Claims Integration and Automation Practices of Voluntary Carriers Spotlight™ Report

Cost: $3,500; published 2022

Voluntary claims practices continue to evolve as customers — brokers, employers and employees — place more value on the benefits provided by voluntary products. The claims process is expected to be easy, especially for employees who own multiple voluntary products through the same carrier. The practice of submitting separate claims related to the same event is being replaced by data sharing between products to automatically open a claim or at least notify employees about potential claims. However, carriers may face obstacles when developing claims integrations. The complexity of some voluntary products makes it difficult to automate claims processing, and developing a streamlined data integration process with medical carriers can be problematic. Carriers also must keep in mind the impact claims integration has on loss ratios and claims volume. For carriers to remain relevant, they must overcome these obstacles to simplify their claims process.

The purpose of the Claims Integration and Automation Spotlight™ Report is to provide important information for carriers about claims processing and claims integration practices for voluntary products, including:

  • Claims outsourcing
  • Claims automation and adjudication
  • Claim payment timeframes by product
  • Claims integration practices
  • Types of claims integration with medical and other product data
  • Methods used to notify claimants
  • Concerns, obstacles and future trends

View Table of Contents

1. Executive Summary

A. Report Objectives

B. Methodology

C. Key Findings

D. Recommendations

2. Findings by Carrier

A. Company Data

1. Voluntary Product Platform

2. 2021 Voluntary New Business Annualized Premium

3. Typical Voluntary Case Size

B. Claims Outsourcing

1. Claims Outsourcing — Life Products

2. Claims Outsourcing — Disability and Accident Products

3. Claims Outsourcing — Cancer, Critical Illness and Hospital Indemnity/Supp Medical Products

4. Claims Outsourcing — Dental, Vision and Wellness Products

C. Claims Automation and Adjudication

1. Artificial Intelligence/Machine Learning Practices

2. Auto-Adjudication Activity and Percentage of Auto-Adjudicated Claims

3. Percent of Claims Auto-Adjudicated by Product

D. Claim Payment Timeframes by Product

1.Average Actual Claim Payment Times for Life Products

2. Average Actual Claim Payment Times for Disability Products

3. Average Actual Claim Payment Times for Supplemental Health Products and Wellness Riders

4. Average Actual Claim Payment Times for Dental and Vision Products

E. Claims Integration Practices

1. Types of Claims Integration with Medical Data

2. Opt-In Requirement and Process for Medical Claims Integration

3. Types of Claims Integration with Life and Disability Data

4. Types of Claims Integration with Voluntary Supplemental Health Products

5. Volume of Integrated Claims

6. Loss Ratio Impact Due to Claims Integration

7. Methods Used to Notify Claimant

8. Claims Integration Charge

9. Use of Technology Platform, Outside Systems or Databases for Claims Integration

F. Claims Concerns/Obstacles/Future Trends

1. Key Concerns or Obstacles for Claims Integration and Automation

2. Future Claims Concerns/Obstacles/Trends





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