Call flow
What are is the Opening, Needs, Solution, and Closing meant to do? Hint: Sales job aid.
Opening: To Connect
Needs: To Explore
Solution: To Leverage
Closing: To Act
How can you show your caller you are actively listening?
Verify what they need, take notes, bring up/ investigate small topics brought up earlier, and recap what has been discussed.
What is a positive word you should use on your calls, especially with escalated callers.
Examples: Absolutely, certainly, completely, definitely, exactly, excellent, fantastic, great, interesting, terrific.
What are the 5 steps to turning an "informational" call into an enrollment?
1: Assume the sale
2: Conduct A Needs dialogue
3: Identify a plan
4: Find a solution, and bring up what was discussed during the Needs.
5: Close with a sense of urgency
What is the PCP ID we use to assign an OON PCP on an application?
00000099001
Provider lookup job aid
After enrolling a caller, what question do we ask before offering the survey?
"Is there anyone else in your household that would benefit from one of our plans?"
How can you personalize your calls?
Examples:
Use the caller's name.
Ask them about their day/ life.
Bring up small things the caller says about them.
Bring up background noises, example people, TV, pets.
If an escalated caller is unwilling to verify HIPAA, what should you do?
Gather the callers zip code and state, then inform them you are able to give them general information about their plan.
Today is 03/20, your caller enrolled into another plan on 02/15/2023 using LIS maintaining but canceled that enrollment. Are they able to change plans, if so what election period can they use?
Yes, they can use LIS Maintaining, or OEP!
What is the difference between an open-ended question vs. a close ended question?
Open- Allows for the caller to elaborate.
Closed- allows the caller to give a one-word reply.
Bonus of 100 points for giving an example of both.
What are the 3 steps to overcoming an objection?
Acknowledge
Clarify
Check
What does the acronym I.C.A.R.E stand for?
I- Introduce yourself.
C-Connect with Consumer.
A-Assess the needs.
R-Recommend solutions.
E-Enroll/ Educate
Instead of saying, "It should be covered." what should we say instead?
"Let me find out..."
"I will look into that for you..."
Any other variation showing we will investigate.
CS transferred you an IBM caller, due to not being able to find their application. Why could this call of been transferred to you, and how do we help?
Application was denied due to enrollment into the incorrect plan, and a new application needs to be taken.
Application is pending, due to missing information, and we need to contact Pending apps.
Member is not on the roster file, and we need to submit an ER.
Bonus: If another valid reason is given +100!
A wife calls in for her husband to look into getting him into the same MAPD plan she is in. You get third party HIPAA and review her plan to make sure it is a good fit, which it is. Is there anything left to do/ check on her account before enrolling the husband?
Relate accounts to ensure that your TE Diff%, and MAEQ/10 reflect the enrollment.
After gathering HIPAA, what section of the call flow is next, and give at least one verbiage for full points.
Initial Needs!
Verbiage:
"What benefits to you use with your current coverage?"
"Do you have any major procedures coming up in the future?"
"Are there additional benefits other than medical and drug coverage that you would like to see included in your plan?"
Give me your reply to the below statement.
"I lost my wallet with my UHC card, and I just need you to send me out a new one."
If you showed empathy, acknowledged the reason for the call, and gave a willingness statement, you get all of the points! Any that you missed will be deducted from points.
What is the difference between empathy, and sympathy?
Empathy is out ability to understand how someone feels, while sympathy is our relief to not have the same problems.
Bonus 100 points for an example of both.
You received a transfer from CS, when you speak to the member, they state their reason for calling is due to their copay at the pharmacy being too high for their 3-month supply.
What would be a reason this member was transferred to us?
Member is no longer enrolled into a plan with us and needs a new plan.
Member has moved. and needs a new plan.
Medication may not be covered and is needing a new plan.
Plan may have a deductible the member does not want and is needing a new plan.
Member may have another insurance companies' coverage and is interested in UHC.
Member may be new to Medicare and is needing a MAPD or PDP.
If another valid reason is given that was not listed, and additional 100 points will be added!
A caller on a Supplement plan with Osteoporosis calls in due to getting a flyer about a MAPD plan offering them dental coverage. What should you do?
Follow the call flow.
Educate on the MAPD plans vs. their supplement plan.
How does the call flow help us achieve first call resolutions?
Ensure callers are educated.
Ensure all questions are answered.
Ensure there will be no laps in coverage.
What are the 5 things a powerful insurance agent has?
Product knowledge, Excellent customer service, Emotional Intelligence, Empathy, and Respect.
Give me your reply to the below statement.
"I have been on the phone for 3 hours now, and you are the 5th person I have talked to. I just need my ID card to work!"
If you showed empathy, acknowledged the reason for the call, gave a willingness statement, and move forward/ probed you get all of the points! If you missed any those points will be deducted.
Give me your reply to the below statement.
"I would like my Spouse to take a look before enrolling."
If in your reply you acknowledged the objection, clarified, asked if the spouse was there, and checked for acceptance you get the full points! If you missed one you lose them all.
Your caller is turning 65 tomorrow, and calling in to se about the IBM plan, and they are on the roster file. The caller is currently getting commercial coverage through their employer Everise. What should you do?
Bonus 100 points for saying happy birthday.
Follow the call flow, educated on the IBM plan, and probe the caller on if they have received anything from their employer about the commercial coverage being credible for Medicare.