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Hays Advocates Case

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4. What are the main criteria your firm uses to evaluate carriers and plan design? How do you monitor the ongoing performance of carriers?
Specific to the large cost components of the benefit program (medical and pharmacy), Hays utilizes proprietary resources to provide much more detailed analysis than what is provided by a typical brokerage or consulting house. The HPI database measures every aspect of medical plan performance (frequency, unit cost and payment efficiency for nine medical service categories). We can effectively determine the best program based on exactly how your plan participants use their benefits.

Once we define the efficiency of the purchasing decisions, we work with the administrator to review their performance guarantees, service standards, ratings, and ultimately best price. We …show more content…
Describe how you would assist NGAM with resolving issues related to claims, billing and other matters. Provide examples.
Should NGAM elect to utilize our Hays Advocate service (included as part of our standard services), each employee and their dependents will be provided a Hays Advocate card that gives them direct access to the members of their Hays team for assistance with any benefits-related questions or issues in person or via a custom 1-800 number and an e-mail address.

The Hays Advocate is a trained insurance professional who understands the intricacies of the healthcare system and how to navigate through it. As soon as a member contacts us, they establish a relationship with their Advocate who stays with them through to the resolution of the problem.

Hays Advocates demonstrate a commitment to service excellence, have strong problem solving skills, and support members as they seek healthcare services and interact with providers and insurers. Hays Advocates handle claims, benefits, grievances, and other issues for no additional cost. Some common issues are:
• Researching a member’s out-of-pocket responsibilities
• Resolving eligibility

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