Job Satisfaction, Health Insurance Benefits, and On-the-Clock Health Insurance Administrative Tasks/Burdens: A Moderated Mediation Model

Abstract

This study examines how individuals’ perceptions of the importance of their health insurance benefits (Insurance Importance) influence their overall job satisfaction (Job Satisfaction), with health insurance satisfaction (Insurance Satisfaction) serving as a mediator and time spent on insurance administrative tasks or burdens (Time Spent) acting as a moderator. Using survey data from a final analytic sample of 296 participants in the United States, we found that Insurance Satisfaction mediates the relationship between perceived Insurance Importance and Job Satisfaction. Moreover, the positive association between Insurance Importance and Insurance Satisfaction weakens when individuals spend more time managing insurance administrative burdens. Our findings highlight the critical need for organizations to strategically prioritize employee benefits, with a particular emphasis on streamlining and enhancing the efficiency of health insurance administrative process to reduce administrative burdens. By implementing such strategies, organizations can improve employees’ satisfaction with health insurance, thereby boosting their job satisfaction.

1. Introduction

1.1. Background

Fringe benefits are non-wage compensations provided by employers, offered as supplementary incentives to enhance employee attraction, motivation, and retention [1,2]. The significance of fringe benefits in fostering employee engagement and motivation has been well-documented in the existing literature [3,4,5], with a wealth of studies underscoring its critical role in enhancing job satisfaction and cultivating employee loyalty [6,7,8]. Among a range of fringe benefits, health insurance emerges as a particularly important component in the United States (USA) [2,8,9], given its capacity to provide financial security against the widely recognized high costs associated with healthcare. According to the Forbes Advisor, in the USA, 67 percent of employees and 68 percent of employers regarded health insurance, especially employer-covered healthcare, as the most important benefit [10].

Despite its recognized importance, limited research has explored how employees’ perceived importance of health insurance influences their overall job satisfaction. While prior studies suggest a positive association between fringe benefits and job satisfaction, the underlying mechanisms and contextual factors remain underexplored. Employees who view health insurance as highly important may interpret its provision as a signal of organizational care and reciprocity, thereby experiencing greater job satisfaction.

A potential mechanism explaining this relationship is employees’ satisfaction with their health insurance. Previous research suggests that job satisfaction was influenced by employees’ evaluations of various subdomains, including compensation and benefits [11,12] Given the salience of healthcare benefits, especially during the COVID-19 pandemic [13,14,15], satisfaction with health insurance likely plays an important role in linking the perceived importance of health insurance to overall job satisfaction.

However, the strength of this link may depend on employees’ experiences with insurance administrative burden. Even when employees consider health insurance highly important, their satisfaction may diminish if they must spend considerable time and effort navigating billing issues, paperwork, and communication with insurers. The complexity and inefficiency of these administrative processes can erode the perceived value of health insurance and reduce satisfaction with it. In other words, the greater the administrative effort required to manage insurance, the less satisfaction employees may derive from this benefit, even if they view it as essential.

Studies have suggested that health insurance administrative burden has become a growing concern among working professionals, particularly in the USA healthcare system, where employees often dedicate considerable personal time to insurance-related tasks such as coverage tracking, billing, and claim resolution [16]. Further, in a qualitative study, George et al. [17] have found that lack of cost transparency of health insurance and the need to spend time to communicate between doctors and insurance was one of the administrative burdens that increased the anxiety of cancer survivors. In addition, Pfeffer et al. [18] have suggested that more significant administrative tasks/burdens associated with health insurance, such as the extensive time spent communicating with health insurers, were inversely related to employees’ job satisfaction and engagement, while being positively related to their stress and burnout. Collectively, these findings suggest that greater administrative tasks/burden may weaken the extent to which employees’ perceived importance of health insurance translates into satisfaction with their insurance coverage, thereby ultimately reducing overall job satisfaction.

