The Basics
Identify a call that should be escalated.
Name at least 2 of 4 identifiers.
A caller may:
Demand action from the company
Request a leader
Demand service
Demand IMMEDIATE response
Name the hashtag you should put in your cases.
#escalatedcall
Name when a grievance should be submitted for the member.
When the member expresses dissatisfaction about something other than the way that a claim or a medical or pharmacy authorization processed.
Name what to do if you had a stressful call and need to step away to get back to yourself.
Advise team lead/supervisor that you had a stressful call so that you can take 15 minutes off the phone.
Name what should be your most-used mentor when serving in this role.
Escalated Call for Member Solutions Team
Give at least 3 things that an account supervisor should do.
Regain trust
Resolve problems
Follow processes
Capture case information
Improve efficiency
Provide feedback to transferring advocate if necessary
Name the steps to create an interaction.
Click the case ID that is being transferred
Click Interaction at the top
Create new interaction
Save
If a member is satisfied by the end of the call, should the grievance still be submitted?
Yes
After handling a stressful call, it is good to reset. Name 3 things that you can do to reset for the next call.
Take a deep breath
Take a moment to acknowledge that you helped this member (or did you best to do so)
Understand that member reaction may have had nothing to do with you, but they were having a bad day
Physical movement - get up and stretch
Pet a coworker
Drink some water
Pray
Positive affirming statements
Any of these (or something different) will work as this answer is different for everybody.
Name the first mentor that should be used when a member is dissatisfied.
Member Grievance and Appeal for Medicare Calls Overview
Member Solutions receives transfers from the Retail Contact Center.
Name the 3 lines of business that MS does not support.
Group Medicare
Dental Disenrollment
Spanish-speaking or Puerto Rico calls
Name at least 3 examples of abusive calls.
Threats of physical harm or violence directed at an associate
Inappropriate religious, cultural, or racial insults
Homophobic, sexist, or other derogatory remarks
Unwarranted sexual advances
Derogatory language regarding geographic locations, associate speech, or dialect
The Centers for Medicare & Medicaid Services requires an appointment of representative (AOR) form when someone submits a dissatisfaction or dispute other than... who?
Member or member's POA
Working in Member Solutions can be fulfilling. It can also lead to _______________ within the company.
Further opportunities
Name the mentor to use when the caller is abusive.
Abusive Calls Overview,
Abusive Calls Associate Procedure, OR
Difficult Call or Chat Types Reference
If a call is warm transferred to MS, should a new case be created?
No. Just use the case that is transferred to youl.
Does MS take abusive calls?
No.
(If you are interested in being on the Abusive Calls team, please speak with your leadership.)
What should a member be told when they express dissatisfaction over having spoken to an offshore agent?
We understand their concern. Our team is committed to high-quality service regardless of location.
Term used to describe the worn out feeling from empathizing with members all day.
Empathy fatigue or burnout.
Note: It is helpful to use coping strategies to deal with empathy fatigue. Leave the office at the (work from home) office. :D
MS doesn't take Spanish calls but we should take other foreign language calls. Name the mentor to use if a call is received from a foreign language speaker and there is no translator on the line.
Foreign Language Call Overview or Incoming Foreign Language Calls
Name the steps to accept a case from an advocate.
Create interaction
Copy the interaction number
Document in QS+
Look for the transferred case
Name the tool that should be used for logging escalated cases for feedback and data study.
Escalated Call Tracker
If a member decides to rescind a grievance, what should still be documented regardless?
QAA and Sales Agent complaints.
Name at least 2 reasons why empathy is critical.
Fuels productive conversations
Helps you find solutions
Leads to appropriate responses
Lowers member defenses
Makes difficult conversations easier
Empathy is critical for many reasons, so we are not limited to just these reasons. :)
Name the mentor that should be used to determine who handles a FIDE HIDE or FL LTC call.
Florida LTC MET and Member Solutions In Scope and Out of Scope Calls