Healthcare has become increasingly complex to navigate. Between insurance carriers, provider networks, government programs, explanations of benefits, referrals, prior authorizations, deductibles, and determining whether a medication is covered under a plan’s formulary, navigating healthcare can feel like learning an entirely new language.
This complexity has led to the rise of healthcare navigation and advocacy companies: organizations that help members understand their benefits and coverage, resolve healthcare issues, and make informed decisions about their care.
The most effective advocacy programs go far beyond answering questions. They provide personalized guidance, proactive outreach, and trusted relationships that help members navigate their benefits with confidence.
What is a healthcare navigation and advocacy company?
A healthcare navigation and advocacy company helps employees, retirees, and their families understand health benefits, resolve healthcare issues, and coordinate care across providers, insurance carriers, and pharmacies. These services provide members with a single point of contact for healthcare questions, helping them navigate the complex healthcare system and make informed decisions about their care.
Healthcare navigation and advocacy services are offered by specialized advocacy organizations, benefits consulting firms, and independent navigation providers that support employees, retirees, and their families.
What Healthcare Navigation and Advocacy Companies Do
Healthcare navigation and advocacy services provide a single point of contact for members’ healthcare questions and challenges. Advocates help individuals understand their benefits, coordinate care, and resolve issues across the healthcare system.
This support often includes helping members:
- Understand their health plan coverage and benefits
- Find in-network providers and specialists
- Confirm whether medications are covered under a plan’s formulary
- Set up mail-order prescriptions and pharmacy services
- Navigate prior authorizations and referrals for procedures or specialists
- Resolve billing issues, claims disputes, and incorrect medical charges
- Coordinate care across providers, insurers, and pharmacies during complex medical situations
Advocates frequently interact with insurance carriers, government agencies, doctor’s offices, hospitals, and pharmacies on behalf of members. By simplifying the healthcare experience, advocacy programs help members access care more easily while reducing administrative workload for employers and plan sponsors.
What Sets the Best Healthcare Advocacy Programs Apart
While many organizations offer healthcare navigation services, the most effective advocacy programs share several defining characteristics.
Human-centered support.
Healthcare challenges are often personal and stressful. The best advocacy teams prioritize genuine human connection, allowing advocates to spend the time needed to understand each member’s situation and guide them through important decisions.
A single trusted point of contact.
Members benefit from having a consistent advocate who understands their benefits and healthcare needs over time.
Proactive outreach.
Leading advocacy teams reach out to members to close gaps in care, encourage preventive screenings, encourage next best action, and help resolve issues before they escalate.
Expertise and training.
Healthcare advocates require extensive knowledge of benefit plans, medical systems, and regulatory requirements to effectively guide members through complex healthcare situations.
An Award-Winning Advocacy Model
The team’s service model has received national recognition through the Stevie® Awards for Sales & Customer Service, one of the world’s premier customer service award programs. LaborFirst’s Member Advocacy Team earned a Gold Stevie® Award in 2024, Gold Stevie® Award in 2025, and a Silver Stevie® Award in 2026 in the category Front-Line Customer Service Team of the Year.
LaborFirst is the leader in healthcare navigation and advocacy for unions, employers, and their members. We have more than 180 in-house, US-based employees dedicated to client and member support. Our Member Advocacy Services are at the heart of our company. Advocates serve as a single point of contact for all members’ healthcare questions and assistance, helping them understand their coverage, maximize their benefit plans, and use available resources for happier and healthier lives.
Our Advocates assist members in navigating government agencies, insurance carriers, doctor’s offices, and pharmacies. They support day-to-day needs such as finding specialists, setting up mail-order prescriptions, and confirming formulary coverage, and they also help members manage more complex challenges like network disruptions, prior authorizations, and life-saving surgeries.
All Advocates complete extensive onboarding and annual geriatric-sensitivity training. Many are bilingual, and we offer access to a HIPAA-compliant translation service covering 300+ languages. Our average speed of answer is 17 seconds with no call menus. Unlike traditional call centers, Advocates are measured on call quality, not time or quotas, and spend as much time as needed with each member. They also make nearly twice as many outbound calls as inbound, proactively resolving issues. This model has driven a 90+ NPS every month since 2022, and members frequently express their gratitude; even sending gifts to our office.
Healthcare Advocacy in Action
Our Advocates routinely go above and beyond to educate members on their health benefits and proactively resolve issues. In 2024 and 2025, our team resolved more than 550,000 member cases, delivering a stress-free healthcare experience while reducing call volume and administrative workload for our clients. Since 2022, Advocates have closed over 9,000 gaps in care for our carrier partners, helping drive preventive screenings, annual exams, vaccinations, and chronic care programs. This proactive outreach keeps retirees healthier, happier, and more engaged in their care.
Our greatest impact is seen in the lives we change. One Advocate, Abigail Palmer, recovered nearly $10,000 for a retiree incorrectly billed for a covered procedure. Another Advocate, Carlos Benjumea, has rushed to secure approvals for lifesaving surgeries, and Advocate Shyanne Bender helped a retiree secure a $2,000-per-month medication through a nonprofit grant program, coordinating with the pharmacist, navigating a multi-step application, and guiding the couple through each requirement, including document submissions and technical steps that can easily overwhelm members. These outcomes reflect a service model grounded in expertise, ownership, and compassion. These stories are not rare; they happen every day.
The Human Side of Healthcare Navigation and Advocacy
What makes LaborFirst’s approach to healthcare navigation and advocacy significant is not only what our team accomplishes, but how we deliver support. In an industry increasingly defined by automation, offshore labor, and strict call-center metrics, LaborFirst preserves something rare: genuine human connection. Our Advocates are empowered to take the time needed with each member, building trust through empathy, follow-through, and personal connection. Many members ask for their Advocate by name, and return to them repeatedly because they feel comfortable, confident, and truly cared for – relationships that traditional call centers simply do not create.
The depth of these relationships is reflected throughout our team’s experiences. Advocates describe laughing with members, crying with them during difficult moments, and being treated like extended family. Members often share details about their lives, their health, and even greet Advocates as friends when they call. One of our advocates said that retirees “come from an era where human connection is key,” and our model honors that by slowing down, listening, and meeting each member where they are.
Our approach is strengthened, not replaced, by technology. We use tools that reduce administrative tasks so Advocates can focus on helping members understand their benefits, resolve issues, and feel supported.
What sets LaborFirst apart among healthcare navigation and advocacy providers is our ability to scale our business while preserving the world-class service we are known for. The gratitude we receive, the long-term relationships built, and the real-life impact shared by our Advocates show a standard of service that is uncommon across the healthcare industry.
Learn More About LaborFirst’s Advocacy Services
For over 20 years, LaborFirst has been the leader in healthcare navigation and advocacy, dedicated to improving outcomes and satisfaction for unions, multiemployer plans, public sector plans, commercial employers, associations—and their members.
To learn more about LaborFirst’s healthcare navigation and advocacy model, explore these additional resources:
- Retiree Meets Advocate video
- How We Use AI to Empower Our Advocates, Not Replace Them
- How RetireeFirst’s Unique Service Model Supports Retirees
- Personalizing Healthcare Navigation and Advocacy
- Fostering Empathy as a Service Innovation