The COVID-19 pandemic has cast a stark light on the pivotal role of healthcare insurance in the USA, as individuals grapple with formidable access obstacles within the healthcare system [13,14,15]. These challenges highlight the importance of understanding how employees’ experiences with health insurance administrative tasks/burden shape their overall job satisfaction. Specifically, the time employees spend managing health insurance administrative tasks/burdens (Time Spent) may moderate the relationship between the perceived importance of health insurance and satisfaction with that health insurance (Insurance Satisfaction). Demanding insurance administrative effort may weaken the positive association between importance and satisfaction. In turn, health insurance satisfaction serves as a key mechanism through which these perceptions influence employees’ overall job satisfaction (Job Satisfaction). Thus, health insurance administrative burden may not only hinder employees’ satisfaction with their insurance but also indirectly diminish their broader satisfaction with their workplace.

The present study investigates these mechanisms within the context of the COVID-19 pandemic. Using data from a self-administered online survey conducted between November and December 2020, this study integrates mediation and moderation perspectives to provide a more comprehensive understanding of how health insurance administrative burden shapes the benefits–satisfaction relationship. The findings contribute to both theory and practice by identifying a practical pathway to enhance employee well-being: selecting and managing health insurance plans that minimize administrative complexity can strengthen employees’ satisfaction with their benefits and, consequently, improve their overall job satisfaction. These insights reflect the strategic role of administrative efficiency in benefit management and its broader implications for organizational effectiveness.

1.2. Theoretical Background and Hypotheses Development

1.2.1. The Linkage Between the Perceived Importance of Health Insurance and Job Satisfaction

The perception of health insurance benefits as important may influence job satisfaction in more than one way. One theoretical pathway is a direct association between the perceived importance of health insurance and job satisfaction. Employees who treat health insurance as highly important may derive satisfaction from their jobs simply because their employer provides this benefit, regardless of their evaluation of the specific insurance plan. This mechanism is supported by social exchange theory [19] which suggests that employees reciprocate organizational provisions with positive work attitudes, and by perceived organizational support theory [20] which posits that employer-provided benefits are interpreted as signals of organizational care and commitment. From this perspective, the mere presence of employer-sponsored health insurance can elicit a sense of gratitude and support, thereby enhancing employees’ overall job satisfaction [21].

Although the majority of USA employers provide health insurance, coverage is still not universal, particularly among smaller firms not subject to the Affordable Care Act’s employer mandate [22]. This variation may result in the presence of employer-sponsored health insurance becoming an important differentiator in shaping employees’ overall job satisfaction.

Based on these theoretical groundings, we hypothesized the following:

Hypothesis 1.

The perceived importance of health insurance is positively associated with job satisfaction.

1.2.2. The Mediating Role of Health Insurance Satisfaction

Insurance Satisfaction is an important element of the wider spectrum of employee fringe benefits satisfaction [11], which is theorized to have a profound influence on job satisfaction. This conceptualization is informed by the Job Descriptive Index, which indicates that employees’ job satisfaction is a composite of five sub-elements, including the nature of the work, compensation, promotional opportunities, etc. [12,23]. In the contemporary work environment, where health-related benefits are highly prioritized [24,25], a trend that has been further accentuated by the USA experience during the COVID-19 pandemic [13,14,15], satisfaction with health insurance has become a particularly salient determinant of overall job satisfaction. Owing to the significant expenses tied to healthcare, health insurance is often regarded by employees as an essential part of their overall remuneration [2,26]. From the perspective of Herzberg’s two-factor theory, health insurance functions as a hygiene factor: while its availability is important, it is the quality of the benefit (i.e., how satisfied employees are with it) that determines whether it contributes to job satisfaction [27].

Complementing this view, Intrinsic and Extrinsic Motivation Theory posits that extrinsic rewards, such as fringe benefits, enhance employee well-being only when they are perceived as valuable and fulfilling [28]. Thus, employees’ personal valuation of health insurance is expected to shape how strongly their satisfaction with this benefit translates into general job satisfaction. In this sense, health insurance satisfaction mediates the relationship between the perceived importance of health insurance and overall job satisfaction, serving as the mechanism through which employees’ perceptions of benefit value are transformed into affective responses toward their jobs.

Based on this theoretical grounding, we hypothesized the following:

Hypothesis 2.

Insurance Satisfaction mediates the relationship between employees’ perceptions of the importance of health insurance benefits and their Job Satisfaction.

