Penguin AI

AI-native platform for automating health insurance administrative workflows

Core Administration Growth Series A

Overview

Penguin AI is a healthcare administrative automation platform for health insurance payers, providers, and risk-bearing organizations. The company develops agentic AI tools to reduce the estimated USD 1 trillion annual administrative burden in the US health insurance system, targeting workflows such as prior authorization, medical coding and risk adjustment, claims adjudication, payment integrity, and appeals management.

The platform is delivered through two channels: Gwen, a configurable AI platform that lets healthcare organizations build custom AI agents for their specific operational workflows, and Snowflake Native Apps that run pre-built solutions directly within a customer's Snowflake environment. This architecture eliminates data movement and integration overhead by processing administrative tasks inside the customer's existing data infrastructure.

Founded in 2024 by Fawad Butt (formerly Chief Data Officer at Kaiser Permanente, UnitedHealth, and Optum) alongside co-founders with deep payer and provider backgrounds, Penguin AI raised USD 29.7M in Series A funding in September 2025 led by Greycroft. Investors include UPMC Enterprises, Snowflake Ventures, SemperVirens, and several health-sector-focused funds.

Products & Services

Gwen Platform

Gwen is Penguin AI's configurable AI platform for healthcare operations. It enables health insurance organizations to create custom AI agents tailored to their administrative workflows without requiring extensive technical infrastructure or AI expertise.

Key Features

Build-your-own AI agent framework for health insurance workflows
Supports prior authorization, coding, claims, and appeals use cases
Enterprise-grade architecture with no data movement required

Target Users: Health insurance payers, integrated delivery systems, risk-bearing organizations

Prior Authorization Solution (Snowflake Native App)

A pre-built prior authorization automation solution available on the Snowflake Marketplace. The app reviews clinical documentation against payer policies and regulatory guidelines, generating audit-ready recommendations for authorization decisions.

Key Features

Automated documentation review and policy alignment
Generates audit-ready authorization recommendations
Operates within the customer's Snowflake account

Target Users: Health insurance payers and utilization management teams

Medical Coding & HCC Risk Adjustment Solution (Snowflake Native App)

A pre-built solution for medical coding quality and HCC risk adjustment automation. Reviews clinical documentation for medical necessity alignment, coding quality, and risk adjustment accuracy.

Key Features

HCC coding optimization and quality checks
Risk adjustment documentation review
Clinical documentation summarization via AI

Target Users: Health plans and risk-bearing provider organizations

At a Glance

Founded: 2024
Headquarters: Palo Alto, California, USA
Employees: 51-200
Funding: Series A

Category & Focus

Category: Core Administration
Subcategories: Prior Authorization Automation Medical Coding & Risk Adjustment Claims Processing Payment Integrity
Insurance Verticals: Health
Target Customers: Carriers, TPAs