Dependents
Spouse calls in and has ongoing verbal authorization to speak and make changes on the employees behalf. The spouse is in the middle of reporting a life event via phone and has to go but wants to give verbal authorization for her sister to continue the call. Can this happen?
No, Verbal Authorization can only be provided by the employee.
Irate caller requests to speak with a supervisor.
What is your next plan of action?
What information do you put in the chat when requesting a supervisor?
De-escalate the call.
Supervisor template:
Name of the EE:
Client:
Case #
Issue/Reason for the supervisor call:
What actions did you take to de-escalate the call:
(True or False)
For ALL BAGS, Children age out EOM they turn 26 for Medical ONLY.
True
Who handles Post 65 retiree coverage.
Employee calls regarding an open case that is still being worked on. What is your next step after providing the update?
Document the call in the open case and reset the call back for the CSR that opened the case.
An employee calls in to report a life event. When processing the life event, he requests to add his spouse but does not have their SSN. What is the next step?
Reach out in chat with the SP name, DOB, Marriage Date, and Address so the CSR lead can update via chat. (Request the SP be added in chat.)
An employee calls advising their coverage is showing inactive with the carrier. What are your next steps before opening a case?
Confirm what benefit the coverage in question is for. (Dental, Vision, etc.)
Review the coverage in MAP.
If active and no recent QLE within the last 7-10BD, contact the carrier to confirm.
If recent QLE, and no EU needed, advise to allow more time 7-10BD & OOP details.
Employee calls advising they received an email regarding their dependent is aging out. What is the first piece of information you need to better assist with their questions?
BAG Code
(Finish the statement.)
If a Western Slope employee defers or waives coverage,_______.
, they forfeit their right to future participation.
True or False
If an appeal case is opened, a follow up must occur every 24-48hrs until the decision is provided.
False
Employee reports a Child loss of coverage life event for 2/1/2025 but was denied. When reviewing the verification cases, there are no case notes to provide a reason why. What is your next step?
Open the verification case to confirm the correct documentation was submitted. (proof the child lost coverage on 2/1/2025)
If the document was wrong, provide the correct documentation to submit with the deadline to submit.
If the document was correct, open a case to have the document reviewed again.
(True of False)
Pod 2 is expected to get a new client effective 5/1..
False.
Pod 2 will be getting a new client effective 4/1 - Dallas ISD...
Which bag number are offers the "Hearing Aid Rider" benefit with Anthem?
(618, 619, 698, 646, 647, 654, 655, 656, 658, 659, 660, 666, 667, 700-704, 712-774)
What will start over if the employee's subscriber ID number changes with the carrier?
The deductible.
An appeal case was just assigned back to you resolved but the call back is set for 3/10/2025. What are your next steps?
Update the case to Waiting participant.
Move the callback to today's date and complete the call back.
If the member answers, provide the update and close the case. If not, reset the callback for the next business day.
The employee's dependent is aging out this year. What information can you give her?
Provide the date child will age out.
Provide COBRA details if the child is enrolled in M/D/V and when the packet will be sent. (Timeframe for COBRA vendor to update and packet to be received)
Advise the COBRA coverage a continuation of what the employee has if they wish to enroll but coverage will only be updated once enrolled and payment has been made.
Employee wants to change his Medical plan and expresses that his spouse will be gaining her own coverage. Will a Gain of Coverage event allow the employee to change his Medical plan?
No, Gain of coverage will only allow you to drop the benefits, not change it.
UKG started working on the 2-14-25 semi-monthly payroll BEFORE the 2-6-25 file was loaded meaning that all semi-monthly employee rows on that file never happened. Frontier is waiting to see what the plan of action is to get those deductions in place. If anyone who is semi-monthly call the FBC asking about timing their deduction (addition/removal/increase/decrease)…. Please refer them to..
Rudi
Western slope retiree children will age out at _.
EOM of turning age 22.
You have been sitting in ready for 5 minutes without a call coming through the queue. What should you be doing?
Completing callbacks due for the day and reviewing open cases in your name and not in your name for potential update request that may be needed.
Employee calls stating that their newborn child is not showing active with the carrier. After research you reveal that the employee did not report the birth life event and are now outside of the timeframe to make the change. The client requires an appeal via case. What information do you need to open a case?
DOB of Child, Birth QLE date.
Reasoning the employee did not make the change within the timeframe and what the request is for. (Wants to add child to medical?)
Callback number.
Advise to submit required DPV and any supporting documentation that would support the request.
(Bottom Line: Include all information (If Sanofi confirm if they will be ok with retros, if approved))
Newscorp QLE timeframe is...
60 days.
Who manages Retiree Medical?
Who manages Pension?
Milliman opt 2
Milliman opt1
What is required if a retiree calls wanting to enroll in coverage and you see the coverage reflects "Deferred Coverage"
Documentation is required when moving from defer status to enrolled status to show continuous coverage has been in place for the prior 12 months.
(On a call) You reach out in chat regarding information you were unable to locate via your resources and open a case for further research. Your question is later answered via chat. What are your next steps?
Locate the case you opened.
Assign it back to yourself if assigned to a lead.
Move callback to today's date.
Call the member to advise of the case resolution.