1.2.3. The Moderating Role of Time Spent on the Health Insurance Administrative Tasks/Burdens

The Self-Determination Theory [29] and Intrinsic–Extrinsic Motivation Theory [28] posit that intrinsic motivation is bolstered by an individual’s sense of autonomy and competence. Applied to the realm of employee benefits, this theory suggests that the degree of control and ease with which employees can access and manage their health insurance influences their intrinsic motivation, and by extension, their job satisfaction. When administrative processes associated with health insurance are streamlined and user-friendly (lower complexity and administrative burden), employees are likely to feel more empowered and capable, which in turn may associate with higher levels of job satisfaction. In contrast, when administrative processes are time-consuming and complex, employees’ sense of autonomy and competence is undermined, diminishing the motivational potential of the benefit. This reasoning is consistent with Herzberg’s framework, which highlights that poorly implemented hygiene factors (e.g., inefficient administration of benefits) generate dissatisfaction rather than satisfaction [27]. Accordingly, we propose that the time employees spend on health insurance tasks moderates the extent to which Insurance Importance translates into Insurance Satisfaction.

Based on this theoretical grounding, we hypothesized the following:

Hypothesis 3.

Time Spent moderates the direct relationship between Insurance Importance and Insurance Satisfaction.

1.2.4. The Moderated Mediation Path

Building on the logic of H1 through H3, we proposed that the indirect pathway from Insurance Importance to Job Satisfaction through Insurance Satisfaction is contingent on Time Spent on insurance administrative burden. Social Exchange Theory [19] and perceived organizational support theory [20] suggest that valued benefits signal organizational care, prompting employees to reciprocate with positive job satisfaction. Herzberg’s two-factor theory [27] further suggests that health insurance, as a hygiene factor, enhances satisfaction only when administered effectively; poorly managed benefits instead generate dissatisfaction. Drawing on Intrinsic–Extrinsic Motivation Theory [28] and Self-Determination Theory [29], excessive administrative burden can reduce employees’ sense of autonomy and competence, weakening the motivational potential of valued extrinsic rewards. Thus, these perspectives suggest that when Time Spent on insurance administrative burden are low, valuing Insurance Importance translates more strongly into Insurance Satisfaction, which then enhances Job Satisfaction. In contrast, under high administrative burden (more Time Spent), this mediated pathway weakens or disappears.

Consequently, we hypothesized the following:

Hypothesis 4.

Time Spent moderates the indirect effect of Insurance Importance on Job Satisfaction via Insurance Satisfaction.

Taken together, our conceptual model is a moderated mediation model (see Figure 1).

2. Materials and Methods

2.1. Procedure and Participants

We conducted a self-designed online survey from November through December 2020 through Amazon Mechanical Turk (Mturk) system. Mturk system posts the survey to its registered users. The system prescreened the eligibility based on the following criteria: (1) participants lived in the USA during the survey period (the IP address must be in the USA); (2) participants had to be 18 years or older; (3) participants were literate in the USA; and (4) the past survey reputation credit was higher than 98%. Reputation credit reflects a worker’s historical approval rate by prior requesters, and prior research has shown that setting a high threshold (≥95–98%) significantly improves data quality and reduces careless responding [30]. Participants received $0.50 USA dollars as incentives after completing the survey. While this amount appears modest, additional costs were incurred for applying strict eligibility filters and ensuring data quality, which increased the overall expenditure per valid response. Material and procedures were reviewed and approved by the Institutional Review Board of the University of Houston-Clear Lake.

There were 393 people who participated in this survey. Invalid responses were dropped because they met at least one of the following priori criteria: (1) repetitive submission using the same IP address (3 respondents); (2) clicked “I am not consent to participate in this survey,” (46 respondents); or (3) chose “Completely uninsured” for the screen question of “In the past 12 months, did you go without health insurance?” (48 respondents). The final sample was thus composed of 296 valid participants.

2.2. Measures

In line with prior research on job satisfaction, our study focuses on employees’ perceptions of health insurance rather than solely the objective provision of benefits. This approach reflects a well-established finding in organizational behavior: it is not only what organizations provide, but also how employees interpret and evaluate these provisions, that shapes attitudes and behaviors [31]. Accordingly, we conceptualize our key constructs as follows: Insurance Importance reflects the extent to which employees personally value health insurance as part of their compensation. Insurance Satisfaction captures employees’ global evaluation of their current health insurance plan. Job Satisfaction represents employees’ overall affective evaluation of their workplace. Finally, administrative burden is operationalized as the proportion of personal time employees devote to health insurance tasks, reflecting a quantifiable dimension of burden [32]. These operationalizations allow us to test how the perceived value, satisfaction, and accessibility of health insurance benefits relate to job satisfaction.

