‍“Our claim team is working extremely hard to stay on top of claims, could I use Silver to reduce our claim load?"

Background

Scott Riordan, Head of Health and Welfare Services at Sentinel, leads the company’s benefits group. In this highly regulated industry, Scott is known for designing simplified solutions that serve brokers, employers, and participants alike. He was recently recognized as the 2024 Leader of the Year by WEX at their WEX Spark event in April 2025.

As the SVP, Health & Welfare or Head of Health & Welfare at Sentinel, Scott understands that delivering customized plans is a critical part of the service Sentinel provides. However, the cost and complexity of operating these plans can limit what’s feasible — and may negatively impact the business.

Over the past few years, Scott’s team has invested in building innovative operational workflows to better serve their clients. One example is their custom tuition reimbursement plan, which includes a purpose-built process allowing employees to submit requests, managers to approve them, and administrators to manage the flow efficiently.

Problem and Opportunity

To support a broad range of clients across the country and across all market segments, Sentinel has developed flexible benefit plans — along with the policies needed to support them. To maintain that flexibility, Sentinel believes it’s essential to keep both claim processing and customer support in-house.

This approach allows Sentinel to meet customer expectations while continuously seeking ways to streamline their operational tools and processes.

Sentinel and Silver had discussed integrating the Silver for Consumer product into the Sentinel participant experiences and when Scott learned about Silver’s consumer offering, he was immediately intrigued:
Could the same AI and technology that enhances the participant experience also help solve Sentinel’s operational challenges?

He reached out to Oded Shekel, CEO and Co-founder of Silver, and proposed a new idea:

“Your consumer offering is cool — but could you use your tech to help us with the claim adjudication process?”

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Crafting the right user experience for Claim Processing

Scott invited the Silver team on-site on October 7, 2024, to design a new adjudication process. He brought together leaders from operations, security, business, and more to help shape the new product. They began with a simple question: What would create the best experience for participants? That prompt sparked a flurry of ideas, which quickly filled the glass conference room wall with sticky notes.

Midday, Catie — who leads the claims team — invited the Silver team to observe her current workflow in real time. They watched over her shoulder as she adjudicated claims.

She opened a claim from Target. The receipt listed “Up & Up,” Target’s generic brand. Catie manually typed the SKU into Google and discovered it was bandages — eligible for reimbursement. But how much could legally be reimbursed? She pulled out her iPhone’s calculator app and began calculating: retail price minus a 5% Target card discount, plus a portion of the paid taxes. Every claim went through a similar process.

"Umm… all of this could be automated."

It was a textbook example of a swivel chair process — and Catie was incredibly patient and generous with her time.

“I spend most of my day just enlarging receipts.”

In the afternoon, the group consolidated all the ideas into key themes and product requirements. We landed on three high-level design principles:

• Minimize changes to existing tools and customer workflows
• Maintain Sentinel’s high standards for security and compliance
• Automate repetitive administrative tasks using Silver’s technology

Solution

The Silver team flew home exhausted but excited. It was clear they could help Sentinel solve a real business challenge.

They followed with an effective design process. It included weekly calls with Catie and monthly checkpoints with Scott and the security team. 

Catie guided the Silver team through the product implementation, ensuring they built a solution she and her team would genuinely enjoy using.

The result was a solution with two key components:

1. A fully automated adjudication process for the easiest claims, powered by AI. AI can read the receipts and documents, match to known eligible expenses and approve the claim, without human involvement. This process had to guarantee low false positives and only make high confident decisions. 
2. An easy to use and incredibly fast tool for the adjudicators to manually review the rest of the claims.

A few other notable improvements were made, all based on feedback from Catie and her team:

• Preloaded next claim: While one claim is being reviewed, the next one loads in the background — eliminating wait time between claims.
  
• Inline evidence viewing: Participant-submitted evidence opens in the same browser tab, avoiding time lost to opening and closing multiple tabs.
  
• Attachment thumbnails: All attachments are preloaded into a single view, with thumbnails for easy scrolling.
  
• Integrated AI signals: AI insights are displayed directly on the page — such as identifying the service or purchase date and flagging whether it matches the participant's submitted information.

During the design sessions, the Sentinel team shared their extensive security and compliance requirements. The Silver team adapted its processes accordingly, kicked off a SOC 2 certification, and by February 15, gained access to production data.

On March 31, Sentinel began the acceptance phase, manually reviewing each AI recommendation before adjudication. Then, starting May 12, Silver went live in production — automatically adjudicating over 30% of all healthcare claims. Catie’s team switched to spot checking the automation after it approved claims, ensuring 

Looking back, the journey took about two months to design the solution, two months to build it collaboratively, and another two months to test it against live data.

Impact

Silver is now automatically adjudicating about 30% of healthcare claims, while the claims team uses the Silver dashboard as their default tool to review the remaining 70%. The entire claim processing workflow has become significantly more efficient.

And the best part? As everyone that works on FSA claims knows, the end of the year is the most demanding period for adjudicators. For Sentinel, the claim team can now plan their end-of-year holiday break and let automation work throughout the holidays.

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Thank you Sentinel Group for being such an amazing design partner !

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The Silver team

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