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Most group carriers are taking a conservative approach to their strategy and operations, changing pragmatically and incrementally. They’re dabbling with digital transformation in some key functions, typically claims and policy administration, but not on an enterprise-wide scale. They’re also making relatively modest investments in simplifying benefits administration, enrollment technology and data exchange options. And to enhance the user experience, they’re making light user interface (UI) updates and deploying basic chatbots to address claimants’ transactional needs.
As we note throughout this Insurance 2030 series, a gradual and piecemeal approach to strategic and operational change is not a recipe for success. Market leaders are thinking more transformationally, redesigning their business and operating models to put employers and their employees at the center of everything, offering appealing and integrated products, easy to use channels and a frictionless claims experience supporting that goal. Supporting this approach will require:
- Doubling down on enterprise-wide digital transformation, enabling the data-driven and lower cost digital operating models that improve the group value chain. This includes technology investments in key areas like claims, data exchange, data and analytics, and generative AI (GenAI).
- Leveraging newfound efficiencies to improve workforce utilization and management. The automation of basic transactional and administrative efforts can help carriers overcome staffing challenges resulting from an aging insurer talent base and tight labor market. Moreover, these efficiency gains can enable a smaller employee roster to focus on providing customers higher value services.
What stakeholders are saying
- Brokers: “Group insurance is a relationship-based business, and clients rely on us to help them choose carriers that meet their needs. Both we and our clients want tools and technology that simplify sales, onboarding, implementation and enrollment.”
- Employers: “To attract and retain top talent, I need to offer employees the best available benefit mix and digital experiences. To keep my employees happy and productive, I also need services that can predict and prevent absenteeism.”
- Beneficiaries: “Understanding my benefits, especially during a major life event, can be stressful. I want an easy-to-understand solution that I can trust to guide and support me.”
- Adjacencies (benefits administrators, TPAs, etc.): “As personalization of services increases, we’ll have an even more critical role in reducing complexity for brokers, employers and their employees and identifying offerings that simplify their decisions.”
Improving the user experience
Neglecting the claimant experience is a losing proposition. Employers know that keeping employees productive means keeping them focused on work, not on their benefits.
Accordingly, employers are looking beyond traditional “product factories” and seeking out carriers that can help them attract and retain talent via health and financial wellness programs, consultative support, and coaching. Group carriers therefore must think beyond their traditional systems and processes to design experiences that meet member and workforce preferences. This means providing members a robust ecosystem of hire-to-retire offerings to keep employees happy and productive at work and both predict and reduce absenteeism. It also entails drastically simplifying how employees access, learn about and use their benefits, especially in the life events that matter most.
What will this customer-first approach look like in reality? It will be a one-stop, digital experience for all products and services. Here’s an example.
- Claim incident
- Leave
- Return to work
- Postscript
Claim incident
Rebecca is in an accident bicycling to work. She suffers a compound leg fracture and loses a front tooth. She immediately has surgery to repair the break. The next week, after she’s back home and undergoing a months-long physical therapy regimen, she’s taken to a dentist for a tooth implant.
Rebecca submits accident details to her insurer using a digital, AI-enabled claimant portal that has easy-to-understand language and guidance with a clear view of all the benefits available to her. The portal features a one-time submission of claim information that triggers her health, dental, accident, hospital indemnity and short term disability policies, as well as her Family and Medical Leave Act and Americans with Disabilities Act accommodations. Instead of having to contact multiple providers to figure out coverage details in a traumatic time, Rebecca can focus on healing and eventually getting back to work.
Leave
Rebecca is out on medical leave for a month. As she recovers, she uses her digital claimant experience tools via her portal. The app recommends dog walking services, gives her the ability to order groceries and schedule delivery online, provides helpful tips on managing pain and reducing recovery time, and other services. This minimizes Rebecca’s stress and aggravation as she heals.
Return to work
After returning to work, Rebecca experiences considerable discomfort sitting in place for more than an hour, which is both tiring and discouraging. Her physician and physical therapist have prepared her for this eventuality but even so, it’s hard to deal with.
Her group benefits portal links her to a therapist who specializes in helping accident victims, suggests online support groups and offers detailed information on the mind-body connection in recovery and tips for coping.
