The AQuity 360 Blog Series – Part 3: Employee Advocacy

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AQ Group Solutions is proud to present The AQuity 360 Blog Series as part of The AQuity 360 Program, helping you to avoid The Reactive Decision Trap. Read this series to see how your organization can build a human capital strategy that proactively aligns with your business strategy and goals.

Part 3: Who is your Employee Advocate in the claims process?

Most group benefit plans do not offer a formal employee advocacy program.  A structured plan member advocacy offering, complimenting your group benefits plan provides enormous value to an organization and their employees. We believe members of a group benefits program need a confidential service that will engage them without the predetermined outcome or defensiveness faced when seeking help or advocacy from an insurer’s customer service department.

Employees, their family members or benefits administrators can contact the PMA team with simple questions about coverage, completing benefits forms or dealing with a declined claim.  Some examples of when a PMA team becomes involved include:

  • Navigation of an out-of-country travel claim
  • Coordination with a Provincial Health or Drug program
  • Research into alternative funding sources for pharmaceuticals
  • Employers leverage the team for assistance with disability claims, return to work plans and billing issues

Plan Member Advocacy acts as an extension of your HR department to help reduce the administrative minutiae many administrators face, and removes the liability inherent in employer involvement in the claims process.

All Plan Member Advocacy interactions are tracked to provide organizations with meaningful data on the types of claims issues their employees are encountering.  This interaction also provides an opportunity for the PMA team to collect meaningful data on treatment path compliance, consumer patterns and identifies opportunities for education and communication that will be valuable for Plan Members. This type of data and real time claims management is only available via a Plan Member Advocacy offering.

Plan Member Advocacy makes an incredible difference to the value of your Group Benefits Program.   Imagine the time, money and stress that can be saved if you had a Plan Member Advocacy team taking care of your organization and employees.  Think of the more strategic priorities Human Resources, Payroll and Administrative teams would be able to focus on with this component of their work removed.


At AQ Group Solutions we believe that every successful organization requires a human capital strategy that proactively aligns with their business strategy and goals.  We created The AQuity 360 Program™ to help you avoid The Reactive Decision Trap™, save time and make more money, attract and retain more great people, and achieve your business goals.

Your business decisions require strategic planning and precision alignment to your overall objectives. Why should your benefits be any different?  Call us to find out how you can strategically align your benefits to your corporate and financial objectives.