1
How many minutes can you put the member on hold?
Within how many seconds should the advocate respond and give immediate attention to the caller at the start of the call?
5 seconds.
What would be the best call type and subtype if a member is calling about his/her explanation of benefits?
Claims - EOB
Give one scenario of when you can provide the monitoring disclosure.
• when a call is transferred to the advocate
• when advocate hears background noise
• when a third-party joins the call
• calling a retail pharmacy
• during outbound calls
• when the caller is on speaker
What is the timeframe if a member requested a copy of his/her EOB?
10-15 business days.
Provide the AEP Closing Script for 'NEW CUSTOMERS'?
“Save time by signing up for automatic payment of your monthly plan premium to make life a little simpler. I can help you with that now if you are interested. You can also use our automated phone system or website to do so at a later time.”
What score should be given if the advocate is muted or unready, causing the caller to say “Hello” first, and no apology is offered, impacting the caller’s experience?
Partial Credit
What is the job aid for the Cigna PHI Grid?
MS0455 - CIGNA PHI GRID
What should the advocate use when introducing themselves on the call instead of a nickname?
Legal Name/First Name
Which piece of information is mandatory and must be provided exactly as it appears on the account during verification?
Full name.
What are the five pieces of information used to verify an account?
• Full Name (mandatory)
• Customer ID
• Date of Birth
• Complete Address
• Primary Phone Number
Provide the Inbound Call Opening Script
"Thank you for calling <Cigna Healthcare or HealthSpring> (based off whisper). My name is (First Name). Who do I have the pleasure of assisting today?"
Provide the monitoring disclosure scripting.
“Because quality is important to us, this call may be monitored or recorded for quality and training purposes.”
TRUE OR FALSE
Confirming a member's first and last name is not mandatory.
FALSE.
Can you provide information to a caller if the verified PHI is only the name and ID number?
NO.