Background

The team at Benefit Extras prides themselves as a premier Third Party Administrator, with white glove treatment and high customer satisfaction. In a company of 15 people, they take personal responsibility seriously and often need to wear many hats to provide exceptional customer service.

In fact, they have a unique setup for handling consumer claims for their consumer driven healthcare accounts such as FSA, Dependent Care, and HRAs. They combine the account management function with the claim processing responsibility and rotate the claim tasks. Every week, they hand off the claim process to one of the 5 members of the account team. The Account Manager then spends a few hours each day to process claims for all participants.

This process optimizes for having a large account team that can create personal connections with customers while providing quick adjudication (usually within a day) to ensure great participant experience.

Opportunity

Chris Erickson, President and Founder of Benefit Extras, values her team’s time and is constantly looking for opportunities to increase their efficiencies. This is especially applicable for routine and compliance heavy tasks that reduce her team’s ability to provide the personal care they are so proud of.

Chris met Oded and Dan, Silver’s Co-Founders, at the WEX Spark conference in April. When Chris heard that Silver can automate a subset of the adjudication tasks, she was intrigued and wanted to learn more, “Oh, my team would love that, but how long would that take to pilot?”

Solution

After meeting for a demo, Chris looped in her team to evaluate the integration and process changes. Oded worked closely with Jessie, an Account Manager on the Benefit Extras team, to connect their claims to Silver to start the pilot. Silver’s platform reads all claims submitted to Benefit Extras and uses AI to extract details from submitted receipts, medical invoices, and explanations of benefits. It then matches eligible products and services against a known database and determines if a claim should be approved. All of the AI insights are shown to the claim processor, alongside a large image of the documents to make reviewing claims fast and simple. Best of all, at the end of the pilot, it will auto approve claims based on Silver’s recommendation.

Jessie immediately picked up on the value of auto-adjudication. It meant the account team can spend more time with customers. Setting up the pilot took less than a week.

The Account team piloted Silver for the next few weeks and they all had a chance to adjudicate claims directly within the Silver product. Oded met each one of them during these rotations to capture feedback and ensure the AI recommendations mirrored their high standards.

The feedback was very consistent during these calls: "It’s very easy to use," "I’m more efficient using Silver," and “Silver saves me a ton of time during the day!" After 3 weeks of pilot, the Benefit Extras officially partnered with Silver.

"I am hearing nothing but positive remarks about Silver 🙂 - and everyone is excited to make the partnership official!”

Results

Today, Silver automatically adjudicates up to 40% of Benefit Extra’s FSA claims every week. For the remaining claims, the Benefit Extras team is manually adjudicating claims on the Silver admin dashboard. They find it much more streamlined to use than their previous tools and process.

Thinking ahead, the Benefit Extras team is looking forward to a more relaxed and normal holiday season. As Silver continues to improve and automatically take care of the majority of their claim processing tasks, even the end of the year spike is not that scary anymore…

‍Thank you Benefit Extras for being such an amazing partner

The Silver team

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