The Benefits Activation Gap: what claims data teaches us about employee engagement

Every claim tells a story.

Sometimes it’s about an employee recovering from a serious illness. Sometimes it’s about a family navigating the loss of a loved one. Sometimes it’s about protecting financial stability after an unexpected disability.

But from where I sit leading claims operations, claims often reveal another story—one that begins long before a claim is ever filed. Too often, employees discover they don’t fully understand the benefits they’ve elected, overlook coverage they already have, or realize too late that they declined protection they now wish they had.

Those experiences have led me to think differently about employee benefits.

I call it the Benefits Activation Gap: the disconnect between enrolling in benefits and confidently using them when life happens.

Employers invest significant resources in designing competitive benefits programs that support the health, financial security, and wellbeing of their workforce. Yet the value of those investments isn’t determined during open enrollment. It is realized months—or years—later, when an employee faces one of life’s most challenging moments and knows exactly where to turn for support.

From a claims perspective, the Benefits Activation Gap is surprisingly visible.

What Claims Data Reveals

Claims operations offer a unique window into how employees engage with their benefits. Every day we see where employees understand their coverage, where confusion exists, and where opportunities for better education emerge.

Patterns become apparent over time.

Organizations that communicate with employees throughout the year—not only during open enrollment—often experience more consistent utilization of benefits. Employees receive reminders about what they elected, understand how their benefits work, and know how to begin the claims process when they need assistance.

We see this firsthand with one large healthcare employer that........

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