If you’re standing up a self-funded or level-funded employer health plan — or you’ve been running one on a patchwork of systems — the operational question lands fast: what software does it actually take to administer one?
A quick boundary first. This isn’t advice on whether to self-fund, how to design your plan, ERISA compliance, stop-loss placement, state filings, or your fiduciary duties. Those are questions for your benefits counsel, your broker, and your stop-loss carrier — not a software vendor, and not this article. What we can speak to is the administration software: the systems you’ll run once the plan is in place and claims start coming in. Get that stack wrong and you’re stitching together five, six, or seven vendors before you’ve paid a single claim.
Here’s the stack — and why it usually isn’t one.
The seven systems it takes to administer a self-funded plan
1. Enrollment and benefits election. Open enrollment, elections, dependent capture, qualifying-life-event changes, and attestations captured with e-signature. This is the front door for every member and every renewal. Bought separately: a benefits-administration platform like Employee Navigator or B-Swift.
2. Eligibility and member management. The system of record — member and dependent profiles, coverage tiers, effective and termination dates, and the eligibility status every downstream system reads from. Bought separately: a ben-admin system plus manual eligibility files pushed between platforms.
3. Claims adjudication. The engine of the plan: claim intake, plan-design application, pricing, cost-sharing, and real-time deductible and out-of-pocket accumulators so every claim adjudicates against current member balances. Bought separately: a dedicated claims payer or repricer — often a base around $20,000 a month just for the claims-payer side, per published market benchmarks, before you’ve built anything else.
4. EDI and clearinghouse. Electronic claim intake (837s), remittance generation (835s), and eligibility transactions, with clearinghouse connectivity so claims and provider data flow in and read cleanly. Bought separately: a clearinghouse contract plus EDI middleware.
5. Contribution billing and provider payments. Premium and contribution billing, member payment methods, provider disbursements, and 1099-MISC and W-9 tracking for the providers you pay. Bought separately: a billing platform, a payment gateway, and separate tax-tracking tooling.
6. Member and provider portals. Branded portals where members pull EOBs, ID cards, and claim status without calling, and where providers can check eligibility and submit bills. Bought separately: a custom-built portal or a bolt-on module.
7. Communications and growth. Email, SMS and texting, a way to reach members by phone, enrollment funnels, and automations. Even a single-employer plan runs on member communication. Bought separately: a marketing platform and a phone system.
Why that’s normally five to seven contracts
Buy those separately and you’re not buying software — you’re buying an integration project. Five, six, seven contracts. Setup fees, per-seat fees, and per-transaction fees on each. Middleware to make systems that were never designed to talk to each other pass eligibility and claims back and forth. And your members’ protected health information scattered across seven platforms, each its own security question your plan is on the hook for.
That’s before you adjudicate a single claim. It’s the reason so many plans limp along on spreadsheets bridging expensive point systems — and it’s exactly the problem worth solving before your first claim hits.
Claimaro is all seven, in one
Claimaro is the whole stack in a single platform: enrollment, eligibility and member management, claims adjudication with real-time accumulators, EDI and clearinghouse connectivity, contribution billing and provider payments, member and provider portals, and the full communications suite — one login, one contract, one bill. Each plan runs on its own isolated database, HIPAA- and SOC 2-compliant controls are built in with a BAA on every plan, and a new environment provisions in minutes, not an implementation cycle. Your claims and financial reporting live in the same system — including the data your plan and its stop-loss carrier rely on to reconcile.
Zero per-claim fees — ever. In a market where claims payers bill you per transaction, Claimaro doesn’t. Your enrollment can double and your team can clear the claim queue every day, and your platform cost doesn’t move a dollar. On a self-funded plan, where you’re already carrying the claims risk, a software cost that grows every time you pay a claim is the last thing you need.
If you’re weighing dedicated claims platforms, we put Claimaro side by side with the incumbents — see how Claimaro compares. And the economics usually decide it: replacing a $20K-a-month claims payer plus six more point systems with one platform, at published pricing from $3,500/month + $5 PMPM with no per-claim fees, is a fraction of what the pieces cost apart.
See the stack, and the number
The fastest way to understand it is to see it. Run your member count through our calculator to size it against what a seven-vendor stack would cost you, then book a walkthrough — twenty minutes, and we’ll show you the whole plan running in one place.