Classification
"I want to make a premium payment" What is your classification?
Billing
"Can you tell me how much it would cost to have an MRI done please" What is your intent?
Benefits: VERIFICATION
Member calls attesting their Late Enrollment penalty, which document should you start in?
Late Enrollment Penalty Overview
Member calls in looking to find out how much their spending account card balance is. Do I take this call?
Yes, we can quote the amount based of DEBUT
What was Ian's previous career path?
He was a fine dining chef
"Can you verify if you have the right address on file for me please?" What's your classification?
Demographics
"I got a letter stating I owe $600 to Humana for my premium, I can't afford that amount all at once" What's your intent?
Billing: PAYMENT ARRANGMENTS
What document in mentor can be used as a road map to get to all topics and the documents needed to solve the issues?
Medicare Advantage Prescription Drug (MAPD) Document Index
"I got a bill from my doctor for $250,000, that's insane, can you please look into it?" Do you handle this call?
No, we transfer to claims until we are trained
What country did Jessica live in and learn the language of when she was a kid?
Japan
"I got a letter from Humana about some sort of savings program" What's your classification and intent?
Communication
"My doctor says you have other insurance on file for me, but I dont have any other insurance but Humana" What's your intent?
COB: MEDICAL UPDATE/DISPUTE
Member is calling about questions for a Continuous glucose monitor and needs to know how to obtain one? What document walks through the PROCESS of obtaining a CGM?
"I got a letter in the mail saying I owe money on medications I received a few years back, do you know why?" Do you handle this call?
Yes we handle this call
Which of these is not a career path Mike has had?
A.) Truck Driver
B.) Cab driver/dispatcher
C.) Traveling Carny
D.) Army Bomb Squad (Explosive Disposal)
Truck Driver
"My doctor was very rude to me, he said I was getting fat" What's your classification?
Complaints and Compliments
"I got a letter saying I have a LEP but I have had drug coverage forever, can you help me?" What is your intent?
Eligibility: LATE ENROLLMENT PENTALY (LEP)/ CREDITABLE COVERAGE
Member calls and wants to know why the claim for their medication has such a high cost. What mentor document is used to research pharmacy claims?
Pharmacy Claim Research
"I am looking for a psychologist in my area" Do you handle this call?
No, transfer to behavioral health
Which of your leaders had the most recent birthday?
Heather
"I got a bill from my dentist, can you help me figure out why?" What's your classification?
Dental Claims
"My doctor office was full of roaches, that cant be sanitary" What is your intent?
Complaints and Compliments: QAA
The member gets mad at you and requests a supervisor, what document helps with the PROCESS of getting them to the escalated line?
Escalated Inquiry Transfers
"I got a medication injected into my knee at my doctor's office and now I have a bill for $1000, can you tell me why?" Do we handle this call?
No, because the injection was provided in a doctor's office that makes it a part B claim, and we transfer to medical claims.
Which of these is Ian's least favorite food?
A.) Duck liver
B.) Cucumbers
C.) Caviar
D.) Brusselsprouts
Cucumbers are the devil's food, they taste like dirty crunchy water