Systems
What system do we use for claims?
HRP
What is the paperwork that the member gets that lets them know of upcoming changes?
Annual Notice of Change (ANOC)
How long is our hold time? Quoted and actual
3-5 minutes; checking in at the 3 minute mark
Who do you let know when you aren't going to be in to work?
When you received a ghost call what is the script you have to read?
Repeat your greeting three time (making sure to give them time between the three greetings to response)
State: Member if you can hear me, I can't hear you. Please call us back at the number on the back of your id card if you require further assistance and Say Quality releasing the call due to no response and disconnect the call.
What system do we use to find the member's Medicaid status?
Market Prominence (MP), Marx, and or GPS.
What are the dates of AEP?
October 15-December 7
What must be stated when doing an outbound call? What KA is this in?
This call will be monitored or recorded for quality and training purposes. KA 2638
How many points do you lose on quality if you don't take ownership?
10
If a Dsnp member calls in and can't provide Medicare id or member id and they state they have been with Aetna since 2021, how would you assist?
You would look up the member and fully validate the account by getting first and last name, dob, zip code and by asking for either full address or telephone number. You would only assist with general information unless the member can provide general information if more information is needed such as level 2, we would ask them again for their id #
The system we use to find, the benefit level with a cpt code is?
Rumba
What is the new vendor coming for the new year?
NationsMarket
What is at the end of the call? (hint: 3 items)
appreciation statement, website, survey
When looking for guidance on different things that may or may not be covered, what can we use? (hint: its a system-sorta that we use that can be found on the wiki page)
Clinical Policy Bullentins
What are the two links we can utilize to actually be logged into the members account to help the members find their eob online and or claims? (step by step walk through with the member)
Verint
Five (5)
What is the goal for First Call Resolution (FCR)?
95%
How many points towards attendance do you get when you are a No Call No Show (NCNS)?
2 points
When does enrollment for insurance coverage start for us with Conduent and for how long?
Annual Enrollment for 2024 is Oct. 30 – Nov. 14 - don't miss your opportunity to select / update your coverage for 2024 coverage period -
What system do you use to find what coverage a member has if they don't have Aetna?
MARx
If a member is wanting to do a plan change for the upcoming year, where do we send them to?
What is the purpose of Quest? Meaning of Quest.
Quality, Understanding, Empathy, Sensitivity, and trust
A cost share protected dsnp member receives a bill in the mail and calls member service for help, we check the dos and it's for the same amount that is left as the member responsibility? What do we have to do as a csr to get this issue resolved for the member?
Call the doctor office to bill Medicaid. (Provide the Medicaid # if need be or bring the member on the line so they can provide the number)- The member is not responsible and the amount we see in gps is the portion we paid as Medicare and the remaining amount left over on the claim is Medicaid responsibility if the office refuses to bill Medicaid they must accept our payment as a full payment.
How many requirements do we have for the NPS incentive and what are they?
5- 1. Work as an active employee during the entire incentive month. Important: This does not include protected time (i.e., FMLA, LOA) or approved paid time off. 2. Must be actively employed on the date of the incentive payout. 3. Meet the NPS target of 84% or greater as an overall site as well as the agent must be at 84% or above for their NPS metric. 4.Meet the incentive requirement of 50% Survey Offer Rate5.Meet the incentive requirement of 25% Survey Response Rate