Systems
What system would you begin and end a call with?
Maestro
Member calls in to change a PCP. What intent would you use to document the call?
Search and Assign Provider
Name 3 types of Macess Routes
Enrollment Route
COB Route
Member Materials Route
What is the call closing that is required at the end of your call?
"Are you satisfied with the service I provided today?"
If a caller does not speak English, what tool would you use to service the call?
Language Line
What system is used to look up all standard operating procedures?
Knowledge Central (KC)
Member calls in to find a new PCP but their plan is no longer active. What intent would this call be documented under?
Eligibility status
Member calls in and you determine the account is no longer active. After checking the state system you determine the state shows the member should be active. What route would you submit?
Enrollment Route
How long should you keep a member on hold before checking back in with them?
2-3 minutes
If you are servicing a call that utilizes a TTY service for hearing and speech impaired callers, what is phrase you should use to indicate a completed statement to the translator?
"Go ahead"
Site advocates utilize to assist members with Provider searches.
Rally Provider search
DAILY DOUBLE!!!!
Member calls to advise their name is spelled incorrectly on their ID card. What would you advise the member and what intent in Maestro would you document under?
To update this information with the NYSOH > Eligibility Intent
Member calls in and requests an AR form be mailed to them. What route would you complete for this member?
Member Materials route
If your caller comes through unverified in Genesys, how many pieces of information must you gather to confirm and authenticate your member?
3 pieces of information -
Date of Birth / First & Last Name / Subscriber ID / Medicaid ID / Full Address on file / Phone Number on file (Follow your HIPAA SOP)
Where can members go to view their own claims, change phone numbers/emails, and view and download their virtual cards?
myuhc.com--> member profile (portal)
Main Phone System
Genesys
Member calls in to ask questions about scheduling transportation for an upcoming appointment. What intent and category would you use to document this call?
View Member Benefits--> Transportation
DAILY DOUBLE!!!!
Caller asks for a Supervisor after all attempts to de-escalate. What are your next steps?
Reach out to Supervisor in chat.
Transfer case in Maestro to Supervisor.
Transfer call to Supervisor.
Name the 3 plan types that we service for the State of NY under Community & State.
Community Plan (C&S)
Child Health Plus (CHP)
Essentials Plan (EPP)
System used to confirm questions on eligibility for a member. Not a UHC website.
ePaces- NY State
What should be documented on the Wrap Up Screen?
Summary of the call details; review the ACD for accuracy before submitting.
What steps must you complete to save and submit a route before closing Macess?
Hit Floppy Disk
Hit F4 (Choo-Choo Train)
Copy SF #
Authorized Representatives have been permitted access to many aspects of a member's account. Name something that an AR is NOT able to do without verbal consent?
Make any changes on the member's account.
ie: PCP changes, Demographic changes, notification settings
What is the correct turn around time (TAT) for an ID card being mailed to a member?
Community Plan = 21 Days
CHP & EPP = 7-10 Business Days