We measured Insurance Importance and Insurance Satisfaction using single-item global indicators. Although multi-item scales are often preferable [24], prior studies have demonstrated that single-item measures of Job Satisfaction and Insurance Satisfaction can be both valid and reliable in capturing global evaluations [33,34,35]. Given the need to minimize participant fatigue in a Mturk-based survey and to ensure clarity in measuring these constructs, we adopted single-item indicators as pragmatic and valid measures of overall perceptions.

2.2.1. Outcome Variables

‘Job Satisfaction’ was our dependent variable that was measured by the question of “During the COVID-19 pandemic, how satisfied are you with your current workplace?” It was assessed by using five-point Likert-type scales (1 indicates “extremely dissatisfied,” and 5 indicates “extremely satisfied.”).

2.2.2. Predictor Variables

‘Insurance Importance’ was the independent variable that was measured by the question of “How important are health insurance benefits for you (and your family)?” It was assessed by using five-point Likert-type scales (1 indicates “not at all important,” and 5 indicates “extremely satisfied.”).

2.2.3. Mediator

‘Insurance Satisfaction’ was the mediator variable that was measured by the question of “Would you say your own health insurance, in general?” It was assessed by using five-point Likert-type scales (1 indicates “poor,” and 5 indicates “excellent.”).

2.2.4. Moderator

We used the ‘Time Spent’ as the moderator. It was measured by the question of “During the COVID-19 pandemic, the proportion of your time completing your health plan administrative needs was done during your personal time?” It was assessed by using five-point Likert-type scales (1 indicates “0–10%,” and 5 indicates “>70%.”).

We operationalized administrative burden as the proportion of personal time respondents reported spending on health plan administrative tasks during the COVID-19 pandemic. This indicator was chosen because time is a widely recognized and quantifiable dimension of administrative burden, and prior research has highlighted the significant costs associated with time spent navigating insurance requirements [18]. Measuring time also minimizes subjectivity and allows for straightforward interpretation across respondents.

2.2.5. Covariates

Covariates include four types: (1) health insurance type, including employer-based health plan, Medicare or Medicaid or Tricare, and private health plan; (2) self-evaluation for health status, which was measured by the question of “Would you say your own health, in general” with five-point Likert-type scales (1 indicates “poor,” and 5 indicates “excellent.”); (3) the burnout from work, which was measured by the question of “During the COVID-19 pandemic, how often did you feel burnout at work? (We defined “Burnout” as “people experience exhaustion and a lack of interest in things, resulting in a decline in your job performance”.)” with five-point Likert-type scales (1 indicates “Never,” and 5 indicates “Always.”); and (4) socio-demographic characteristics, including age, gender, education background, marital status, employment status, and household income.

2.3. Statistical Analysis

In reporting the descriptive statistics, the mean values and standard deviations for each variable were calculated. Furthermore, an examination of intercorrelations was conducted to explore the interrelationships among the variables by employing “polyserial” correlations. This approach is especially effective for datasets containing both ordinal and continuous variables, which acknowledges the ordinal characteristics of certain data while accurately identifying linear relationships [36]. In addition, the Cronbach’s alpha for the variables was 0.68. While this is slightly below the conventional 0.70 threshold, it is generally regarded as acceptable in the social sciences, particularly when scales are short and heterogeneous [37,38]. In addition, because this alpha was calculated across multiple constructs rather than within a single multi-item factor, it likely underestimates the internal consistency of individual measures.

In accordance with statistical practices prevalent in the field of management, we classified all ordinal variables as continuous for the purposes of our regression analyses. We employed “Structural equation modeling (SEM)” in Stata to examine the associations in our model. Firstly, to test the mediation effect between Insurance Importance (independent variable) and Job Satisfaction (dependent variable), Job Satisfaction was regressed on the mediator variable (Insurance Satisfaction), Insurance Importance, and covariates, and then Insurance Satisfaction was regressed on Insurance Importance and covariates. We employed “medsem” package to further to conduct mediational analysis [39]. Secondly, Insurance Satisfaction was regressed on Insurance Importance, the interaction term (Insurance Importance * Time Spent), and covariates. Upon establishing the presence of both mediation and moderation effects, we proceeded to concurrently assess all associations in an integrated model using the PROCESS Macro Model 7 package in SPSS, developed by Hayes [40].

