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We turn ideas into scalable products with proven delivery across 18+ industries. EXPLORE NOW!

One Trusted Identity Per Member, Resolved by Agents That Know When to Stop

A national health services organisation was reconciling member records by hand. We built a LangGraph multi-agent platform on Databricks that resolves every incoming member event into one governed, auditable golden identity — and escalates to a human steward whenever confidence falls below the threshold.

Build Your Identity Resolution Platform

About the Project

For a healthcare payer, few problems are as deceptively simple as knowing with certainty that the member in front of you is the same member represented across a dozen other systems. When identity is uncertain, everything built on top of it inherits that uncertainty: eligibility checks, claims adjudication, care coordination and member outreach all risk acting on the wrong record, or on a fragment of the right one. The platform resolves incoming member events into a Member Identity Graph — a continuously updated representation of true member identity that eligibility engines, claims processors and next-best-action systems can depend on as a shared source of truth.

Industry

Healthcare Payer and Administration

A national health services organisation ingesting member data from enrollment platforms, claims feeds, provider networks and third-party administrators. The source does not name the client.

  • Payer Operations
  • Master Data
  • Agentic AI
The Problem

The same person exists as several partly overlapping records, and no system knows they are the same person

Each source captures identity slightly differently — a name spelled one way here, a date of birth transposed there, an identifier present in one feed and absent in another.

  • Fragmented Records
  • Failed Eligibility Checks
  • Claims Rework
  • Audit Exposure
Orchestration

A LangGraph multi-agent workflow on Databricks, running five specialised agents

Extraction, matching, scoring, escalation and resolution are coordinated as one workflow with the state, memory and control flow needed to handle exceptions gracefully rather than forcing every case through an identical pipeline.

  • LangGraph
  • Databricks
  • Five Agents
  • Durable Checkpointing
The Output

A Member Identity Graph that downstream systems consume as infrastructure

Because identity resolution is exposed as a dependable governed service, the client's teams are extending the same platform to an Intent Manager Agent — the first downstream capability built on the infrastructure rather than beside it.

  • Golden Identity
  • Eligibility Engines
  • Claims Processors
  • Next-Best-Action
Governance

Tool registry, AI guardrails, immutable audit trail and policy expressed as configuration

Every agent operates against a BaseTool contract, every output is validated against policy before it is acted upon, and every decision lands in a trail from which the reasoning can be reconstructed on demand.

  • BaseTool Registry
  • Pydantic Validation
  • AI Guardrails
  • Immutable Audit Trail
Build your idea

Talk to our experts

Scope an agentic AI platform where governance, auditability and human oversight are architectural requirements rather than compliance afterthoughts.

  • Free Consultation

Fragmented Identity Is Not a Data Hygiene Issue. It Is Compounding Operational Risk

Manual reconciliation is slow, expensive and fundamentally unable to scale to the event volumes a national health services business generates.

Inherited
Every downstream decision carries the identity risk. Eligibility checks may fail or return conflicting answers. Claims may be processed against the wrong record, creating rework and member frustration. Outreach may miss members entirely, or reach the wrong individual with sensitive information.
Manual
Historically this was addressed through data stewardship teams reviewing and merging records by hand. That approach cannot keep pace with national event volumes, and it makes consistency a function of who happened to review the record.
Audit
A healthcare organisation must be able to demonstrate not just what decision was made about a member, but why and on what basis. When reconciliation depends on people and notes, that reconstruction depends on them too.

Confidence, not automation,
is the design target.
The platform knows when not to decide.

Build Your Agentic Platform

From an Incoming Member Event to a Golden Identity

  • A Member Event Arrives

    A Member Event Arrives

    A Member Event Arrives

    • From an enrollment platform, a claims feed, a provider network or a third-party administrator
    • The record carries whatever identity fields that source captured, in that source's own format
    • Source systems sit outside the platform; the platform does not ask them to change how they capture identity
  • Extraction and Normalisation

    Extraction and Normalisation

    Extraction and Normalisation

    • Large language models extract and normalise the messy source data
    • Retrieval-Augmented Generation grounds that work in verified reference data rather than model memory alone
    • The source does not name the model or the store, so neither is named here
  • Deterministic, Then Probabilistic Matching

    Deterministic, Then Probabilistic Matching

    Deterministic, Then Probabilistic Matching

    • Rule-based entity matching resolves the high-confidence, unambiguous cases, where identifiers agree exactly
    • The harder cases — misspelled names, transposed digits, incomplete records — are matched probabilistically and with fuzzy logic
    • Layered logic rather than a single algorithm: certainty is treated as a matter of fact or of degree, depending on the case
  • Confidence Scoring and the Threshold

    Confidence Scoring and the Threshold

    Confidence Scoring and the Threshold

    • Each potential match is assigned a confidence score
    • A threshold-based decisioning framework converts that score into one of two paths: resolve automatically, or escalate
    • The threshold is the gate that decides whether a machine or a person resolves the match
  • Human-in-the-Loop on a Durable Interrupt

    Human-in-the-Loop on a Durable Interrupt

    Human-in-the-Loop on a Durable Interrupt

    • Below the threshold, the workflow pauses, preserves its full state and waits for a human steward's determination
    • Once the determination is made the workflow resumes cleanly rather than restarting
    • Oversight is engineered into the workflow rather than appended to it
  • Resolution Into the Member Identity Graph

    Resolution Into the Member Identity Graph

    Resolution Into the Member Identity Graph

    • The resolved event updates the golden identity that downstream systems read
    • Every output passes an AI guardrail that validates it against policy before it is acted upon
    • Every decision lands in an immutable audit trail from which the reasoning can be reconstructed on demand

What the Architecture Had to Get Right

Hover a row for the design decision behind it.

What This Build Demonstrates

Agentic AI deployed at the core of a regulated operation, not bolted onto the edge of it.

Global presence

Three offices. One team.

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