Greeting/Closing
What should you always do at the beginning of a call and the ending of the call?
Thank the caller
What way should you address callers when they Identify themselves? Give Example?
Ms, Mrs, Miss, and Mister
Hey Mrs, Jackson how are you.
This should be checked in AC before discussing a member's benefits?
Member Eligibility
What are 3 ways to obtain an ID cards?
Website
Mobile App
What should you offer and or ask the member to partake in on every call?
The Survey/ DTC (Digital Champion)
What Tone is necessary when speaking to our members to provide great support?
A tone that is happy and willing to assist.
This tool is used after formulary lookups for price checks to verify medication costs?
Trial Claim
If a medication requires special approval, representatives should provide this information along with the fax number/phone number so the prescriber can submit the request?
Prior Authorization (PA)
When acknowledging the member at all times how should you address them?
Always Address members by last name
What are the best ways to make a member feel heard and understood? (Hint) theses are Core Soft skills.
Positive Attitude
Empathetic
Customer First Mindset
These alerts can identify lower-cost medication opportunities for members?
Proactive Savings Alerts
When a member asks why an override cannot be completed immediately, representatives should explain this timeframe?
Override Window
1. First and Last name
2. Member ID
3. Member Address/ Zipcode
If you are Listening with the intent to just respond to our members what soft skill are you not using?
Active Listening
During a price check, this should be reviewed to understand deductible and initial phase impacts on cost?
Accumulators
If a PA request has been denied, representatives should provide members with information about this next step?
The Appeals Process
Caller: Hi, I was hoping to get some information about my prescription coverage? Do your best call flow
teacher decides if points are awarded or half points
they must greet caller
they must Hippa verify
they must restate call reason
they must reassure and investigate
what should we always remember about our members and how we service them?
They are people first and they need our help and we should service them like family
Representatives should encourage use of this resource to obtain processing information and manage prescriptions online?
Web/App and Digital Champion
What is delivering a world-class customer service experience by combining Eligibility, Formulary Lookup, Prior Authorization, Price Check, and Digital Champion value adds in a single call?
A member calls because their prescription was rejected at the pharmacy. After reviewing the account, you confirm the med is eligible for PA
Go through your call flow, how would you go about this.