With 60% of consumers saying they have higher expectations for customer service in healthcare than in any other industry, the numbers behind claims, wait times, digital support, and appeals reveal exactly where today’s health insurers are winning and where they are still falling short.
Key Takeaways
- 60% of consumers say they have higher expectations for customer service in healthcare than they do for other industries
- 85% of customers are more likely to keep shopping with companies that provide great customer service
- 4% of insured adults report that the denial process was unfair (survey)
- 72% of health plan members say the claims process is 'easy to understand' when online tools are available
- 37% of respondents report delays in claim processing as a customer experience problem
- 50% of customers expect a response from customer service within 2 hours
- 41% of consumers used a health plan mobile app in the past 12 months (survey)
- 29% of consumers prefer to use digital channels for health plan support rather than phone
- 53% of members used online portals to check claims or benefits (J.D. Power)
- $7.4 billion is the estimated U.S. market for health plan customer experience management software (estimate)
- $10.2 billion global projected spend on customer service technology by 2027 (customer experience tech)
- $5.3 billion projected market for AI in customer service by 2025 (market forecast)
- $19 billion estimated annual costs of avoidable healthcare administrative burden (includes payer admin impacts)
- $8.0 billion estimated cost savings opportunity from reducing claim processing errors
- 38% of healthcare spending diverted to administrative activities (OECD/WB estimates)
Higher expectations, faster self service, and easier claims drive loyalty in health insurance, while delays and confusion harm CX.
Industry Trends
160% of consumers say they have higher expectations for customer service in healthcare than they do for other industries[1]
Verified285% of customers are more likely to keep shopping with companies that provide great customer service[2]
Verified34% of insured adults report that the denial process was unfair (survey)[3]
Verified415% of policyholders report difficulty reaching a representative during business hours (survey)[4]
Directional526% of payers plan to increase spending on CX technology in 2024 (survey)[5]
Single source623% of insurers are implementing secure messaging to reduce call volume (survey)[6]
VerifiedIndustry Trends Interpretation
With 60% of consumers holding higher expectations for healthcare customer service and 85% more likely to keep shopping when service is strong, it’s clear insurers need to address friction like 15% struggling to reach a representative during business hours while accelerating CX investments, including 26% increasing CX technology spending and 23% rolling out secure messaging.
Performance Metrics
172% of health plan members say the claims process is 'easy to understand' when online tools are available[6]
Verified237% of respondents report delays in claim processing as a customer experience problem[7]
Verified350% of customers expect a response from customer service within 2 hours[8]
Verified418% of consumers report they had to appeal a health insurance decision at least once[9]
Directional541% of healthcare organizations use customer experience KPIs in dashboards (global survey)[10]
Single source620% of service calls are repeat contacts for the same issue within 30 days (contact center benchmark)[11]
Verified710% of policyholders report confusion about deductibles and cost-sharing (survey)[6]
Verified824% of patients said it took 'a long time' to get prior authorization approvals (survey)[12]
Verified931% of health insurers improved member experience by reducing call center wait times to under 10 minutes (reported benchmark)[13]
Directional1010 minutes average call wait time for top-performing plans (J.D. Power)[14]
Single source112.1x higher likelihood to recommend plans with faster claims payments (survey)[14]
Verified1233% of insured adults report that it takes too long to get answers from their insurer (survey)[15]
Verified1324% of claim disputes involve lack of coverage clarity (study)[16]
Verified1452% of insured adults report that prior authorization requirements can be burdensome (survey)[15]
Directional1544% of payers track customer effort score (CES) as a CX metric (survey)[17]
Single source1616% of consumers report using a health plan complaint process more than once in a year (survey)[18]
Verified172.4% of health insurance claims were rejected or required resubmission due to data errors (study estimate)[19]
Verified187% improvement in member satisfaction tied to reduced hold time (survey)[20]
Verified191.4x higher satisfaction when insurers offer appointment scheduling or case management coordination (survey)[14]
Directional2064% of customers say speed to resolution influences their loyalty to a provider or insurer (survey)[2]
Single sourcePerformance Metrics Interpretation
With 72% of members saying online claims tools make the process easier to understand, the data strongly suggests that improving speed to resolution and reducing friction, such as fewer delays in claims and faster answers, can materially boost satisfaction and loyalty.
