Frozen
What is the percentage for how much our tone of voice impact a member?
A. 35%
B. 38%
C. 40%
D. 55%
B. 38%
Which business area impact our CAHPS results the most?
A. Pharmacy
B. Providers
C. Surveys
D. Operations Customer Service
D. Operations Customer Service
What are one of the key behaviors for excellent customer service?
A. Govern
B. Facilitate
C. Analyze
D. Apologize
B. Facilitate
Root Cause Analysis is asking what is the problem, how did it occur and why did it happen?
T/F
False. Root Cause Analysis is asking what is the problem, how did it occur, why did it happen, and how can we resolve so it doesn't happen again
Emotional intelligence is about being nice to the member's.
T/F
False
Be Honest
In the ____ stage you will help members understand what Medicare is, who qualifies, and how to get enrolled. Which part of Medicare will help cover member medications they are taking while being admitted into the emergency room?
A. Understanding Plan Details
B. Medicare Basics & Enrollment
C. All of the above
D. Pharmacy Support
B. Medicare Basics & Enrollment
You may speak with a broker if
A. A valid HIPAA form is on file naming the broker
B. The member is present to provide verbal consent
C. All of the above
D. If they state they are a broker
C. All of the above
Part B insurance help beneficiaries pay the cost for hospice care.
T/F
False. Part A insurance help beneficiaries pay the cost for hospice care.
In the event of an emergency/life-threatening situation where the member is unavailable or incapacitated and does not have a POA or AR on fil you may not provide information to the caller as a one-time courtesy
T/F
False. In the event of an emergency/life-threatening situation where the member is unavailable or incapacitated and does not have a POA or AR on fil you may provide necessary information to the caller as a one-time courtesy
Medicare is replacement insurance for members who were dual eligible. T/F
True
Organizations creates a network with doctors and hospitals to provide healthcare to members.
T/F
False. Organizations creates a network with doctors, hospitals, and other providers to provide healthcare to members.
Medicare Star Ratings determines if a member is eligible to be with Medicare.
T/F
False. Medicare Star ratings determines if an insurance provider is eligible to work with Medicare.
I assisted a member last week. Reports show member called back in again two days later about another issue. Did I complete FCR (First Call Resolution)
Yes or No
Yes
Customers base their 1st impression ___ on how you speak and ____ on what you actually stated.
A. 80% and 20%
B. 85 % and 15%
C. 92% and 8%
D. 90% and 10%
D. 90% and 10%
In healthcare or insurance, this means the person with POA can speak for the member and make decisions.
T/F
False. In healthcare or insurance, this means the person with POA can speak for the member and make decisions, and access their private information.
What are one of the four C's?
A. Ask the Customer
B. Clear
C. Concrete
D. Convince
A. Ask the Customer
First Call Resolution is resolving a customer's concern on the initial call with the member's assistance.
T/F
False First Call Resolution is resolving a customer's concern on the initial call with little to no assistance form the member (no homework for the customer)
Which part of Medicare will help cover member medications they are taking in the hospital?
A. Part B
B. Part A
C. Part D
D. Part C
B. Part A
If the unlisted third party contacts our plan on a conference call with the member, you may speak with the third party as long as the member gives verbal permission.
T/F
True
For Medicare Part D CAHPS is 15% of the metric for the Medicare Star Rating
T/F
False
The claim submitted by the doctor is paid by Medicare.
T/F
False.
The claim submitted by the doctor is paid by the insurance company.
Once you've entered the Member ID, you need to verify the following information:
A. Full name, Medicare ID, Address, Phone number
B. Full name, Medicare ID, Address, DOB
C. A. Full name, Medicare ID, Address, Phone number
D. Date of Birth, Permanent Address, Home phone or Mobile number
D. Date of Birth, Permanent Address, Home phone or Mobile number
If the status is "FAILED" or blank in the self service activity box, you must verify all required information, including:
A. Full name, Member ID, Address, Phone number
B. Full name, Member ID, Address, DOB
C. A. Full name, Medicare ID, Address, Phone number
D. Name, Member ID, Address, DOB
A. Full name, Member ID, Address, Phone number
What is one way to become more verbally effective?
A. Pace and Animation
B. Attitude
C. Build Rapport
D. Personalize
A. Pace and Animation
What are the six step to service recovery?
A. Listen, Repeat, Apologize, Empathy, Explain, Thank You
B. Listen, Repeat, Sympathize, Empathy, Explain, Thank You
C. Listen, Repeat, Apologize, Empathy, Recall, Thank You
D. Listen, Analyze, Apologize, Empathy, Explain, Thank You
A. Listen, Repeat, Apologize, Empathy, Explain, Thank You