Compliance
This needs to be verified by the customer on every call.
What is SSN, DOB and Address.
This type of QLE is triggered with a move.
What is moving to a new zip code, county or state?
Give a rebuttal for a customers plan not being accepted by their provider.
Anything that includes: Finding a new plan, searching for what the provider accepts, seeing if customer is open to switching providers.
This must be done in between calls.
What is tickets.
True or False: When a customer disconnects after you remain silent on a call and don't engage with them, this is Call Avoidance.
What is True.
This must be said at the beginning of every call, even on call backs.
What is Recorded Line?
This type of QLE is triggered with Loss of Coverage.
What is Loss of Employer Coverage, Lost of Medicaid/CHIP/COBRA, Turning 26 (aging off parents coverage), Plan Termination or Loss of benefits?
Give a rebuttal for a customer wanting to cancel because last year they had a better plan, and this year their copays went up and there isn't any other $0 plans available.
Anything that includes: Mentioning the plans changing going into this year and old plans no longer being available, pitching a plan with a premium, and/or probing to see the customers usage with the plan to see if keeping higher copays still make sense instead of changing to a premium plan.
This is how you close a call properly.
What is "Is there anything else I can assist you with before we end the call?"
This is considered Call Avoidance when transferring a call out to a carrier or Marketplace when it's not a cancel, and theres nothing you can do to help the customer.
What is staying on the line for over a minute after the transfer?
This is anything that shows you are avoiding taking another call, sitting on a dead call, incentivizes a customer to hang up or burning leads (etc).
What is Call Avoidance.
This type of QLE is triggered with family changes.
What is marriage, divorce, birth or adoption, or death of a household member?
Give a Rebuttal for a customer saying they wanted insurance, not a discount plan.
Anything that includes: No deductible, no waiting period, OOP Max, covers up to 50%, Prescriptions savings, Diabetic supplies, and being able to stack with other coverage.
This is when you should be in the queue ready to take calls.
What is BEFORE 9:00 am?
This is how long you have to dispo a call, before it's considered Call Avoidance
What is 30 seconds.
If this isn't submitted within the 90 days, the customer could lose coverage.
What is Required Documents.
This type of QLE is triggered with Income or House changes.
What is major income change affecting eligibility, Household size change, gaining lawful status or citizenship?
These situations would constitute cancellation without rebuttal.
What is Medicaid, Medicare, or Change of Income being too low.
Before wrapping up the call, this should be done.
Pitch Ep, if the customer doesn't already have it.
This is a question that is considered Call Avoidance, usually asked at the beginning of a call or shortly after engagement.
What is "Is now a good time to talk?"
This is required before the plan goes into effect.
What is Binder Payment.
This is how long QLEs allow enrollment after the event.
What is 60 days?
Give a rebuttal for a customer wanting to cancel because when they had coverage last year, they didn't get money back on taxes.
Anything that includes: Reassuring the customer that as long as the information we have is correct they won't be penalized and/or If they call us throughout the year and update their income they won't be penalized.
This is what you should do before placing a member on hold, as well as what you should do while their on hold.
What is set a hold expectation of 2-4 minutes; Check in with them every 2-4 minutes.
This is could be considered Call Avoidance when a customer is placed on hold in what situations.
What is Placed on hold for more than 4 minutes without checking in.