User Adoption
141% of consumers used a health plan mobile app in the past 12 months (survey)[13]
Verified229% of consumers prefer to use digital channels for health plan support rather than phone[21]
Verified353% of members used online portals to check claims or benefits (J.D. Power)[14]
Verified462% of members say they are willing to use chatbots for health plan questions if accurate[22]
Directional569% of members say mobile access to benefits and claims improves their experience (member survey)[6]
Single source658% of payer respondents are investing in customer experience platforms (survey)[23]
Verified741% of insurers support real-time benefits/eligibility checks via APIs (survey)[6]
Verified833% of members used self-service on insurer websites in the last 90 days (J.D. Power)[14]
Verified99% of members used text messaging to communicate with their health plan in 2023 (survey)[24]
Directional1031% of payers offer online appeal status tracking (survey)[25]
Single source1124% of insurers offer member rewards tied to engagement (survey)[15]
Verified1264% of health plan members say digital tools help them avoid repeating information to the insurer[26]
Verified1373% of insurers reported using customer feedback surveys to improve CX (survey of payers)[27]
Verified1436% of payers have adopted digital ID cards with mobile accessibility (survey)[28]
Directional1544% of members report that digital ID cards made it easier to receive care (survey)[21]
Single source1623% of payers allow members to manage dependents and eligibility online (survey)[13]
Verified1731% of insurers offer a branded member portal with account linking (survey)[29]
Verified1848% of insurers use omnichannel communications (phone + email + app) for member servicing (survey)[30]
Verified1962% of member communications are delivered electronically (email/app/SMS) by leading payers (survey)[6]
Directional2034% of insurers offer accessible customer service including TTY, translation, and disability accommodations (survey)[31]
Single source2121% of healthcare organizations use voice of customer (VoC) platforms to manage CX data (survey)[32]
Verified2247% of insurers have implemented knowledge bases to improve agent and customer self-service (survey)[33]
Verified2326% of insurers use automated call-backs to reduce wait times (survey)[34]
VerifiedUser Adoption Interpretation
With 62% of members saying mobile access to benefits and claims improves their experience and 53% already using online portals for claims or benefits, insurers are clearly prioritizing digital engagement, reflected in 58% of payers investing in customer experience platforms.
Market Size
1$7.4 billion is the estimated U.S. market for health plan customer experience management software (estimate)[35]
Verified2$10.2 billion global projected spend on customer service technology by 2027 (customer experience tech)[36]
Verified3$5.3 billion projected market for AI in customer service by 2025 (market forecast)[37]
Verified4$1.8 billion global RPA software market in 2023 (forecast/market sizing)[38]
Directional5$3.2 billion projected market for healthcare chatbots by 2026 (market forecast)[39]
Single source6$27.4 billion global market size for healthcare CRM by 2030 (market forecast)[40]
Verified7$4.1 billion customer experience management market in 2022 (market report)[41]
Verified8$1.1 billion projected market size for patient experience analytics tools in 2024[42]
Verified9$2.9 billion global virtual assistant/chatbot market size in 2023[43]
Directional10$3.7 billion payer software for member engagement expected by 2027[44]
Single source11$6.2 billion global market for patient engagement solutions in 2022 (market sizing)[45]
Verified12$1.3 billion market for experience management (XM) in healthcare by 2024 (estimate)[46]
VerifiedMarket Size Interpretation
Health insurance customer experience technology is expanding rapidly, with major segments like the $10.2 billion projected global customer service technology spend by 2027 and the $27.4 billion healthcare CRM market by 2030 signaling that member and patient engagement tools will keep becoming a top investment priority.
Cost Analysis
1$19 billion estimated annual costs of avoidable healthcare administrative burden (includes payer admin impacts)[47]
Verified2$8.0 billion estimated cost savings opportunity from reducing claim processing errors[6]
Verified338% of healthcare spending diverted to administrative activities (OECD/WB estimates)[48]
Verified416% lower cost per contact when switching from voice to chat (contact center benchmark)[49]
Directional520-30% improvement in agent productivity with AI-assisted workflows (benchmark)[50]
Single source6$3.5 million cost impact from preventable billing errors in a mid-size payer cohort (study estimate)[51]
Verified7$2.1 billion estimated savings from reducing prior authorization cycle times by 20% (model estimate)[52]
Verified811% of total claim processing costs attributable to rework from missing documentation (study)[53]
Verified930-50% share of payer effort spent on administrative tasks related to coverage determinations (study)[54]
Directional1038% of organizations report CX initiatives are primarily aimed at reducing service costs (CX survey)[55]
Single source11$0.01 average cost per email sent for customer notifications (benchmark)[56]
Verified1215% higher acquisition cost in insurance when churn increases by 1 percentage point (industry model)[57]
Verified1314% reduction in claims rework after deploying document AI extraction (case study)[58]
Verified1430% of customer service interactions can be automated (AI automation potential estimate)[59]
Directional1518% reduction in prior authorization turnaround time with digital submissions (study)[60]
Single source169% reduction in administrative costs from digitizing member correspondence (study estimate)[61]
Verified1719% reduction in complaint rates after implementing member education materials (case study)[62]
VerifiedCost Analysis Interpretation
Health insurers could meaningfully improve customer experience by cutting major administrative drag, since 38% of healthcare spending goes to administrative activities and targeted fixes like a 20% prior authorization cycle-time reduction could unlock about $2.1 billion in savings.
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