WHAT DOES AN ADVOCATE DO?

Published: Nov 08, 2024 - The Advocate reviews declined claims referred to the team, advises clients on claims strategies for sensitive or complex cases in various liability and specialty lines, and identifies applicable policies to analyze and resolve claims. These professionals lead the claims process, ensuring progress from initial notification to closure, and conducting detailed reviews and strategy discussions to optimize outcomes. Collaboration with internal teams and market contacts is essential to successfully settle claims, alongside developing marketing materials and representing the organization in client interactions to highlight the value of claims advocacy.

A Review of Professional Skills and Functions for Advocate

1. Client Advocate Duties

  • Escalation Management: Address escalations that impact the client's continuing to work with the company.
  • Contract Maintenance: Maintain the client's ongoing agreement with Global Payments Integrated.
  • Proactive Outreach: Using criteria and data tools approved by management, reach out proactively to the most at-risk clients regularly as determined by both management and CRM data tools.
  • Retention Strategy: Offer retention options to the client from a list of previously determined choices to prevent attrition or churn.
  • Negotiation Skills: Use negotiation options that are previously determined acceptable by the management team.
  • Client Needs Analysis: Resolution may involve an investigation into the client’s support history or needs analysis based on the client’s business needs.
  • Performance Reporting: Report on client interactions to drive key learnings for management.
  • Churn Monitoring: Act as a Red Flag Warning system for churn trends to specific competitors in the marketplace.
  • Cancellation Processing: Act accordingly with cancellations to terminate products and update CRM with ongoing fees or cancellation costs.
  • Collaboration: Work together with Client Care and Pricing Analysis teams to address high-volume rate reviews and rate review requests through proactive efforts.

2. Advocate Details

  • Pricing Negotiation: Negotiate with clients to establish a pricing plan so both the company and business can successfully continue.
  • Client Education: Educate and answer client questions regarding pricing structures, rates, fees, interchange, and statements.
  • Contract Extension Negotiation: Negotiate contract extensions when pricing adjustments are made.
  • Relationship Management: Have value-driven and relationship-building conversations with clients while addressing pricing needs.
  • Escalation Management: Effective handling of at-risk escalations shared through Partner channels.
  • Campaign Support: Assist with Partner-organized campaigns to enhance Client Experience and attrition efforts.
  • Inquiry Response: Respond to inbound IM, phone, and email inquiries from internal departments, clients, and partners regarding the use of Global Payments Integrated products and services.
  • Client Liaison: Act as a central point of contact for high-profile clients.
  • Account Management: Maintain ongoing client relationships and account management.
  • Team Participation: Participate and execute responsibilities in PRT’s.

3. Claims Advocate Responsibilities

  • Declination Review: Review declinations that may be referred to the Advocacy team.
  • Claims Strategy Advisory: Provide coverage and claims strategy advice to clients on major, contentious, sensitive, or complex claims across a variety of management liability and specialty product lines.
  • Policy Analysis: Identify appropriate policies and/or coverages on complicated claims and analyze notifications against the same to provide solutions to clients against future risks.
  • Claims Leadership: Lead claims processes for clients, conduct detailed client claim review meetings, and participate in claims strategy discussions to ensure progress from notification through to closure.
  • Stakeholder Communication: Communicate with clients, internal teams, and relevant contacts within the market to ensure the successful settlement of claims across all relevant lines.
  • Claims Processing Coordination: Work with the Marsh Operations team to ensure the effective handling and processing of claims on market and internal systems.
  • Broking Collaboration: Work with Broking colleagues to provide claim information for business renewals.
  • Regulatory Compliance: Comply with appropriate regulatory, systems, and controls procedures.
  • Thought Leadership Development: Develop thought leadership materials.
  • RFP and Marketing Support: Work on RFPs and marketing materials to help win and retain clients.
  • Client Representation: Represent Marsh in client meetings, articulating the claims advocacy proposition as both a differentiator and a revenue generator.

4. Youth Advocate Job Summary

  • Client Navigation: Help clients understand and effectively navigate the health care and social services systems.
  • Youth Needs Assessment: Identify and address youth’s needs with the goal of promoting healthier family functioning.
  • Support Provision: Provide youth with supports geared to improve functioning and promote the development of skills as defined in treatment goals.
  • Self-Advocacy Training: Help youth learn how to advocate for themselves with the systems of care/service they are connected to.
  • Communication Liaison: Liaison between youth, parents, other service providers, and natural supports to bridge gaps and foster improved communication and outcomes.
  • Treatment Goal Establishment: Work with the Treatment Team/Care Team to establish treatment goals for youth utilizing historical and current information available.
  • Documentation Compliance: Ensure required documentation for all case actions (clinical notes) are completed within established timeframes.
  • Interdepartmental Collaboration: Work collaboratively with other departments including Health Office, Care Management, AODs, etc.
  • Professional Boundaries Maintenance: Maintain appropriate professional boundaries with clients and staff.
  • Policy Representation: Represent PRD policies at New Provider Orientation/New Hire Orientation.

5. Patient Advocate Accountabilities

  • Rapport Building: Build rapport telephonically and act as the primary point of contact for the patient.
  • Initial Patient Contact: Responsible for initial contact with patients (i.e., verifying and editing patient demographic information as well as explaining the process to patients).
  • Benefits Explanation: Understand and explain benefit information, including financial responsibilities, to patients.
  • Insurance Updates: Update patients on changes in insurance, additional information needed per insurance plan, and identify any breaks in service.
  • Follow-Up Communication: Follow up with patients regarding questions and concerns, as well as progress and adherence.
  • Order Processing: Take orders from patients for accessories and vests.
  • Shipment Explanation: Explain the shipment process and set expectations for product delivery, including replacement shipments.
  • Grievance Resolution: Document, investigate, provide information, and resolve patient grievances.
  • Complaint Referral: Refer complaints that involve the threat of litigation to Risk Management.
  • Record Maintenance: Maintain accurate and up-to-date records of all patient contacts.
  • Issue Analysis: Assist the Manager with interpreting and analyzing issues as they relate to current systems and procedures.
  • Facilitation: Act as a facilitator for management personnel and physician staff regarding resolving Patient Relations issues/problems (i.e., rounding on patients and/or visitors).