We performed all analyses using Stata 18 (StataCorp, College Station, TX, USA) and SPSS 29 (IBM. Chicago, IL, USA) from January to February 2024. We set the significance level at 0.05 for all p-values. To test the indirect and moderated mediation effects, we employed a nonparametric bootstrapping procedure with 5000 resamples Hayes [40]. Bootstrapping involves repeatedly resampling the dataset with replacement and estimating the indirect effect in each resample, which produces an empirical sampling distribution [41]. This approach allows for the calculation of bias-corrected confidence intervals that are more robust than traditional normal-theory methods [42].

3. Results

3.1. Descriptive Analyses Results

A description of the sample was shown in

Table 1. Descriptive Statistics (N = 296).

Measures	Mean ± S.D. (N/%)
Covariates
Age
18–25	27 (9%)
26–35	108 (36%)
36–45	71 (24%)
46–55	40 (14%)
56–65	32 (11%)
>65	18 (6%)
Gender (Male)	115 (39%)
Education Background
Less than HS or HS Grad	17 (6%)
Some college	36 (12%)
Associate’ degree	36 (12%)
Bachelor’s degree	125 (42%)
Post-Grad degree	82 (28%)
Marital Status
Single	102 (34%)
Married	163 (55%)
Separated or divorced	23 (8%)
Widowed	8 (3%)
Employment
Full time employed	187 (63%)
Part time employed	32 (11%)
Self employed	32 (11%)
Unemployed	29 (10%)
Others	16 (5%)
Household Income
<$40,001	70 (24%)
$40,001–$80,000	115 (39%)
$80,001–$120,000	54 (18%)
$120,001–$160,000	27 (9%)
>$160,000	30 (10%)
Self-Evaluation for Health Status	3.38 ± 1.02
Burnout of work	2.95 ± 1.09
Health Insurance Type
Employer-based health plan	172 (58%)
Medicare or Medicaid or Tricare	71 (24%)
Private health plan	53 (18%)
Predictor Variables
Employees’ Perceptions of Health Insurance Importance	4.33 ± 0.89
Moderator
Time Spent on the Health Insurance Administrative Tasks/Burdens	1.82 ± 1.01
Mediator
Health Insurance Satisfaction	3.27 ± 1.14
Outcome Variable
Job Satisfaction	3.61 ± 1.20

. The mean of Insurance Importance was 4.33 with a 0.89 standard deviation; the mean of Time Spent was 1.82 with a 1.01 standard deviation; the mean of Insurance Satisfaction was 3.27 with a 1.14 standard deviation; and the mean of Job Satisfaction was 3.61 with a 1.20 standard deviation (See Table 1).

Table 2. Results of intercorrelations.

Research Variables	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)	(11)	(12)	(13)
Covariates
(1) Age	1
(2) Gender (Male)	0.00	1
(3) Education Background	0.08	0.07	1
(4) Marital Status	0.04	0.11	0.12	1
(5) Employment	0.01	0.18	−0.18	0.03	1
(6) Household income	0.11	−0.07	0.38 ***	0.15 *	−0.16 *	1
(7) Self-evaluation for health status	−0.07	−0.02	0.23 ***	0.06	−0.16 *	0.25 ***	1
(8) Burnout of work	−0.28 ***	0.15 *	0.06	−0.12 **	−0.14 *	0.02	−0.04	1
(9) Health insurance type	0.05	0.03	0.28	−0.06	0.28	−0.30	−0.13	−0.03	1
Predictor Variables
(10) Employees’ perceptions of the importance of health insurance benefits	0.20 **	0.11 *	−0.02	0.10 *	0.07	0.04	0.09	0.09	0.05	1
Mediator
(11) Health insurance satisfaction	0.05	0.05	0.21	0.07	−0.17 *	0.27 ***	0.45 ***	−0.06	−0.04 *	0.26 ***	1
Moderators
(12) Time spent on the health insurance administrative tasks/burdens	−0.12	−0.09	0.07	0.08	−0.28 *	−0.11 *	−0.16 **	0.43 ***	0.21 **	0.03	0.01	1
Outcome Variables
(13) Job satisfaction	0.12	−0.05 *	0.12 *	0.04	−0.17 *	−0.33 *	0.30 ***	−0.33 ***	−0.13 *	0.04	0.46 ***	−0.13 *	1

