Handbook
How Many Days of No Call No Show Are Considered Work Abandonment ?
3 Days
As long as they can verify City and State , its okay to continue the call without getting the zip code .
FALSE
***HIPPA VIOLATION***
When a Member States They Don't Have Time To Complete Survey
Examples * " I am at work " or " I am Driving "
Call Back
What Are 3 Forms Of Unacceptable Communication When Calling Out Of Work ?
Voicemails, Emails and Text meassage.
If Member is Away At College
What Should You Do ?
Ask for another number.
If not, you can mark as Left Message.
Which 6 Holidays Are We Not Required To Work On ?
* New Years Day
* Memorial Day
* Independence Day
* Labor Day
*Thanksgiving Day
* Christmas Day
As long as the person who answers states they filled out the PRD(Personal Representation Designation ) form , you can speak with them on behalf of the member over 18years old.
TRUE
CAO Call or Nursing Home
Wrong Number
Before Getting PHI , What Do You Want To Adv The Member ?
Call is being recorded for training and quality purposes
If the P/G states “I already completed the survey for my other children.”
Give 2 of the main responses you would adv them of
o Apologize for any inconvenience but advise the parent/guardian that survey must be completed per individual/child.
o Advise that it is a requirement for all medical insurance companies that provide coverage for Medical Assistance consumers.
o Advise parent/guardian that we will attempt 2 more times to complete survey, then mark as Call Back Later.
How Long In Advance Should You Put In A Request For PTO?
2 weeks
True or False :
When you reach out to a member who is not available to do survey but the person on the phone states she is his wife , you can continue the call even though there is no " care of" listed.
FALSE
No Dial Tone / Busy Line
No Answer
How Many Surveys Should Be Completed Weekly ?
60 surveys
If a mbr/Pg says " I didn't pick this insurance "
what do you as a rep adv?
How are Points accumulated
123 Attendance Policy
Point Value
16 min-4 hours .50 of a point
4 hours-8hours 1 point
Actions
1pt - Verbal Warning
2pts - Writing Warning
3pt - Suspended without pay until Employee Reveiw Board Hearing.
True or False :
When a mbr states they already completed the survey , you do the closing & use call outcome " completed survey"
FALSE
** apologize , rebuttal & try to do the survey .
(they will say anything so they don't have to speak to us)
Customer does not answer, or is not available or if speaking with someone who is unable to complete the survey
Left Message
If mbr 18 or older is unavailable , who are you allowed to speak with ?
( Care of ) person.
If a member askes for Id # , what is your response ?
Contact the mbr service number on the back of your insurance card , they will further assist you.
Employee Eligibility: The FMLA defines eligible employees as employees who:
(1) have worked for the employer for at least 12 months;
(2) have worked for the employer for at least 1,250 hours in the previous 12 months
If for some reason the 2nd attempt says (completed survey) use Callback Or No answer for call outcome.
FALSE
If it says 2nd attempt was completed , then 3rd attempt should be left message ( so we do not reach out again )
Give at least 4 reasons why call outcome "disconnected" will be used and you send a Snip It to your Supervisor
* Death
* imprisonment
* Chose another insurance plan
* No longer lives in PA
What are All The Performance Metrics ?
Quality Score - 95%
Success to Contact Rate - 50%
Contact Rate - 15% or more
Refusal Rate - 10% or less
150 dials daily
60 surveys a week
If Mbr Stated They Haven't Received Their Welcome Packet or Insurance Card , What Would You Advise?
* Adv Effective Date
* Id Cards Typically Take 10-14 days to arrive after that effective date