C-suite, board members, a bunch of "foundations", probably some for-profit contracting services for IT and accounting (also managed by the c-suite, probably). Unraveling health insurance admin costs is probably similar to Panama Papers level of financial engineering, especially after the ACA capped profit margins, the companies just turned to malicious compliance.

If you look at the 10-K for any of the 7 publicly listed health insurers, administrative cost increases are minuscule compared to healthcare expenditures.

You can get rid of half the employees and cut everyone’s pay by half, and it won’t make much difference.

I think the US’s biggest problem in healthcare is liability. Every entity is spending so many resources on making sure that they do not get blamed in the event there is a lawsuit, because the damages are huge.

In countries with taxpayer funded healthcare, this liability issue is much less because you are dealing with the government only and suddenly liability and damage amounts are reduced.

I think we can just go a step further and kill their entire toxic business model. After decades of observing how it behaves, it should be pretty clear that it's always going to devolve down to privately-ran death panels.

Is their pay out of line with executives in any other similar sized businesses?

As far as I can tell from the financial reports, profit margins are so low simply because expenses are that high, and its across at least 7 publicly listed health insurers.

The main cause of low profit margins that I can tell is high healthcare expenses (and lots of competition and state regulation so they cannot increase premiums more).