05/27/2026
Artificial intelligence is reshaping how health plan claims are processed, and for employers, that comes with new responsibilities.
As insurers and TPAs increasingly rely on AI and automated tools for claims processing and utilization management, plan fiduciaries may face growing oversight obligations to ensure those tools are producing accurate outcomes and fair appeal processes. This is an emerging area of ERISA risk that employers, particularly those with self-funded plans, should be watching closely.
Here's what's on the radar:
🤖 AI & Claims Accuracy - Fiduciaries may be expected to monitor whether AI-driven claims decisions are consistent, accurate, and compliant with plan terms.
🔒 Data Privacy & Cybersecurity - Health plans hold large volumes of sensitive participant data. Employers may face increasing expectations around HIPAA compliance, breach response planning, and vendor data protection practices.
📋 Vendor Oversight - Periodically reviewing agreements with TPAs, PBMs, stop-loss carriers, and wellness vendors remains a critical fiduciary best practice, especially as technology plays a larger role in plan administration.
The landscape is evolving quickly. Staying informed and proactive is the best way to manage fiduciary exposure before it becomes a liability.
Have questions about your plan's fiduciary practices? We're here to help.
📩 [email protected] | 732.704.7633
🔗 www.thecacompanies.com
