Learn how to communicate effectively with your benefits providers and vendors during a dispute. Find out how to choose the right channel, be professional, follow up, escalate, and improve.

Pinpoint the key elements of the dispute, such as the specific service or benefit in question, the type of error (e.g., incorrect charge, incorrect information in the Explanation of Benefits), and the desired resolution (e.g., reimbursement, reprocessing of a claim, etc.). The EOB should outline why a claim was paid or denied. Understand the reasons provided by the benefits provider for any issues (e.g., claim rejected for insufficient documentation, incorrect coding, or out-of-network services). Clearly state the outcome you're seeking, whether it’s a reprocessed claim, an adjustment to the invoice, or a reimbursement for a previously denied service. Be specific about what you want to happen next.

Make sure you are following up with both parties in the dispute when appropriate. Professional communication can go a long way to keep relations civil.

Last updated on Nov 15, 2024

How do you communicate with benefits providers and vendors during a dispute?

Benefits disputes can be stressful and frustrating for both employees and employers. Whether it's a claim denial, a billing error, or a contract violation, you need to communicate effectively with your benefits providers and vendors to resolve the issue as quickly and smoothly as possible. Here are some tips on how to do that.

1 Understand the dispute

Before you contact your benefits provider or vendor, make sure you have a clear understanding of the nature and scope of the dispute. Review the relevant documents, such as the plan summary, the contract, the claim form, the explanation of benefits, or the invoice. Identify the specific problem, the parties involved, the dates, the amounts, and the evidence you have to support your position. Write down the facts and details in a concise and organized way.

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Muhammad Suhail

TOP LINKEDIN VOICE EARNED 44-BADGES HAVING 31-YEARS BANKING INDUSTRIES EXPERIENCE ON DIFFERENT ROLE AS HIGHLIGHTED IN MY PROFILE ALONG WITH DIFFERENT IMPORTANT SKILLS DULY ENDORSED BY LINKEDIN HIGH PROFILE MANAGEMENT.
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Pinpoint the key elements of the dispute, such as the specific service or benefit in question, the type of error (e.g., incorrect charge, incorrect information in the Explanation of Benefits), and the desired resolution (e.g., reimbursement, reprocessing of a claim, etc.). The EOB should outline why a claim was paid or denied. Understand the reasons provided by the benefits provider for any issues (e.g., claim rejected for insufficient documentation, incorrect coding, or out-of-network services). Clearly state the outcome you're seeking, whether it’s a reprocessed claim, an adjustment to the invoice, or a reimbursement for a previously denied service. Be specific about what you want to happen next.

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2 Choose the right channel

Depending on the urgency and complexity of the dispute, you may need to choose the most appropriate channel to communicate with your benefits provider or vendor. For simple and routine issues, you may use email or online forms to submit your inquiry or complaint. For more urgent and complicated matters, you may need to call or schedule a meeting with a representative or a manager. Always keep a record of your communication, including the date, time, name, and title of the person you spoke to, and the outcome or action items.

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3 Be professional and courteous

Even if you are frustrated or angry, you should always communicate with your benefits provider or vendor in a professional and courteous manner. Avoid using abusive, threatening, or accusatory language. Instead, use a calm and respectful tone, and focus on the facts and the solutions. Express your concerns and expectations clearly and politely, and listen to their perspective and response. Acknowledge their efforts and cooperation, and thank them for their time and attention.

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Brian Alberts

Senior Manager, HR Benefits at Bridgestone Americas
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Completely agree. I always begin with thanking them for their time and effort. I summarize my concerns and give them an opportunity to share their side. I show grace, but look for a reasonable response. It’s important to me that we both understand what occurred, next steps and timing, and ultimately what we can do differently going forward. I’m encouraging, but focused on progress.

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Tara Hogan

Data-focused professional with expertise in benefits administration and SaaS platform management.
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Working with a Benefits Administration Vendor, I can say there are many factors involving a dispute. Finger pointing is one way in which these have been communicated. This is not courteous or professional when the person hasn't done research or has a limited understanding on the full scope of the dispute. I am more apt to research and respond in a timely manner if I'm approached with "Can you please look into this" versus "there's a problem with your system" or "your system isn't working correctly or won't let me do something".

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4 Follow up and document

After you communicate with your benefits provider or vendor, you should follow up and document the progress and results of the dispute resolution. Send a confirmation email or letter summarizing the main points and agreements of your conversation, and attach any relevant documents or evidence. Ask for a written response or confirmation from them within a reasonable timeframe. Keep track of any actions or changes that they make or promise to make, and verify that they are consistent with the terms and conditions of your plan or contract.

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Nicholas Hanna, SHRM-CP

Human Resources Systems Administrator - Ascentra Credit Union and President - Board of Trustees at Robert R. Jones Public Library.
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Make sure you are following up with both parties in the dispute when appropriate. Professional communication can go a long way to keep relations civil.

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5 Escalate if necessary

If you are not satisfied with the response or resolution from your benefits provider or vendor, you may need to escalate the dispute to a higher level or a third party. Depending on the type and severity of the dispute, you may contact their supervisor, their customer service department, their compliance officer, or their ombudsman. You may also seek external assistance from your state insurance department, your federal agency, your legal counsel, or your arbitration service. Be prepared to provide all the documentation and evidence you have collected, and explain why you are escalating the dispute.

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6 Learn and improve

Finally, you should learn from your experience and improve your communication and relationship with your benefits provider or vendor. Evaluate what went well and what went wrong in the dispute resolution process, and identify any areas for improvement or clarification. Communicate any feedback or suggestions to your benefits provider or vendor, and thank them for their partnership and support. Review and update your plan or contract if necessary, and educate yourself and your employees on the benefits policies and procedures.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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How do you communicate with benefits providers and vendors during a dispute?

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1 Understand the dispute

2 Choose the right channel

3 Be professional and courteous

4 Follow up and document

5 Escalate if necessary

6 Learn and improve

7 Here’s what else to consider

Benefits Administration

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