Benefits administration (ben admin) technology platforms are often miscategorized as merely “enrollment systems.” As a result, the innovation focus has primarily been on the employee annual enrollment experience. But now, thanks to artificial intelligence (AI), ben admin technology providers are bringing year-round value and efficiency to both HR administrators and their employees.
What we’re seeing now: One area AI is helping revolutionize is system configuration. Several ben admin vendors are leveraging AI to streamline their implementation process. For example, instead of parsing through lengthy plan documents and manually entering rules and rates, implementers can just upload the documents, and AI creates the benefit plans and imports rates in a fraction of the time it took before. These systems are now more accurate and ready to use in less time - a win for the system provider, the client, and their employees.
What we might see soon: While many voluntary benefit carriers have embraced API technology for faster transfer of eligibility data, many medical carriers have not and are still relying on 834 EDI files for eligibility. If AI could be employed to reduce the time required to build and test EDI files, they could be in production in half the time it currently takes. As a result, feeds would be stood up prior to the plan effective date. This would eliminate the need for manual files or data entry due to feeds not being in production and prevent resulting access to care issues.
What we’re seeing now: A variety of ben admin vendors are now providing digital assistants for HR administrators. Admins can ask these assistants to develop and schedule recurring reports, create targeted employee communications, and develop impressive dashboards that provide critical analytic insights for leadership teams. Features like these provide immense efficiency for HR admins, reducing the time spent on these tasks from days or hours to just minutes.
What we might see soon: Taking AI assistants to the next level might solve additional challenges such as billing reconciliation. Reconciling carrier bills can be so time consuming for HR admins that it often goes undone – leading to carrier overpayments, access to care issues for employees, and even denied claims. Now imagine an HR administrator being able to simply import their carrier bill and payroll report, and having the AI assistant analyze the data and deliver the discrep- ancies (with suggestions on how to resolve them) within a few minutes.
What we’re seeing now: Several vendors recently released vastly improved decision support tools powered with AI. As a result, during annual enrollment an employee is provided comprehensive guidance for all benefits, including voluntary and worksite products, not just medical. Using AI, these tools instantly consider the specific employee’s profile and present packaged options based on a variety of complex considerations. Some of these tools even include the option to consider the individual employee’s claims history as well. This means employees can complete their annual enrollment faster and with more confidence than ever before.
AI is also improving the capabilities of employee-facing chat bots within ben admin systems. These assistants can now do more than just answer a few commonly asked questions. For example, they can answer employee questions about the specific benefits in which they are enrolled or help them navigate to the correct area of the platform to initiate a qualifying life event. This is extremely helpful, especially if they need assistance when HR is not available. It also increases year- round utilization of the ben admin system while reducing the number of inquiries to HR.
What we might see soon: Going a step further, these chat bots could be enabled to help employees price medical procedures and locate the best-rated, most cost-effective practitioners and facilities. This would not only reduce stress for employees facing medical procedures but would also help bend the cost curve for self-insured employers. Additionally, the chat bot could also “nudge” employees participating in worksite benefits with wellness rewards to get their preventative exam and file their wellness claim. This could increase employee benefit utilization and satisfaction.
Leading providers of benefits administration technology are using generative AI to deliver measurable time and efficiency gains within their systems. As the cost of AI decreases and we transition to agentic AI, it will be exciting to see how much more value these platforms can provide to clients through new and innovative breakthroughs.
Kisha Moliere
Vice President & National Practice Leader
Benefits Administration Technology
