3 Best Practices for Benefits Administration Success

best practices for benefits administration

Plan Participants as Data Drivers

From January 1 to December 31, all of the plan participants that you work with on behalf of your employer partners are generating one of the most valuable assets available to any business: data. This includes details about the plan participants themselves as well as their families, their health, and how they’re using their benefits. As a TPA, understanding this data is incredibly important to the success of your relationships and your business.

It’s not just about understanding how plan participants use their benefits, however. It’s also understanding what they’re not doing with them. Specifically, are they using the benefits selections they’ve opted into? Is one particular medical plan being used more in relation to others? If so, how and why? How are participants using their voluntary benefits selections? Are supplemental solutions like life insurance, AD&D, and others being added on? Are FSAs and HSAs being used, or are people signing up, putting money in, and forgetting them?

Note that it’s important to understand the distinction between selection and usage. Since we’re required to have healthcare coverage, you’ll naturally see employees opting into medical plans — or not due to coverage through a spouse or other provider. However, while benefits such as medical and dental help participants proactively manage their health through regular checkups and protect them afterward, voluntary benefits such as AD&D and life insurance are naturally more reactive based on the circumstances. So, participants opting in rather than using the benefits may be the better indicator in some instances.

That said, plan participants are indirectly telling TPAs, employers, and brokers alike what matters to them and their families throughout the year via their benefits activity. As healthcare laws continue to change and benefits shift in cost and features, it’s never been more important to understand how your partners’ benefits are being chosen and used by plan participants. Let’s take a look at a few best practices of benefits administration to help your TPA capture, use, and leverage this data for success.

1. Build Intelligence Into Your Workflow

Quite simply, the best way to gain the level of understanding of plan participants’ preferences and activity that you need is through a software solution. While many TPAs are still processing EOBs manually through emails and faxes, the use of automated software eliminates this time-consuming manual work and also allows activities to be tracked more efficiently and accurately. Software solutions like TPA Stream provide instant reporting on these data points. This allows you to see just how much and how often participants are utilizing their benefits — or are not utilizing them. 

Building this kind of intelligence into your workflow helps you understand the overall health data life cycle and how participants are engaging with the benefits offered to them by their employers, which ties in closely with the next item on our list of best practices for benefits administration: how data functions in your sales toolkit.

2. Use Data to Inform Your Sales Strategy

Another benefits administration best practice is to use what you learn through your software platform to grow your business. If you partner with brokers as part of a sales strategy, informing them about the latest trends in benefits selection and utilization will help you in a couple of ways (brokers will already have a significant amount of data on this, but as a TPA, you’re the boots on the ground and can supplement their data).

First, this knowledge can help you to grow employer relationships you’ve already established alongside your brokers. Perhaps a current product is more popular or heavily used than others. Data will help you make the case to the employer that it needs to invest in certain plans over others. Or perhaps a certain voluntary benefit hasn’t seen as much utilization recently as in previous years, and another product would be appropriate.

Second, it helps you secure new relationships. Data you’ve gathered from your existing client base can again help you make a compelling case to a prospect that certain benefits are in greater demand and are more likely to be used. This helps employers improve their offerings and make their benefits package more appealing to prospective candidates.

3. Apply What You’ve Learned Forward

Using data as a best practice in benefits administration is a cyclical process. With a software solution in place, you must consistently use what you learn throughout the year not only in sales opportunities but also to make improvements both internally and for your clients. 

The systems you put in place earlier this year and the data that you gain from them will provide results downstream toward the end of the year. What you learn at that time must guide your decisions at the top of the following year. But why wait until year-end to generate reports and analyze the information? 

Great practitioners of this process will make adjustments frequently to ensure their organizations are on the best course possible at all times (and to keep their business partners informed on progress and trends). Perhaps monthly or quarterly reviews of performance are needed. While benefits programs will be in place for a full year, your processes as a TPA can certainly be redirected or enhanced at any point to ensure you remain a valuable and informative partner to your clients and brokers.

Once your organization is armed with data that could necessitate change, help your employer partners and brokers understand its meaning. Don’t simply provide data — translate it. Tell them what it means. Show them what plan participants want, prefer, and use the most — and why. Help them make better, more informed decisions about what to offer. And use the same data to make changes in how you manage your part in the process to make it more efficient, productive, and ultimately profitable for your business.

Gain Deeper Insight with TPA Stream

Ready to put these best practices for benefits administration to use for your organization? We’re here to help. As a health data integration platform, our technology not only streamlines and automates a significant amount of your workload but also provides you with the insights you need to make better business decisions. Learn how our platform has become part of our clients’ sales strategy, and how we can do the same for you.

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