Benefits Certification Agent

The Benefits Certification Agent is an AI-powered digital worker that automates the review of employee submitted certification documents for Proof of External Coverage.

Here’s how this agent works:

1. Evaluates uploaded certification documents using predefined weighted criteria.
2. Extracts relevant data.
3. Validates the data against pending actions and calculates a confidence-based match score. 
4. Approves or rejects certifications based on the evaluation.

Designed to streamline certification processing, the Benefits Certification Agent maintains a complete audit trail of all evaluations and decisions, helping organizations improve accuracy, reduce turnaround time and minimize administrative workload.

Powered by the Oracle AI Agent framework and advanced large language models (LLMs), the agent interprets document content, applies standardized validation logic, and performs role-based actions securely within existing system permissions.

The agent is accessed directly from the Benefits Summary page, allowing benefits administrators to manage certification reviews within their existing workflow.

With the Benefits Certification Agent, you can: 

• Automatically review employee submitted Proof of External Coverage documents.
• Validate certification details against pending actions.
• Reduce manual document review and administrative overhead.
• Maintain a complete audit trail of document evaluation and outcomes.

This assistant is: 

• Preconfigured: Ready to use immediately.  You just need to enable the Enable Benefits Certification Agent on Enrollment Summary constant in Visual Builder Studio.
• Secure: Strictly enforces data access controls to protect sensitive employee and dependent information.
• Compliance-focused: Keeps benefit enrollments aligned with legal requirements. 

Document Requirements:

Here are the requirements to be processed by the Benefits Certification Agent:

• In this release, the agent supports only PDF files. PDFs that are created from images (JPEG, PNG, and so on) may not work.
• The current release supports Proof of External Coverage documents only, future releases will include other document types.

The agent reduces manual intervention while ensuring consistent, compliant decision making.

Steps to enable and configure

• Your environment must have the appropriate services for Oracle Applications Platform deployed. For more information, see FAQ2521 on My Oracle Cloud Support. 
• Set the Enable Security Console External Application Integration (ORA_ASE_SAS_INTEGRATION_ENABLED) profile option to Yes and enable permission groups for the appropriate roles. See Access Requirements for AI Agent Studio.
• The Benefits Certification Agent is delivered disabled by default and can be enabled through configuration.  You can’t modify the Benefits Certification Agent.

How do I enable the Benefits Certification Agent?

Once enabled, the agent is available on the Benefits Summary page in the Pending Actions region. Click the agent to evaluate all pending actions.

Key resources

• Explore AI Agents for Oracle Fusion Cloud Applications
• How do I use AI Agent Studio?
• How do I use Benefits AI Agents?
• Start Here: Learning Opportunities to Get Started with Benefits Agents
• A Guide to Successfully Implement Benefits AI Agents

Access requirements

The agents you can view depend on the roles and privileges assigned to you. To access this agent, your role must be explicitly granted access to it by an AI Studio Administrator. See How can I give users access to AI agents and Access Requirements for AI Agent Studio.

This is a built-in and runnable agent and is not available in templates. To interact with this AI agent in product pages, users must be assigned a configured job role that contains this duty role:

Fai Genai Agent Runtime Duty (ORA_DR_FAI_GENERATIVE_AI_AGENT_RUNTIME_DUTY)