Supporting our Clients Yates will support employees by offering guidance and advocacy, and involve the carrier when the situation requires their direct intervention or when there are complexities that need carrier-specific resolution. Our goal is to ensure a smooth and positive experience for employees while minimizing the burden on your internal team. All of the support for HR and your employees are handled by your local support team. Claims Support
Initial Support If an employee has a claim issue, our team will assist them in understanding the benefits process, review their claim details, and help identify where the issue may have occurred (e.g., billing errors, eligibility concerns, missing information). We would correct the issue or provide guidance on how to file an appeal or resolve any issues internally.
Escalation & Education
Tracking & Follow-up
If the issue cannot be resolved or if further intervention is needed (e.g., a claim denial, incorrect payment, or delays), we would escalate the matter to the carrier on behalf of the employee. We will see this situation through until claim is resolved. We will provide the member with additional updates throughout the process and final education if needed based on the situation.
We track and report back all open and closed claim issues with the HR team. We monitor claim issues to see if there are trends with a specific vendor or if additional member education is needed for the entire membership.
Employee Education & Engagement through the Plan Year
Effective communication and engagement around medical benefits are critical not just during open enrollment to ensure employees fully understand and appreciate their healthcare benefits. The complexity of medical benefits can often overwhelm employees, leading to confusion or disengagement, which can impact their overall satisfaction and healthcare outcomes. We promote employee engagement and education by providing clear, client specific communication strategies that help employees navigate their benefits with confidence. By sending ongoing education throughout the year, the goal is to drive better health outcomes, optimize plan utilization, and ultimately enhance both employee well-being and plan success.
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