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Humana defines abusive as any derogatory or harmful language or behavior directed at an associate personally. What mentor will help you with a difficult call?
Abusive Calls Overview
Member called because they last agent they spoke with was wonderful and they had a great experience and would like to give KUDOS! What is the Classification and Intent you would use?
Classification: Complaints or Compliments
Intent: Compliments
Members call and express dissatisfaction about some part of their healthcare experience and wants to file some type of complaint.
Member Grievances Complaints and Appeals Medicaid Calls Overview
A member calls and needs to schedule a ride to a Dr. Appt. What Classification and Intent will you choose?
Classification: Transportation
Intent: Scheduling
Member calls and they are in need of a status of their enrollment. What Classification and Intent will you choose?
Classification: Enrollment
Intent: Status
Member calls because they have questions about a letter they received in the mail. What is the classification and intent for this call type?
Classification: Communication
Intent: Got a Letter/Call
Member calls and they had moved. They are in need to change their mailing address. What is the Classification and Intent you would choose?
Classification: Demographics
Intent: Change
This FAQ type mentor will help you if a member calls with various questions about their Humana Spending Account Card
Humana Spending Account Card FAQ
This mentor is the initial steps of an incoming call form an impression of Humana.
**It's important that callers are greeted and authentication is verified through the Automated Information Line before giving protected health information.**
Incoming Call Medicaid Overview
This mentor is something that you need to have open on a DAILY BASIS
Integrated Calls Document Index
Here you will locate names of stores that are accepting certain payment type cards, balance and other information that relates to their "card"
Humana Spending Account Card Overview
This excel sheet will help you on the phone with choosing topics that best fits why the member is calling
CRM Service Classification and Intent (CI)
Go365 is a great program to help members with and incentives program. It encourages members to improve their health by doing things like going to a fitness facility and getting a preventive screening.
Go365 Medicare Overview
This mentor provides the procedure when the caller speaks a language other than English.
Incoming Foreign Language Calls
Classification: Fulfillment
Intent: ID Card Status
A member calls and needs a balance on their Humana Spending Account Card. What classification and Intent will you choose?
Classification: Humana Spending Account Card
Intent: Healthy Options
A bad actor is someone who engages in malicious or harmful behavior. Actions include fraud where someone attempts to impersonate a Humana member. This mentor will help you identify the bad actor.
Tips for Identifying Bad Actors
This mentor is Nonemergency medical transportation (NEMT) benefits help members get to and from their home and appointments.
Nonemergent Transportation Overview
Advocates use this procedure when a Health Risk Assessment (HRA) Guidance Alert is present in Customer Relationship Management (CRM).
Health Risk Assessment Calls
Member calls because they are having issues with their Humana Mobile App. Issues found when self-servicing tasks within the MyHumana mobile app (example: pages or tools are not functioning as expected, discrepancy in information).
What mentor will help you resolve those issues?
Resolve MyHumana Mobile App Issues
A provider calls (hint: we do not talk to providers) with questions about a member. What Classification and Intent will you choose?
Classification: Misrouted Call
Intent: Transferred to Correct Skill
You should not get Welcome Calls or should not be skilled to get a Welcome Call. In the event that you do, what mentor will you use to help with that call type.
Welcome Calls Medicaid Overview
A member calls with questions about changing their Primary Care Provider (PCP). After questions have been answered, the member asks you to change the PCP on file. What Classification and Intent will you choose?
Classification: PCP Change
Intent: PCP Change Made
We already determined and discussed many times that Integrated Calls Document Index is the mentor that you will use on a Daily Basis.
(Show Answer to Team)
In order to get the full 500points. You or a member of your team will need to share your screen and walk the class through (from the beginning) how to get to that mentor or you will not get the points.
HAPPY SCREEN SHARE :)
A member calls because they would like to register their account and start using the Humana App. What Classification and Intent will you choose?
Classification: Web/Mobile
Intent: Registration