Artificial Intelligence (AI) is everywhere, and it’s changing the way many industries operate, including group benefits. From catching fraud faster to helping employees stay healthier, AI is quietly transforming how benefit plans are managed and experienced.
While this technology may sound futuristic, it’s already being used by Canadian insurers and plan providers in real, practical ways. And for employers and benefit consultants, understanding how AI fits into the future of group benefits can help build smarter, more sustainable plans.
Fighting Benefits Fraud in Smarter, Faster Ways
Fraud detection is one of the biggest and most successful uses of AI so far in the benefits world. Each year, it’s estimated that the Canadian insurance industry loses more than $600 million to fraud or abuse - sometimes from employees, and sometimes from health providers submitting claims on their behalf.
AI is helping insurers analyze thousands of claims almost instantly, spotting unusual patterns that humans might miss. For example:
- The Canadian Life & Health Insurance Association (CLHIA) is working with an AI company called Shift Technology to identify suspicious claims across the entire industry. This partnership allows insurers to share de-identified data, making it easier to detect fraud trends that might not show up in just one plan.
- Alberta Blue Cross uses machine learning to flag abnormal claims like repeated submissions or unusually high costs for a particular provider.
This kind of AI-driven insight helps insurers and employers protect their plans, control costs, and make sure legitimate claims are processed quickly and fairly.
Making Administration Easier for Everyone
Anyone who’s ever managed a benefits plan knows how much paperwork and data entry can be involved. That’s where AI can help behind the scenes with streamlining claims processing, automating simple tasks, and speeding up responses to employee questions.
According to Benefits Canada’s 2024 Group Benefits Providers Report, insurers are using AI to help with:
- Faster claims processing by reading and categorizing claims automatically.
- 24/7 chat support, where AI can answer common plan member questions like “What’s covered?” or “How do I submit a claim?”
- Data cleanup, identifying duplicate records or outdated information so HR teams don’t have to.
This kind of automation doesn’t replace people; it supports them. When AI handles the repetitive work, plan administrators and consultants can spend more time where they’re needed most: helping clients and employees make the most of their plans.
Helping Employees Stay Healthier
One of the most exciting areas of AI is how it can help spot potential health issues earlier, and even suggest personalized wellness or treatment options.
Imagine if your benefits platform could help identify when an employee might be at risk for burnout or a chronic health condition before it becomes a serious issue. AI makes this possible by analyzing patterns in claims, health assessments, and other data (all securely and anonymously).
According to Accenture Canada, employers could soon use AI tools to combine internal data (like absenteeism trends) with broader information (such as community health data) to predict where support might be needed next.
While this kind of predictive care is still in its early days, it points to an exciting future where benefit plans don’t just react to illness but help prevent it.
Creating a Better Experience for Plan Members
AI can also make benefits feel simpler and more personal.
Many insurers are using AI-powered virtual assistants to answer questions instantly, recommend benefits that fit an employee’s lifestyle, or even send reminders about preventive care and coverage deadlines.
In fact, a recent Environics study found that almost half of Canadian organizations are already using AI to improve customer or employee experiences.
Think of it like having a digital benefits guide that’s available anytime and anywhere, helping plan members understand and use their benefits more effectively.
Balancing Innovation with Responsibility
Of course, AI comes with important considerations. In Canada, health information is highly regulated under privacy laws like PIPEDA and provincial health legislation. That means any use of AI must include strong data protection, transparency, and human oversight.
There’s also the question of fairness. Algorithms must be carefully tested to avoid bias - for example, ensuring they don’t unfairly flag certain providers or types of claims.
And because AI is still learning, human judgment remains essential. It’s not about replacing people; it’s about equipping them with better tools to make informed, fair decisions.
Final Thoughts
AI is transforming the benefits landscape in Canada in ways that once seemed impossible. It’s catching fraud that humans could never spot, speeding up claims, reducing admin headaches, and even helping people stay healthier.
But at its best, AI isn’t about technology; it’s about people. It’s about creating benefit plans that are smarter, fairer, and more personalized.
As we move through 2025 and beyond, benefit advisors, insurers, and employers who embrace AI responsibly will be well-positioned to offer better value to their plan members and to make benefits feel more human than ever.
To learn more, please contact us.
- Nicole DeCorby, B.Ed.
Benefits Account Manager
Although the author is affiliated with a partner firm of Q Wealth, this publication was prepared prior to its affiliation with Q Wealth, it is not an official Q Wealth publication, and the author is not a registrant or research analyst of Q Wealth. The views expressed herein are those of the author alone, and they have not been approved by, and are not necessarily those of, Q Wealth. This publication is for information purposes only, it is not legal, tax, accounting or investment advice and should not be relied as such.
