General knowledge
A Texas employee from Sodexo wants to be out 2 weeks to care for her son. What kind of leave does she need?
FML continuous leave
What do you do if a caller wants to report FML time for yesterday? (complete process)
Validate caller, find leave, use the FML report time template. Paste email on leave notes/task.
If a customer calls in to set 3 different intermittent FMLA to care for each of her autistic children, she will have___ weeks allowed in a period of 12 months
12
I should transfer to VA when...
Filing for STD/LTD
Can I offer the Language line if I'm having difficulties understanding my caller?
No
A new father wants a leave to spend time with his recently adopted daughter (FDO: 03/16/2026). What additional step should you follow?
Send the bonding email template
Explain the process for an Account not listed?
1. Ask reason for claim, if OWH proceed (only STD))
2. File under Account not listed
3. Collect: Company name, Work address, HR name and contact number
4. Don't submit
What can an EE use the OR PFML for?
Own and Family health
Bonding
Sexual assault and domestic violence
GIFT
200
What should I do if my caller is requesting intermittent bonding time?
-Check AM for instructions
-Check Account Summary Sheets
-Ask your TL to confirm
What are the following goals for intake?
- AHT
- QA
- CSAT
- ADH
- AHT - 11:00
- QA - 92
- CSAT - 4.5
- ADH - 94
Explain the full process for second eye review.
1. Send 2nd eye review email template
2. Don't submit claim
3. 2nd eye team will submit if OK
4. If not OK, you will be asked to fix it and send template again.
John calls requesting a bereavement leave, since his dad past away. What resources can you use to check if we handle bereavement for his company?
Account manual
Account summary sheets
Just file the claim and see
Capria Harding works for Owens and Minor Medical and wants to file a leave for the heart transplant she had on Dec 28th. She didn't realize she had to call NYL, what would you do?
File under Owens and Minor / Accendra Health
If John is filing for a leave to care for his 22-year-old daughter, what would you do to ensure the leave doesn't automatically become ineligible?
Select that the daughter is incapable of self care
iAM - disable
Fineos - select yes in 'incapable of self care
Mary calls NYL because she is ill and can't work her full schedule, so she wants to work only 6 hrs. and replace them on Saturdays. What kind of leave does she need?
ADA - workplace accommodation
What should I do when filing a claim in iAM and the system won't let me submit because there is a conflict with another leave?
Copy conflict message in iAM notes and proceed with call closing as normal.
If a HealthTap EE calls because they got injured and won't be able to work ever again, what product should I request for him?
STD
What toggles should you use in Fineos for a Colorado
AVF Partners employee who will be out 1 month for surgery.
1. Request a leave
2. Group disability incident
Explain difference in process between Prenatal Disability and Birth Disability
Prenatal disability - no need to adjust dates for APP, can be continuous or intermittent
Birth disability - enter only 6 weeks from EDD on Dates of Absence, let APP complete the time
What benefits can run concurrently with what?
Continuous OH - STD/FML/PFML/CA VDI
Intermittent OH - FML/PFML or PFL
Family Health - FML/PFL or PFML
A caller inquired about the status of their claim but was informed their claim is incomplete and got transferred to intake to complete it. What could be the possibilities you need to explore and what would you do in each case?
- 2nd Eye Review Accounts - advise claim is under review
- Portal/Web Claims: advise it was not submitted, offer assistance to file claim.
- Call Drop or Callback Scenarios: Fineos - new claim // iAM - continue claim, confirm everything.
-ANL - ANL return call template
- Unresolved iAM conflict - iAM Conflict-Retuned call template
Explain the two state benefits that NYL handles for California.
CA PFL - care for family/bonging/military exigency.
CA VDI - EE own health condition.
Sandra needs to care for her parents. His dad had surgery last Monday and she needs 3 weeks to care for him, but yesterday, her mother fell while walking the dog and broke her hip, she now needs to care for her as well, she is at the hospital and will need surgery, it was schedule for 04/16 and she may need 4 weeks of bedrest after that. How would you help Sandra?
Option 1: File for the father's leave for 3 weeks and the remaining time to care for the mother.
Option 2: file for the father's leave up to the start of the mother's leave.
What should I do if an EE is calling about critical illness?
Check ADL to confirm benefits:
if with NYL --> Intake - Voluntary
If not with NYL, ask if they have them with Cigna --> Cigna supplemental health