How to Remove the 6 Biggest Benefits Billing Hurdles from Worksite Benefits Programs

Overwhelmed office worker

Attracting top talent requires employers of all sizes to offer a diverse set of employee benefits in their organizations. Employees have an increasing role as consumer of these benefits, enabling them to select the right amount of insurance coverage to meet their personal and family needs. This is a critical part of employee satisfaction and retention.  

Examples of worksite benefits include employee-paid voluntary plans, buy-up plans for additional coverage (sometimes subject to evidence of insurability), and bundled products, which may be age-banded. Often, this involves multiple insurance carriers across the portfolio of benefits offerings.

One of the major goals for employers around voluntary benefits is being able to offer these plans without bearing an unacceptable financial and administrative burden. When adding voluntary benefits, the industry best practice is to offer a “one-stop” shopping environment that simplifies enrollment and administration. Ideally, employees can enroll for all benefits in one place, and employers should be able to consolidate the provider bills for the healthcare and voluntary benefits similarly.

While enrollment, benefits administration, and claims payments may get the lion’s share of the worksite benefit planning and implementation focus, it is billing, billing reconciliation, and payments that often tilt the scale on ROI and overall achievement of objectives.

The 6 Biggest Benefits Billing Hurdles

Jumping over hurdles

Employee benefits vary in complexity ranging from fairly simple to complex coverages. All of these scenarios have a few challenges in common to address:

  1. Keeping Accurate Enrollment
    In addition to the annual enrollment windows, there is a steady flow of adds, life event changes, and terminations that have to be properly managed within billing windows.
  2. Lack of Industry Data Exchange Formats
    Files come in on spreadsheets, custom file formats, and various combinations of XML, EDI and API formats.
  3. Multiple Handshakes
    Data may pass through payroll, enrollment, benefits administration, and other third-party systems and processes such as Brokers and TPAs. Each of these parties may have different or varying degrees of technological capabilities.
  4. Varying Rules at Group (Master) and Subsidiary (Segment) Levels
    Rules may vary based on self-insured, employer plans, associations, and captives. Proper allocation of costs requires the correct rules-based architecture to properly invoice, enable auto payment, and facilitate reporting and analytics.
  5. Manual Intensity in Many Environments Creating a Tsunami of Adjustments and Customer Inquiries
    Often TPAs, Brokers, and other insurance administrators hire staff to work through issues, manually calculate invoices, and resolve customer concerns. This increases costs above expected targets. In some cases, there may be multiple billing systems within an organization or operation with different user interfaces and capabilities, also adding to the complexity of billing administration and increasing the chance of error.
  6. Customer Retention Concerns
    An invoice is often viewed as one of the stickier parts of the customer experience. If even one of the many pieces of important information is missing or incorrect, the invoice itself can be incorrect. The information that can cause an incorrect invoice includes employee counts or dependent considerations, missing coverages, lagging evidence of insurability notification, build up of retroactive adjustments, human error, and other related issues. When this happens, it can cause negative customer satisfaction issues to all parties involved in the ecosystem– including Employers, Carriers, TPAs, and Brokers.

The good news is that there is a new solution to remedy these challenges. AdminaHealth’s Billing Suite SaaS platform can be introduced as a replacement to your existing manual or system processes or act as an extension to your current capabilities.

Improving Billing by Leaps and Bounds

Race winner

AdminaHealth’s Billing Suite SaaS Platform offers the industry the first fully integrated healthcare and voluntary benefits billing and payment management platform. Through our HITRUST and NIST compliant SaaS platform, we can easily configure the rules to meet your plan design regardless of complexity. We can directly support your business on a PEPM subscription model or “white label” if maintaining your brand is a requirement.

Worried about your data from a legacy system? We can accept any data format and transform your billing and payment management processes into automated, modern, headache-free systems.

Ready to Pass the Baton to one of the Fastest-Growing SaaS Companies in Healthcare, Insurance, and Voluntary Benefits?

Passing the Baton in a Relay Race

Whether you are a Broker, Consultant, Insurance Carrier, TPA, Association, Captive, Self-Insured, Benefits Administration firm, or other partner in the industry, AdminaHealth can resolve these and other billing, reconciliation, and payment challenges in healthcare insurance and voluntary benefit programs. For more information please visit us at or contact us at [email protected].

Invoicing laptop

About the Author:

Frank Bianchi

Frank Bianchi is the Chief Sales and Marketing Officer at AdminaHealth. He is responsible for leading and growing the Sales and Marketing team, overseeing marketing strategy, and establishing and maintaining relationships and partnerships with key stakeholders. Frank brings over 20 years of experience in the insurance benefits industry, where he has had a track record of implementing digital transformation, platform modernization, process automation, and competitive differentiation.

About AdminaHealth®

AdminaHealth® is an API-First cloud-based provider of the industry-recognized AdminaHealth Billing Suite® supporting healthcare, insurance, and voluntary benefits.

Our SaaS platform automates bill consolidation and reconciliation and streamlines payment management. We integrate with leading Enrollment and Benefit Administration systems to ensure accurate premium billing, resulting in significant operational efficiencies.

We support all billing types and coverages for small, medium, and enterprise businesses. We are the only billing SaaS solution that has adopted the NIST Cybersecurity Framework and has earned the elite HITRUST CSF Certification®.