1
What information is required for an unauthenticated account?
For an unauthenticated account, the following details are required:
+1000 points
What tool should we utilize if the member called in to pay for their premium?
EBilling
+10000
TAT for EMME Letters
7-14 Days
-5000 on your opponent's score
What is the first thing you should do when greeting a member?
It means giving full attention to the member and responding thoughtfully.
+10000
What information is required for an authenticated account?
Only the First and Last Name are required for an authenticated account.
X4 on your teams score
How many months past due can a Prescription Drug Plan (PDP) be before account termination?
The account can be 3 months past due before termination.
+20000
What is the main difference between authenticated and unauthenticated account requirements?
An unauthenticated account requires multiple identifiers (ID, DOB, ZIP Code), while an authenticated account only needs the member’s name.
-50000
How long does it take for SSA updates to reflect in Humana CRM?
It takes 45–90 days for updates to process and reflect in the system.
+10000
What tools should we utilize if the member called in to change their name and they mentioned that they already contacted SSA?
WiPro
-10000
Where is the timeframe stated for Medicare Advantage with PDP account termination?
The timeframe is provided in the notice.
x2 on your team score
What is the condition for using Humana's plan?
Members (MM) cannot use the plan if they transfer to a different state or change their address.
+10000 points
What should you do if a member confirms they do not have other insurance?
You should create a case and route it to the COB (Coordination of Benefits) Department.
-10000 points on your opponents score
What should you do first when checking if a member received a letter?
Open the member's account and click RTI on the upper left-hand corner of the person page.
Back to zero on opponent's score
What does it mean to “listen actively”?
It means giving full attention to the member and responding thoughtfully.
+10000 on your opponent's score
What does HIPAA stand for
Health Insurance Portability and Accountability Act
+10000 on your opponent's score
What are the steps to create a case for COB?
+50000
: What does “advocate with empathy and purpose” mean?
It means standing up for the member’s needs while showing genuine care and understanding.
Back to zero on the opponent's score
What tools should we utilized to check the pharmacy benefits of a member?
RXConnect Pro
+10000 points
How do you simplify a process for a member?
By breaking it down into easy steps and using clear, simple language.
Back to zero on opponent's score
What tools should we utilized to check the in-network doctors of Humana and member's plan?
Go/Paag - Find Care
What should you do if the member did not receive a letter?
+10000
A member is frustrated and confused about a billing issue. How would you apply the “Show Genuine Care” behavior?
I would listen actively, acknowledge their frustration, express empathy, and clearly explain the billing process with transparency and positive framing.
+10000
What strategies can you use to anticipate a member’s needs proactively?
Reviewing their account history, asking open-ended questions, and offering information or solutions before they ask.
+10000
You’ve offered a solution, but the member is still unsure. What should you do next under “Resolve & Recap”?
I would explore alternative solutions, explain them clearly, and then summarize the key points and next steps to ensure understanding.
+50000
How would you demonstrate “Take full ownership” in a situation where you need to transfer the call?
I would explain why the transfer is necessary, stay on the line until the handoff is complete, and ensure the next agent is fully briefed.
+10000