Call Actions
How many action codes are agents required to select on completed calls?
Six
What must be documented on every call regardless of if the call is complete or incomplete?
The interaction ID from Genesys Cloud
When leaving a voicemail, what is the verbiage regarding our hours of operation?
Monday through Friday, 8:00 a.m. to 7:00 p.m. ET
What is not a HIPAA identifier but must be confirmed as it appears in our system?
The member's full name
When discussing ancillary services what six benefits do we discuss with members?
Dental, Vision, Hearing, Fitness, Transportation and Rewards
What action code should you utilize if you cannot locate the member within the HRA platforms and must transfer the member to the secure IVR line?
HRA - Alternative Offered
During your Welcome Call a member inquired about their copay for an MRI - Where would you document this within OMNI?
Benefits and Eligibility
What is the new opening statement for outbound Welcome Calls?
Thank you for choosing [Wellcare] as your new Medicare Advantage plan. We’re excited to welcome you! During our call today, we will share the benefits your new plan has to offer, ensure you have a primary doctor you trust, confirm your doctors are in-network, and answer any questions you may have about your new plan.
How many identifiers must be confirmed for an Outbound and Inbound call?
two
Which African country is home to Mount Kilimanjaro?
Tanzania
What action code should you select if the member has a PPO plan and prefers to see an OON PCP?
PCP PPO - OON Provider
A call complete template requires three sections: Reason, Action - what is the third?
Resolution
How many sections have been added for enrollment verification?
Six
When speak to an authorized representative on behalf of the member how many identifiers must they provide?
Two
When confirming the PCP on file should agents confirm the provider listed in Genesys or OMNI?
OMNI
What action code should you select if the member has no questions regarding their rewards?
Rewards - No Questions
What is the site code for LWC STARCare?
LWC Welcome Call SC
What verbiage do you only provide to members who have a PPO plan?
As you may know, with your Preferred Provider Organization (PPO) plan, you have the flexibility to choose doctors, specialists, or hospitals that are not in network and your plan does not require a referral to see specialists, but please keep in mind that some specialists may request one.We do encourage you to see a [Wellcare] network physician. Network providers are familiar with your plan and may help you better understand how to use your benefits. It’s also important to know your costs may be higher if you use a provider who is out of network.
What is the definition of the Health Plan / Product ID
Examples include Member ID, Medicare Beneficiary Identifier (MBI), Health Insurance Oversight System (HIOS ID), Client Identification Number (CIN), etc.
What disposition should agents utilize for a completed welcome call?
CallComplete
Name the six required Call Action categories
Enrollment, HRA, PCP, Rewards, Specialists, Spendables/SSBCI
What fields are required for a call to be dispositioned as "CallComplete"?
Enrollment, HRA, PCP, Rewards, Specialists, and Spendables/SSBCI
What services are included for those who qualify for the SSBCI benefit?
healthy food, Rent & utilities assistance, Gas Pay-at-pump, robotic companion pets, and Pest control items
What must be confirmed before HIPAA during an inbound call?
The agent must confirm that we are speaking with the member
In a website browser address bar, what does "www" stand for?
World Wide Web