Soft Skills
What is an example of being polite and professional?
What is : Example provided by MEC
What are the 4 necessary components that need to be entered into Salesforce for CPA?
What is : Copay ID, Group, BIN, and PCN.
What 2 things need to be done for a member that wants to refuse the program?
What is: Verify HIPAA and Read the Refusal statement.
What would the LCR status be if the CD is Enrolled and MDD is Enrolled CPA available?
What is: Closed Enrolled
Is it important for MECs to read the TT's verbatim?
What is: Yes
If a mbr expresses that, this is the fifth time calling in to get taken care of or enrolled what soft skill would you apply to this situation?
What is: Empathy
Example: I apologize that you have had to call in so many times but I am going to make sure you get taken care of today.
What is: no
What is the process for an MEC to update a case to Not Eligible?
What is: The process is to send an email to the escalations team to have them update the status to NE.
Can you change a case to NE if the member is no longer eligible for PRx?
What is: No
What part in the talk track is the biggest opportunity for the call center has when it comes to QA?
What is: Reading the closing verbatim
What tone is considered best for customer service, Monotone or inflection?
What is: Inflection. We don't want the mbr to think they are just a number and we don't have time for them. Think about when you call a business. How would you like to be treated.
If there is a CPA lookup should you look up the mbrs CPA there first?
What is: Ask the mbr for the CPA first and if they don't have it with them but have applied for it, use the CPA lookup next.
If you are having tech issues on your call, is it ok to reroute the mbr back into the queue?
What is: It is never ok to re-route a mbr back into the queue. The process is to read the Unable to Hear the Caller TT.
If a case is UTC on CD and MDD, what will a new status be for the LCR?
What is: Reopened New
This process is used to transfer a mbr to the survey at the end of the call?
What is: End the call, there is no transfer option
When a member has to repeat themselves over and over, what are you not doing on the call?
What is: You are not actively listening
It's important to actively listen on every call without the member having to repeat things over and over. It can seem like you are distracted and not focused on your calls.
If the CPA requires a DC, where would you notate the last 4 of the DC and expiration?
What is: Priority notes
Should you shut down your computer and log out of all programs at the end of your shift?
What is: Yes, this can help with tech issues.
This is done after you update a Fully Integrated Mbr to the UTC status.
What is: Fully Integrated Mbrs can not be in the UTC status
Can you give members a hint on any of their information if they are unsure?
First letter of street address
First letter of last name
What is: NEVER, if they can't verify what is on their case or in COS they will need to contact their health plan.
Role Play: What does a good example of great customer service look like between an upset caller and an MEC?
What is : Example provided by MECs
Caller and MEC
If the member has Medicare, Medicaid or govt assistance as secondary are they eligible for CPA or PRx?
What is: If mbr has assistance as secondary they would not qualify for CPA but they would qualify for the PRx program.
What should be removed after the member has completed the Dupixent or Taltz COB request?
What is: Priority notes
CVSS is calling and there are multiple drugs on a case. The existing drug is Refused and now they have a new drug, what will all of the statuses be?
What is: Refused
What was July's EOM average for your Team's QA?
What is: Current team average (Supervisor)