How behavioral analysis helped improve benefits education and reduce costly mistakes
Benefits plans are only as effective as the participants’ ability to use them. When participants don’t understand their plans, it doesn’t just impact them—it creates a ripple effect of support tickets, lost funds, and missed compliance opportunities.
In this post, I’ll walk through how I used data to uncover trends in participant confusion—and transformed those insights into an education strategy that saved time, money, and frustration.
Participants were consistently submitting claims for ineligible expenses or outside the eligible time period. This led to:
High rates of forfeiture (participants losing funds)
Denied claims requiring manual appeals
Frustrated participants escalating their issues
Increased workload for Customer Service, Compliance, and Claims teams
Rather than handling these issues reactively, we decided to dig into the root causes.
Using Excel and Python, I analyzed several months of cases flagged as “Participant Error.”
Variables analyzed:
Plan type (HSA, FSA, DCA, etc.)
Timing of the claim (e.g., before coverage start)
Participant account status (active, terminated)
Appeal outcomes
Repeated escalations by the same individuals
Some of the most common patterns included:
Misunderstanding of eligible expenses (especially dental vs. medical)
Confusion about coverage periods after termination
Repeated errors by participants who were never properly onboarded
High volumes of claims submitted just after plan year rollover
We visualized this in Python using bar and pie charts to show:
Most common types of errors
Percent of errors by plan type
Number of escalations prevented after education intervention
This bar chart highlighted the most frequent misunderstandings, which helped prioritize our education efforts.
We designed a multi-tiered education approach based on our findings:
Pre-enrollment emails highlighting top confusion areas
Onboarding sessions focused on plan differences and timing
Updated claim instructions with visual guides
Short videos answering the “top 5” participant questions
Monthly “learning labs” for internal support teams to strengthen their knowledge
40% reduction in repeat errors within one quarter
Increase in successful claim submissions
Fewer escalations to the Compliance team
Improved participant satisfaction in post-interaction surveys
Participant errors aren’t just a nuisance; they’re a signal. By treating them as data points, you can design smarter education, streamline operations, and protect both your participants and your organization.