Benefits teams can spend more than a week of staff time every month handling transactions that don’t move cleanly through the system.
For a benefits program with 5,000 active accounts, the new PYMNTS Intelligence report produced with SoFi Tech Solutions titled “Making Health and Wellness Benefits Perform: What Modern Card Infrastructure Changes” models what happens when 5% of accounts require manual attention each month. At 15 minutes apiece, eligibility disputes, reimbursement requests and reconciliation exceptions add up to about 62.5 staff hours.
That makes benefits infrastructure an operational-efficiency calculation as much as a way to administer HSAs, FSAs and other programs. The data point to a cost that can be easy to miss when companies evaluate benefits technology: the employee time consumed after a transaction encounters a problem.
The Cost Is in the Exception
Benefits administration involves a series of processes around enrollment, allocation, spending, eligibility and reconciliation. The technology underneath the program determines how much of that activity happens automatically and how much lands on somebody’s desk.
In a 5,000-account example, a 5% monthly exception rate produces 250 cases requiring attention. Multiplying those cases by 15 minutes produces 62.5 hours of loaded staff time each month. A $45 hourly loaded labor rate puts the monthly cost at $2,813 and the annual amount above $33,750.
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The dollar figure is useful, but the 62.5 hours may be the more consequential operating metric.
Benefits organizations don’t necessarily eliminate those employees when exceptions decline. They can redirect the capacity. Staff time previously spent investigating eligibility disputes, handling reimbursement requests or reconciling transactions can instead go toward monitoring program use, participant support and administering additional benefits. Rather than asking only how much a platform costs, employers and administrators can measure how frequently transactions require human intervention and how much staff time those interventions consume.
Straight-Through Processing Moves Into Benefits
Several of the capabilities described in the report attack exception volume before it reaches an administrator.
Category-level spend controls can apply eligibility rules when a purchase is attempted. Real-time authorization can approve or decline transactions based on both eligibility and available balances. Direct API connections can move data among eligibility, enrollment and claims systems without a manual handoff. Centralized administration can give benefits teams a common place to monitor exceptions and program performance.
The operational goal resembles straight-through processing elsewhere in financial services: increase the share of activity completed without human intervention and reserve staff attention for cases that genuinely require judgment.
Batch processes and manual file transfers can work against that objective. Platforms relying on manual uploads or batch reconciliation can surrender some of the speed and labor savings expected from modernization.
For benefits executives evaluating infrastructure, there’s a relatively straightforward set of measurements. How many transactions or accounts require manual handling each month? How long does each exception take? What causes the exceptions? And how much of that work can be prevented upstream rather than processed faster after it occurs?
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