* p < 0.05; ** p < 0.01; *** p < 0.001.

presents the bivariate intercorrelations of measured variables. The predictor variable, Insurance Importance, was positively correlated with Insurance Satisfaction, serving as the mediator (r = 0.26, p < 0.001), while Insurance Satisfaction was positively correlated with the outcome variable, Job Satisfaction (r = 0.46, p < 0.001). The moderator variable, Time Spent was negatively correlated with Job Satisfaction (r = −0.13, p < 0.05) (See Table 2).

3.2. Regression Analyses

The full results of the moderated mediation model are presented in

Table 3. Results of moderated mediation model.

	Health Insurance Satisfaction	Job Satisfaction
	β (SE)	β (SE)
Covariates
Age	0.03 (0.06)	0.07 (0.06)
Gender (Male)	0.03 (0.13)	0.15 (0.13)
Education Background	0.08 (0.05)	0.03 (0.06)
Marital Status	−0.13 (0.08)	−0.08 (0.08)
Employment	−0.01 (0.04)	−0.13 ** (0.04)
Household income	0.13 * (0.06)	0.02 (0.06)
Self-evaluation for health status	0.40 *** (0.06)	0.08 (0.08)
Burnout of work	−0.11 (0.06)	−0.34 *** (0.06)
Health insurance type	−0.02 (0.08)	−0.07 (0.08)
Predictor Variables
Employees’ perceptions of health insurance benefits	0.25 *** (0.07)	−0.07 (0.07)
Moderator
Time spent on the health insurance administrative tasks/needs	0.14 * (0.06)
Mediator
Health insurance satisfaction		0.38 *** (0.06)
Interaction Effect
Employees’ perceptions of health insurance benefits * time spent on the health insurance administrative tasks/burdens	−0.14 * (0.07)

* p < 0.05; ** p < 0.01; *** p < 0.001.

.

Hypothesis 1, which predicted a positive association between Insurance Importance and Job Satisfaction, was not supported. The relationship between Insurance Importance and Job Satisfaction was not statistically significant.

Hypothesis 2 predicted that Insurance Satisfaction mediates the relationship between Insurance Importance and Job Satisfaction. Consistent with this hypothesis, Insurance Importance was positively associated with Insurance Satisfaction (β = 0.25, p < 0.001) which, in turn, was positively related to Job Satisfaction (β = 0.38, p < 0.001). Moreover, the indirect effect of Insurance Importance on Job Satisfaction via Insurance Satisfaction was significant (Bootβ = 0.09, 95% Bootstrapped CI = (0.04, 0.16)) (See

Table 4. Results for time spent on the health insurance administrative tasks/needs as a moderator of the indirect effect of Employees’ perceptions of health insurance benefits on job satisfaction via health insurance satisfaction.

	β (Bootstrapped SE)	Indirect Effect	95% Bootstrapped CI of Indirect Effect
Low level of time spent on the health insurance administrative tasks/burdens	−0.82 (0.04)	0.14 ***	(0.061, 0.226)
Mean level of time spent on the health insurance administrative tasks/burdens	0.00 (0.03)	0.10 ***	(0.041, 0.159)
High level of time spent on the health insurance administrative tasks/burdens	1.01 (0.036)	0.04	(−0.026, 0.122)

*** p < 0.001.

), whereas the direct effect of Insurance Importance on Job Satisfaction was nonsignificant (β = −0.07, p = 0.34). Taken together, these results suggest that Insurance Satisfaction mediates (full mediation model) the relationship between Insurance Importance and Job Satisfaction, providing support for Hypothesis 2.

Hypothesis 3 predicted that Time Spent moderates the relationship between Insurance Importance and Insurance Satisfaction, which was supported by our results. The interaction term of between Insurance Importance and Time Spent was significant and negative (β = −0.14, p < 0.05). This indicates that the positive effect of Insurance Importance on Insurance Satisfaction weakens as employees spend more of their personal time dealing with administrative insurance tasks. Figure 2 shows the simple slope plot for this interaction following [43]. As shown in Figure 2, the slope of Insurance Importance predicting Insurance Satisfaction is steeper at low levels of administrative burden, but flattens and becomes nonsignificant at high levels.

