Alaffia Health, an agentic AI platform for health plan claims operations, has raised a $55 million Series B round to accelerate adoption of its technology across payer workflows as health plans grapple with rising medical costs, tighter regulatory scrutiny, and an estimated $570 billion in annual administrative waste. The financing was led by Transformation Capital, with participation from existing investors FirstMark Capital, Tau Ventures, and Twine Ventures, bringing Alaffia’s total funding to more than $73 million.
Founded in 2020 by siblings TJ Ademiluyi and Adun Akanni, Alaffia positions its approach as a blend of clinician expertise and transparent AI designed for real-world payer environments where traceability, configurability, and clinical oversight are critical. The company says it partners with regional and national health plans to scale clinical review capacity, reduce turnaround times from weeks to days, and improve consistency in findings. Alaffia’s platform evaluates claims against the complete patient medical record and is designed to support more defensible outcomes across the claims lifecycle, with the company citing average savings of 20%+ on high-cost facility claims and a 5x+ ROI for health plans using its solutions.
Alaffia said it will deploy the new capital across three areas: advancing its AI, engineering, and product development efforts; launching additional AI agents and expanding to new modalities to broaden platform capabilities; and scaling growth initiatives to meet rising demand across the healthcare ecosystem. The company also plans to expand hiring across engineering, product, and growth. As part of the round, Transformation Capital Managing Partner Todd Cozzens has joined Alaffia’s board.
Alaffia describes itself as an operations partner for health plans, supporting workflows spanning payment integrity, utilization management, and appeals. The company says it has saved health plans $100 million and counting in medical costs and is focused on helping payer teams work faster with greater accuracy while maintaining the clinical rigor and transparency needed to build trust among clinicians, operators, and regulators.
KEY QUOTES
“Health plans are under immense pressure to reduce administrative costs and drive affordability for their members, and like many industries, they’re starting to see the value of emerging AI solutions. With this funding, we’re expanding our team and platform so we can continue solving some of the most expensive operational challenges in healthcare and ultimately reduce the burden on the system as a whole.”
TJ Ademiluyi, Co-Founder and CEO, Alaffia Health
“Payment integrity is one of the most untapped opportunities in healthcare, in part because payers are harder to build for due to their complex and diverse rule sets. Alaffia has built a core clinical review platform that is already delivering millions in savings and can scale beyond payment integrity to become foundational infrastructure for health plans. By reducing administrative waste and improving accuracy across claims operations, Alaffia ultimately helps lower costs for health plans — creating a more affordable healthcare system for consumers.”
Todd Cozzens, Managing Partner, Transformation Capital
“Healthcare doesn’t need more automation that no one can explain — it needs AI that clinicians, operators, and regulators can trust. We founded Alaffia to bring transparency and clinical rigor to claims operations, and this funding allows us to scale that mission as we help health plans reduce waste and operate with confidence.”
Adun Akanni, Co-Founder and COO, Alaffia Health
