How Benefits Providers Can Build Confidence and Compliance in Benefits Administration with AI

Benefits providers handle some of the most sensitive documents in claims. Not only do administration teams need to protect the privacy of healthcare users, they also need to remain compliant when bringing this sensitive user data to employers. And since benefits programs are quickly becoming more flexible, more personalized, and more digital, there’s plenty of room to add efficiency with AI. 

With so much personal and financial data, identity verification becomes critical. AI-powered KYC solutions can help benefits providers remain compliant, reduce fraud, prevent impersonation, and streamline the onboarding process for new members. 

Using Onboarding Data to Refine Plan Offerings Builds Trust and Loyalty

Benefits programs are more important than ever before, as employees increasingly rely on their employers to provide resources they trust. To put it into perspective, respondents to the 2025 MetLife Employee Benefits Trends Study trust their employer more than the healthcare system, educational institutions, and the federal government. In the same survey, 53% of employees felt that more affordable benefits enhanced their trust in the organization, and 41% said that expanded benefit offerings did. 

As benefits programs become more personalized to each organization’s needs, they collect tremendous amounts of customer data. This data is sensitive, needs protection – and, when properly deidentified, can be a source of real value. Today’s AI tools can not only help benefits providers to quickly onboard clients and secure their files, it can also help detect gaps in existing coverage and design new combinations or options to provide more coverage at a lower cost. 

AI Applications in Benefits Administration

According to Moody’s, 53% of organizations are actively using AI in 2025. More than that, 59% of those organizations actively using AI said their data was either superior or high quality. While it’s not clear whether better data begets greater AI use or whether AI creates better data, it’s likely good news for benefits providers. AI applications can be used to support benefits administration when:

• Looking for underinsured employees or gaps in coverage. AI tools can analyse claims histories and benefits utilization rates across similar organizations and flag areas, groups, or even expected targets where employees end up paying out of pocket. Insurers might offer affordable coverage tiers or optional riders for these employees. 
• Benchmarking plans with enrollment data, utilization, or demographics can help organizations to meet the same targets as others in their industry, ensuring the benefits package (and the job) are competitive.
• Automatic fraud checks (like multimodal biometrics or cross checking IDs) can flag items for disqualification or manual review, ultimately reducing costs.
• Natural language processing (NLP) can review policy documents to find wording (for example, a visit to a therapist might be under paramedical services on one plan, and psychologist on another) that might offer better opportunities or lower costs. 

Decision makers often rely on employee surveys, HR guidance, and industry benchmarks to guide the benefits options available to an organization or employer. However, the same data required for onboarding and compliance can often be used safely and securely with AI to provide more insight into utilization, demographics, and coverage. The right combination of human review and efficient AI can make a powerful difference for benefits administrators – and the employees that depend on finding benefits that fit their lives.