Hypothesis 4 predicted a moderated mediation effect, such that the indirect relationship between Insurance Importance and Job Satisfaction through Insurance Satisfaction would depend on the level of Time Spent on insurance administrative burden. As shown in Table 4, the indirect relationship between Insurance Importance and job satisfaction via Insurance Satisfaction was significant and negative when Time Spent was at low level (Bootβ = −0.82, 95% Bootstrapped CI = (0.06, 0.23)) but was non-significant when Time Spent was at high level (Bootβ = 1.01, 95% Bootstrapped CI = (−0.03, 0.12)). Moreover, the index of moderated mediation was significant (index = 0.05, Bootstrapped SE = 0.03, 95% Bootstrapped CI = (−0.11, 0.00)). These findings confirm the moderated mediation effect. Therefore, Hypothesis 4 was also partially supported.

4. Discussion

Our findings demonstrate the relationship between the time spent on health insurance administrative tasks/burdens) and its role on the tie of employees’ perceptions of the importance of health insurance benefits, health insurance satisfaction, and job satisfaction. Specifically, our results suggested that the time spent on administrative tasks/burdens required for health insurance moderates the association between employees’ perceptions of the importance of health insurance benefits and health insurance satisfaction that in turn mediates the relationship between employees’ perceptions of the importance of health insurance benefits and job satisfaction. These findings extend the existing literature, which broadly recognizes health insurance as a pivotal element for job satisfaction [3,4,5,18], by delineating how health insurance administrative tasks/burdens further shapes this dynamic.

Through mediation analysis, we found that the relationship between Insurance Importance and Job Satisfaction was fully mediated by Insurance Satisfaction. That is, the relationship between Insurance Importance and Job Satisfaction does not occur directly (indicated by the full medication results). Instead, it happens entirely through Insurance Satisfaction. The findings demonstrated if an individual places high importance on health insurance, then they were more likely to have higher satisfaction with their health insurance, then that satisfaction with health insurance was more likely to increase their job satisfaction. The present study presents a new insight into the dynamics of the association between employee benefits and their job satisfaction. Specifically, our finding indicate the critical role that health insurance satisfaction plays in the broader context of employee well-being and job satisfaction, which echo previous research findings [3,6,7,8,18]. The implication of this finding highlights the importance of the alignment between employee expectations and the actual quality of health insurance benefits in the context of organizational strategies aimed at improving employees’ job satisfaction.

Our study also contributes to the current knowledge on the potential moderators that can mitigate adverse effects stemming from the administrative tasks/burdens of health insurance. We found that the time required to navigate these administrative tasks/burdens moderated the relationship between employees’ perceptions of the importance of health insurance benefits and health insurance satisfaction. Specifically, the interaction effect of time spent on health insurance administrative tasks/burdens and employees’ perceptions of the importance of health insurance benefits was negatively associated with health insurance satisfaction. Studies have shown that the potential adverse effects from the administrative tasks/burdens can extend to a broader range of aspects. For example, Herd and Moynihan [32] indicated that the administrative tasks/burdens of health insurance can produce negative outcomes via psychological stress mechanisms, such as increased stress, frustration, anxiety, reduced autonomy, and perceived stigma. Pfeffer et al. [18] further estimated the direct costs incurred by employees managing health insurance administrative tasks/burdens to be around $21.75 billion annually, with over half of this time expended during work hours, amounting to approximately $11.4 billion. Pfeffer et al. [18] thus posited that the administrative tasks/burden of health insurance emerges as a critical organizational issue. The ramifications of health insurance’s administrative tasks/burden extend beyond individual employee well-being to encompass broader organizational outcomes, through its influence on employee satisfaction [18]. Therefore, our finding emphasizes the imperative for organizational policies and practices to prioritize the selection of streamlining and enhancing the efficiency of health insurance administration. By focusing on reducing administrative tasks/burdens of health insurance, organizations might improve both individual employees and organizational well-being.

