Voluntary benefits are a critical part of American wellbeing due to the rising costs and coverage gaps in major medical insurance. However, maximizing the value of supplemental coverage presents a challenge for consumers who are largely expected to manage claims processes on their own.

During medical events, consumers are burdened with the need to remember relevant policies and have a “pHD” in their coverage to appropriately file claims and receive reimbursement. As a result, usage of these plans is unconscionably low. The #1 challenge listed by carriers in the claims integration space is improving the customer experience for claims while 1) tackling manual processing for complex products and 2) developing relationships with medical carriers to share data, accurately.*

The industry has moved to improve the inadequacies of the claims processing experience through automated claims notification and filing. These processes aim to reduce friction and ensure value for employees using automation.

Sina Chehrazi, CEO of Nayya, emphasizes the critical role of claims integration capabilities in today's benefits landscape.

"Starting in 2024, claims integration capabilities are being required by consultants and employer groups. Carriers without these capabilities won’t be able to compete in today’s market. They shouldn’t. The days of artificially low loss ratios are almost over. Employees and their families need and deserve these funds: 52 weeks a year."

The Truth Today: Not All Claims Integrations Are Created Equal

While a worthwhile pursuit, many who have tried their hand at claims integration were quick to discover the nuance of complexities.

Here’s why:

1. Claims integration requires complex data mapping from siloed sources across benefits carriers, employers, and medical carriers.
2. The technology needed to automate claims identification, validation and determinations quickly and accurately is very complex - it requires a very nuanced understanding of underlying plan structures and medical claims enrichment.
3. The ability to communicate back to the consumer in a way that drives action requires trust and engagement expertise.

Entities have struggled to deliver on claims integration in a meaningful way. Until now.

Introducing Nayya Claims

As the leading innovator in employee benefits technology, Nayya is thrilled to announce our latest product in enabling world class group benefits experiences for the end-employee. Nayya Claims is a groundbreaking product that leverages industry expertise, algorithms, sophisticated analytic methodologies, artificial intelligence and data science to automate claims processes for supplemental health plans.

This achievement marks a significant leap forward in the industry, addressing the pressing need of benefits carriers and broker intermediaries for effective claims integration capabilities.

Arik Gaisler, CTO of Nayya, speaks to how Nayya Claims contributes to our larger product development philosophy stating the following.

"We are continuously striving to raise the bar of consumer value through innovation. Nayya Claims is another testament in our campaign for employees. By enabling connectivity between medical claims data and supplemental health benefits in one platform, we are raising consumer awareness of claim opportunities and reducing friction from healthcare."

How Nayya Delivers a Frictionless Claims Experience

Nayya has developed a cutting edge solution that connects with any medical payor in the US market, enabling dynamic, seamless, consumer-driven software to deliver product value precisely when employees and their families need it most.

By mapping medical claims data to supplemental health policies, Nayya Claims is able to identify and process supplemental health claims on the employee’s behalf. Nayya is raising the bar for claims integration solutions by prioritizing the following critical capabilities:

• Privacy + Flexibility: Easily embeddable and dynamic consent based workflows that operate under HIPAA and with the best interest of the consumer
• Efficiency + Accuracy: Sophisticated algorithms and models that synthesize complex logic in order to streamline carrier processes
• Consumer Experience: Advanced data mapping and enrichment to remove friction through automation for a consumer-friendly approach

The New Era in Group Benefits

Nayya is poised to unveil its anchor partners for Nayya Claims in the coming weeks and months, showcasing strategic collaborations that demonstrate the product's efficacy and transformative potential within the industry. These innovative carriers and platforms are deploying Nayya Claims to hundreds of US employers with effective dates of 1/1/2025.

Nayya Claims joins Nayya’s product portfolio, including Nayya Choose, Nayya Use, and Nayya Retirement. Nayya remains committed to staying ahead of emerging trends in group benefits. The company recognizes the evolving landscape and is dedicated to offering innovative solutions that address the changing needs of both benefits providers and consumers, acting as a personalized employee benefits co-pilot for end-employees.

About Nayya: Nayya is a leading employee benefits technology company that leverages artificial intelligence and data science to drive a new era in group benefits. Nayya unites the employee benefits experience across health, wealth, and wellness with innovative technology that brings clarity and efficiency to the benefits landscape. Empowering benefits carriers and broker intermediaries to differentiate through employee experiences that enhance the value of their offerings.

*Source: Claims Integration and Automation Practices of Voluntary Carriers, Eastbridge Consulting, 2022