All
Name 2 plans under POD 3 of the CS Pod Structure
BlueKCBCOM Health (Broward Community)
Santa Clara Family Heath Plan (SCFHP)
Zing Health
HealthTeam Advantage
LA CareMass
Advantage
BCBS Rhode Island
Sentara Medicare (Optima, Virginia Premier)
Sentara Medicaid (Optima, Virginia Premier)
UPMC
636 Pipefitters
AgeRight Advantage
Ally Align
HealthPartners MN
Legacy Assurance
Partners Health Plan
Fallon Health
BCBSTN
New Hanover Health Advantage
What is the current PERS process?
Pending creation of 2025 process
What must be included when documenting your investigation in ZenDesk?
This individual stated they wanted to be an engineer after High School
Who is Sia
This plan is terming reimbursements on 12/31/2024
Perennial - AllyAlign
Who is Kaitlyn Nolter and what is she approved to do?
Geisinger rep approved to submit rollovers.
What is a rollover?
A rollover is when a plan requests to have unused funds rolled over from one month/quarter to the next available.
What is the monthly closed ticket goal for each Escalations agent?
This individual stated they wanted to be a reporter or a journalist when they were younger.
Who is Tran
This plan is de-implementing only the grocery benefit from their 2025 benefits.
PacificSource
Who is Michael Caro and when would we reach out to him?
Michael Caro is a part of the finance team and you would reach out to him when asked to bill a plan for an order or a rollover.
What is the ghost order process for Mail Order Only Plans?
Confirm with MCO that there is not an order in the back end system.
Mail Order Only
Get approval from CS to credit account due to a ghost order
Push to Nations Credit Tracker (Advise Malu once pushed to the Nations Credit Tracker to have Apps team load)
Outreach member to place an order again
Name one of the response examples provided in the Escalations Team Expectations.
This individual shared she would love to give back to her parents if she ever had the opportunity to do so
Leticia
This plan is implementing Infant Diapers, Incontinent Products, Feminine Hygiene, Asthma Products to their 2025 benefit expansion
Sentara Medicaid
List one of the 4 ways discussed as a team to overcome obstacles
Ask questions
Never assume information, Get clarification from group
Write notes on errors made for next time you come across the same issue
CTRL +F to find similar questions asked
What is the example of a gas hold listed in the Escalations Process Tab of the OneNote?
Aetna- Member went to the gas station on 07/29/2024 which held a pre authorization of $50. Gas Hold was released on 08/07/2024 but to their July wallet.
Name one of the examples of Attendance Misuse provided in the Escalations Team Expectations form:
1. Dishonesty/Falsification
2. Job Abandonment
3. Missed Punches
4. Timecard Review
This individual thought that they would be a lawyer.
Who is Emily
What is the 2025 benefit expansion for Jefferson Health?
Meals
What contributes to 10% of your QA score?
Formatting (Grammar and Clarity)
What are the 4 required pieces of information needed when submitting a coaching request?
Call Date:
Member Name:
NHID:
Interaction ID:
Name step #4 on the full cycle ticket process listed in the Escalations Team Expectations sheet
This individual selected New York as one of their holiday destinations.
Who is Gina
Name 1 new plan is that is a new implementation for 2025
Alameda Alliance for Health
BCBSTN
Habitat Health
Johns Hopkins Health Plans
Nascentia Health
Qualexa
Secur Health
Simpra Advantage
Solis Health Plans
UCare
Ultimate Health Plans
Umoja