4.1. Theoretical Contribution

Beyond confirming the hypothesized mediation and moderation effects, our findings advance theoretical understanding at the intersection of administrative burden, organizational design, and employee benefits. First, by applying the concept of administrative burden [32] to the employment context, we extend a framework traditionally used in public policy to organizational behavior research. We show that bureaucratic complexity in health insurance administration functions as an organizational design variable that can diminish the perceived value of employee benefits and, in turn, reduce job satisfaction. This conceptual extension shifts the focus from the mere provision of benefits to the processes through which benefits are accessed and managed, highlighting the importance of administrative efficiency as a dimension of perceived organizational support. Second, our findings contribute to ongoing debates on how benefit systems motivate employees by demonstrating that the motivational potential of health insurance, a core fringe benefit, is contingent upon employees’ administrative experiences. This insight refines both Herzberg’s two-factor theory by illustrating how poorly implemented hygiene factors can generate dissatisfaction, and social exchange theory by showing that perceived administrative fairness influences employees’ reciprocity toward their organizations. Together, these perspectives highlight that the effectiveness of employee benefits depends not only on whether they are provided, but also on how they are designed, delivered, and managed. Finally, situating our results within the broader context of the evolving USA employment landscape, our study highlights that the value of employer-sponsored benefits increasingly depends on their usability and transparency. In this way, our work advances theoretical discussions of administrative burden and organizational design by positioning benefit administration as a critical, yet often overlooked, mechanism linking HR structures to employees’ job satisfaction.

4.2. Practical Significance and Implications

Although the indirect and interaction effects were moderate in size, they carry meaningful implications. A one-standard-deviation increase in Insurance Satisfaction corresponded to a substantial increase in job satisfaction, suggesting that even incremental improvements in employees’ experiences with insurance administration can yield tangible organizational benefits. For managers, these findings underline the practical value of selecting streamlining health insurance plans and providing support resources that minimize the time employees spend navigating administrative processes. Collectively, such efforts can strengthen employees’ satisfaction with their health insurance and, consequently, improve overall job satisfaction.

4.3. Limitations

Several limitations are present in our study. Primarily, the cross-sectional nature of this study inherently limits the establishment of causality, although the medication model may imply a causal relationship. Additionally, the data were collected through the MTurk platform, whose samples, although diverse and widely used in social science research, may not fully represent the broader employee population due to potential self-selection bias. Moreover, the relatively low level of participant compensation may have influenced response quality, even though attention checks were included to help ensure data reliability. These factors may limit the representativeness of our sample and, consequently, the generalizability of our findings. Another limitation is that Insurance Importance and Insurance Satisfaction were measured as a global construct. While this approach is consistent with prior research using single-item global indicators, Insurance Satisfaction is inherently multidimensional, including financial, administrative, and provider-related domains. Future research may employ multi-item scales that differentiate these dimensions, which may provide a more nuanced understanding of how specific aspects of Insurance Satisfaction influence Job Satisfaction. An additional limitation concerns the reliability of our measures. The reported Cronbach’s alpha of 0.68 indicates only modest internal consistency. While such values are not uncommon in early-stage research and with short scales and given that some of our key constructs were measured with single global items (e.g., Job Satisfaction, Insurance Satisfaction), they may restrict the precision of our estimates. Future research should improve reliability by including additional items for each construct and by developing multidimensional scales of Insurance Satisfaction and related variables. Lastly, the relatively modest sample size of 296 participants may constrain the statistical power of our analysis and the robustness of the findings, particularly when investigating more subtle effects or interactions within the data.

5. Conclusions

Our study demonstrates the critical role of strategically prioritizing employee benefits by streamlining and enhancing the administrative processes associated with health insurance. Simplifying these processes not only improves employees’ ability to access and manage their health coverage but also significantly enhances their overall job satisfaction.

Beyond organizational implications, the findings carry broader societal relevance. In the USA healthcare system where employer-sponsored insurance remains the predominant form of coverage, administrative burdens have been increasingly recognized as not only personal stressors but also systemic and policy-level challenges. Our findings indicate that such burdens can undermine the perceived value of health insurance as a key employment fringe benefit, potentially diminishing employee employees’ job satisfaction and their organizational commitment.

Reducing administrative complexity through policy reforms, a simplified health insurance administrative process, and improved transparency may therefore be essential, not only to strengthen employee satisfaction but also to sustain the long-term viability of employer-sponsored health insurance within the American workplace.