All about the steps
This step tells us to understand the issue by asking probing questions, setting up the Class/Intent, and reviewing AND providing contact handling/guidance alerts.
Step 3
When researching the issue, per the call flows direction, where does it refer you to look.
Group Medicare Call Document Index or go/GMAIRC
It is suggested to acknowledge these member icons sometimes found on the Person Account or Search page in CRM.
New member, Birthday, Extra Help/Low Income Subsidy and Repeat Caller.
This is the ONLY provider call type we would handle. Outside of this we would Blind transfer to the CCC provider line.
Pharmacy calls (benefits and claims)
When the member doesn't have more questions but ISN'T satisfied with the resolution given we are advised to offer empathy, recap the call and go to this step.
Step 9
Thank you for calling____. My name is (name), your healthcare _____, how may I help you.
Humana; advocate
Once member's issue is resolved, we end the call on a positive note by telling them this mandatory statement.
"Thank you for calling Humana, we are always here to help."
You must follow this process document, linked in the overview on every call.
Custom Connect Group Medicare Call Handling
This step provides transfer guidance
Step 5
If there is a dial tone associates follow this section in Incoming Call Overview.
No Caller on the Line
This suggested statement should be advised for new members.
"I see that this is your first year with Humana. Thanks for the opportunity to serve you."
Linked in the overview, this is where you would go for further instructions on how to verify a Retiree First caller
Access Humana Advocate Information on Hi!
Step 1 and Step 11 remind us to do this for our new members.
Offer to review their new plan.
While phone numbers don't need to be confirmed on every call, standard verification/authentication processes still apply within this rule
90-day rule
This is the recap statement made before closing the call.
It's been a pleasure helping you with (call reason)."
Calls from these types of associates are contracted to handle calls from Humana Group Medicare members. We don't transfer these calls to the provider line.
Retiree First
This steps helps us close the call.
Step 12
We handle calls from this bot technology. She calls Humana on behalf of the provider asking to verify benefits, obtain claim status and so forth.
Eva Bot
also acceptable Eva
This step offers suggested verbiage for a mandatory Issue Resolution question. Which step talks about issue resolution.
Step 8
Each associate provides an advocacy stylp approach with our members, using these 4 characteristics.
Trusted, Compassionate, Informed and Proactive.