Non-clinical advocates who give employees a trusted point of contact for benefits navigation, claims questions, billing concerns, and everyday healthcare support, with escalation to clinical resources when a situation calls for it.
Navigating benefits, healthcare questions, and employee support needs can be overwhelming, especially when employees are unsure where to turn. Our non-clinical advocacy services give employees a trusted point of contact for guidance, education, and hands-on support, helping them better understand their options and take the next best step.
We assist employees with benefits navigation, claims questions, provider and resource guidance, billing concerns, appointment coordination support, and general healthcare-related inquiries. By helping employees resolve everyday issues faster, we reduce confusion, improve the employee experience, and ease the administrative burden on HR teams.
When a situation requires additional attention, our advocacy team can escalate the matter to the appropriate carrier, vendor, clinical resource, or internal contact to help ensure the employee receives the right level of support. This gives employers confidence that their people are not left navigating complex situations alone.
For employers and HR teams, this means:
Our goal is simple: help employees feel supported, informed, and confident while giving HR teams a reliable partner in managing day-to-day benefits and healthcare navigation challenges.
Helping members understand and use their benefits. Typical capabilities include: - Explaining medical, dental, vision, life, disability, HSA, FSA, EAP, wellness, and voluntary benefits - Helping members understand what is covered - Explaining plan design basics such as deductibles, copays, coinsurance, out-of-pocket maximums, and networks - Guiding members to the right benefit or vendor for their need - Supporting new hires, life events, open enrollment, and plan transitions
Helping members understand and resolve claim-related issues. Typical capabilities include: - Explaining Explanation of Benefits documents - Helping identify why a claim was denied, delayed, or partially paid - Coordinating with carriers, TPAs, PBMs, or vendors - Supporting appeals preparation from an administrative standpoint - Tracking claim issues through resolution - Helping members understand billing discrepancies
Helping members find and access in-network care options. Typical capabilities include: - Searching for in-network providers, facilities, labs, imaging centers, and pharmacies - Confirming network participation when possible - Helping members understand referral or prior authorization requirements - Supporting appointment access by directing members to the right resources - Identifying lower-cost sites of care such as urgent care, retail clinics, imaging centers, or telehealth
Helping members make informed, cost-conscious decisions. Typical capabilities include: - Comparing site-of-care options - Explaining preventive care coverage - Helping members understand prescription cost alternatives - Directing members to transparency tools, centers of excellence, or preferred vendor programs - Educating members on how to avoid unnecessary out-of-network expenses
Helping members resolve administrative access issues. Typical capabilities include: - Confirming enrollment status - Helping correct demographic or dependent information - Supporting ID card issues - Explaining qualifying life events - Helping coordinate with HR, brokers, carriers, or benefits administration platforms - Resolving access issues with vendor portals or benefit programs
Connecting members to the right partner resource. Typical capabilities include: - Referrals to EAP, telehealth, wellness, disease management, fertility, caregiving, financial wellness, mental health, or leave programs - Helping members understand when and how to use each program - Reducing vendor confusion by acting as a front door for benefits questions - Following up to confirm the member reached the right resource
Acting as a concierge for benefits-related problems. Typical capabilities include: - Coordinating between member, employer, carrier, broker, TPA, PBM, and vendors - Escalating unresolved issues - Documenting case activity - Providing status updates - Closing the loop with the member - Identifying recurring issues that may require employer or broker intervention
Improving understanding and utilization. Typical capabilities include: - Plain-language benefit explanations - Personalized guidance based on the member's situation - Open enrollment support - Benefit reminders and nudges - FAQs and decision support - Education around how to use care appropriately
Second opinions result in changed diagnoses or treatment plans in a meaningful percentage of complex cases
Site-of-care guidance consistently reduces the cost of procedures without sacrificing quality
Advocacy intervention in catastrophic cases can reduce claim costs significantly
Employees with access to advocacy report higher satisfaction with their benefits than those without it
Coordination with navigation support ensures employees get the right level of help, from administrative to clinical
Connect with the Blue Solvere team to explore how this solution fits your organization.
