Canada (EN)
Navigating the U.S. healthcare system is a complicated, time-consuming and often confusing process, especially for employees who are already coping with illness, injury or caregiving responsibilities.
Instead of feeling supported, they are often confronted with fragmented information, inconsistent guidance and administrative hurdles at exactly the moment when clarity matters most. For something as fundamental as health, this degree of friction becomes unacceptable and unsustainable.
All too often, this leads people to make decisions they later regret. Nearly two-thirds (63%) of workers say they’ve regretted a healthcare decision in the last 12 months, most often because they rushed into treatment without asking the right questions, took advice from someone who was not a healthcare professional or didn’t get a second opinion, according to the 2025 Alight Employee Mindset Study.
This is deeply concerning, and not just only because of the potentially catastrophic results of an ill-advised treatment. There is the added stress, cost and downtime for an employee who merely wanted to address a health issue but got caught up in a confusing cycle of information overload with no clear answers. And this erodes trust.
Outside of work, employees have grown accustomed to an intuitive, personalized experience that anticipates their needs. Increasingly, they are expecting similar consumer-grade experiences when it comes to their benefits. And just like the applications that have become such a central presence in their non-work lives, the benefits platform they will come to rely on to deliver the tools, resources and guidance they need to navigate the benefits ecosystem will also use AI to deliver a personalized, transformational experience.
Unlocking the power of AI in benefits administration
This growing comfort with AI presents a defining opportunity for employers. When thoughtfully embedded into benefits administration, AI is more than a support function. It becomes a decision partner, guiding employees through complex choices across health, wealth and wellbeing. According to a new report from OpenAI, three in five U.S. adults have used AI tools for their health or healthcare in the past three months. They’re primarily using AI to find information when they first feel sick, to prepare for visits with their clinicians and to better comprehend patient instructions and recommendations. They’re also using it to deal with the administrative aftermath of billing, claims and denials.
The next phase of AI in benefits administration is not defined solely by automation or efficiency. It is defined by anticipation—using data, context and timing to guide employees before confusion, regret or friction can occur.
An AI-enabled benefits platform plays a central role in this future state by connecting disparate systems, surfacing relevant insights and supporting confident decision-making across health, wealth and wellbeing.
In practice, this phase takes shape through capabilities such as:
- Personalized recommendations to help employees find the benefits and retirement savings plans that are best suited to their specific situation.
- Always-on virtual support to ensure employees receive timely, accurate information in the moment they need it.
- Decision-support tools that help employees make smart, confident decisions about selecting and using their benefits.
- Intelligent health plan guidance tools that ask questions and pull in relevant data, like prior claims, to recommend a health care plan.
- Provider choice tools that help employees find a quality hospital or doctor that best meets their needs or determine if a current provider is part of a particular network.
- Adaptive savings calculators, investment advice and retirement-readiness evaluation tools to help employees decide where that allocate savings among different accounts.
Privacy, governance and responsible AI in benefits experiences
As AI becomes more deeply embedded in benefits experiences, its long-term success depends on trust. Clear governance, strong data protections and transparency are not supporting considerations. They are prerequisites for sustained adoption.
Since 2023, there has been a rise in the percentage of workers who feel comfortable sharing personal data in exchange for more tailored guidance, according to our Mindset Study. More than three-quarters (77%) now say they are comfortable sharing health information, up from 69% in 2023, while 73% are comfortable sharing financial information, up from 65% in 2023.
That’s not to suggest governance and privacy concerns have gone by the wayside. On the contrary, AI has raised the alarm on a whole new slate of potential issues in those areas, which must be of utmost importance to employers and benefits administration providers alike. A strict commitment to governance and transparency, coupled with a focus on privacy and data security and zero tolerance for wrong information, is paramount.
A high-tech, human touch approach to benefits administration
AI is not a future state ambition, nor is it a three- or five-year plan. It’s here, it’s happening now. It's reshaping how employees experience their benefits and how organizations support them during life’s most consequential moments. But while technology is an important enabler, it can never fully replace the guidance, empathy and high-touch support delivered by trained humans. The goal is not to replace human judgment or empathy, but to elevate it by using AI to remove friction, surface insight and ensure that when employees need guidance most, it is informed, timely and deeply human.
