operators, and regulators can trust,” said Adun Akanni, co-founder and COO. By offering traceability and transparency, Alaffia aims to avoid the regulatory backlash currently facing AI-only denial algorithms.

The Metrics of Efficiency

The pitch to health plans is simple: faster audits and higher savings.

Speed: Alaffia reports reducing turnaround times from weeks to days.
Savings: The platform has delivered 20%+ average savings on high-cost facility claims.
ROI: Major health plan clients are seeing a 5x+ Return on Investment.

To date, the company claims to have saved health plans over $100M in medical costs.

“Health plans are under immense pressure to reduce administrative costs… and like many industries, they’re starting to see the value of emerging AI solutions,” said TJ Ademiluyi, co-founder and CEO of Alaffia.