After a few more weeks of physical therapy and healing, Rebecca’s pain and discomfort start to ease. Now she begins concentrating on expenses. The portal clearly explains what she should expect to pay and any recourse she may have to lower her out of pocket costs. Her coverage keeps her payout manageable but she wants to be prepared for any eventualities. She consults with a financial coach her group benefits offers to understand how she can prepare financially for any future health-related issues.
Postscript
Several months later, Rebecca feels like her old self again. She’s very pleased with her benefits — and by extension her employer. She can’t envision her care and recovery going any smoother and genuinely appreciates the assistance she’s received and how easy it’s been to access so many vital services (some of which she didn’t even anticipate). She shares her experiences with her benefits administrator, colleagues and friends, painting a flattering picture of her company and group benefits provider.
Improving competitiveness through operational efficiencies
An aging industry workforce and challenging labor market have motivated many P&C carriers to start automating (including via genAI) basic transactional and administrative efforts, which in turn is complementing their attempts to focus on providing higher value services. In comparison, group carriers are behind the curve on modernizing their operations. To enhance employee productivity and offer high-end claimant experiences like Rebecca’s, unified, data- and analytics-driven digital functions and processes are an absolute necessity. Here are some areas that can benefit the most from these enhancements.
- Distribution: While broker and agency relationships will remain vital to a strong sales pipeline, particularly for customers with complex needs, technology can replace many steps within distribution through automated quoting, RFP generation and pricing. This reduces the need for large internal sales teams, particularly for basic products. Brokers instead can concentrate on helping employers find one-stop-shop group providers instead of cobbling together individual offerings from multiple carriers.
- Account service: Sophisticated integrations and automations can digitize client onboarding/implementation and employee enrollment, requiring minimal carrier involvement in the process. Billing can be a similarly digital, no-touch experience. Moreover, cloud-based systems integrations can automatically communicate employer roster changes to the carrier. The client-carrier personal interactions that remain can address complex, higher value issues instead.
- Claims: Maintain a team of specialists to support complex claims and provide claimants with value-added services for important life moments. However, the vast majority of claims submissions can be digital, with intuitive and comprehensive submitter instructions embedded in the experience. After submission, most claims can be auto-adjudicated, leveraging machine learning to make simple claims decisions. In this scenario, a claimant typically receives a response and receives payment digitally within a day.
Here’s an example of how operational modernization can enhance workflow management.
- Capabilities
- Management
- Enhancements
Capabilities
Greg is a leave manager with a team of six specialists. He reviews his digital ops dashboard every morning to understand his team’s capacity, utilization and throughput, and to inform how he assigns specialists cases based on their skill level, productivity and workload. This enables Greg and his team to maintain an efficient workflow while meeting client and claimant quality and service expectations.
Management
Greg notices that one of the specialists, Jeff, has a lower throughput than usual. He checks in with him and learns that Jeff’s wife, Rebecca, has been in an accident and needs his help during recovery. Greg limits the new cases Jeff can accept for the next quarter to give him some breathing room while still serving his existing claimants effectively.
Enhancements
After noting via dashboard tracking that there are quality and efficiency shortcomings related to leave decisions, Greg works with product management to prioritize enhancing the leave decisioning tool.
The path forward: What group carriers should prioritize
Putting the customer first. This is much more than building a flashy website. It’s designing your business around members and their employees to offer them appealing, integrated products and services. On a practical level, this means providing members an ecosystem of hire-to-retire offerings and an ease of use that keeps employees happy and productive. Their resulting satisfaction will be the driving force for your profitable growth.
Supporting your strategy with enterprise-wide digital transformation that enables data-driven and lower cost digital operating models. This includes technology investments in claims, data and analytics and GenAI that increase carrier efficiencies and lower costs. It also simplifies how members and employees learn about, access and use benefits.
Applying efficiency gains to workforce utilization and management. Automating basic transactional and administrative efforts can help carriers address staffing challenges. In turn, this can help a smaller employee base concentrate on providing customers higher value services.
Contributors
PwC’s Bonnie Majumdar, Rob Walker, Jim Quick, Mark Rosenthal, Haley Wellener, Catherine Nolan and Marie Carr contributed to this report.
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