Opening/Closing
What is the basic demographic information you must obtain for every call?
First name and last name, phone number, residential address, and member ID (if they have one)
Prior to providing any plan information, you are required to read what?
Scope of appointment
After reading SOA, what do you need to provide to member?
How can you earn an exceeds for A4 Set Accurate Expectations
Restate reason for call and provide TTEC commitment statement
Before submitting an application, you must get an agreement from member using what scripting?
Verbal attestation script
What is included in the call opening?
Full name, branding, licensed agent
Before clicking apply, what do you need to offer and send to your member?
Quick Quote
Notes are required for every call, what QA category is this evaluated in?
C1 Correctly Used Resources and Systems
How can you earn an exceeds for B3 Utilized Probing Questions?
Ask more than the minimum required (PCP, pharmacy, medications, budget/current premium). Examples: Specialists? DME? Interested in hearing vision or dental? ETC
What part of your call introduction is considered critical compliance?
Licensed agent
What is included in call closing?
Confirmation # (if application was completed), phone #, HOOP, branding
What are the 4 required eligibility questions?
Employer coverage, Medicare A & B, Medicaid, LIS
What are the proper hold and transfer procedures?
Ask permission to place on hold, thank caller for holding, provide number to dept you are transferring to, and keep hold times within 90 seconds
How can you earn exceeds for D1 Displayed Active Listening Skills?
Agent does not interrupt caller, Agent takes notes so caller does not have to repeat themselves, Agent brings up something mentioned earlier in the call, ETC
When we need to do a Marx check, prior to asking for MBI/DOB/Social security, what do you need to do first?
Provide context to member as to why you need that information
Your call disposition must match what to be considered accurate?
Outcome of the call
Needs questions should be asked on every enrollment call to identify the ONE most suitable plan. Which needs questions are required to be asked for critical compliance?
Current plan premium and monthly budget
When gathering medications, what items do you need to verify with member?
Name, dosage, form, quantity, frequency
How do you earn exceeds in D2 Handled the call in Professional Manner?
Agent utilizes member's last name throughout call, avoids acronyms, agent does remains professional during call by not inserting personal opinions on politics, finances, etc. Agent does not mention system issues
How do we verify HIPPA?
Two pieces of information (full name and one other piece of info such as member ID or phone #)
If the call drops during enrollment, and you have to make outbound call to your member, please provide example of introduction to meet introduction and compliance.
This is "First name and last name", licensed agent with Aetna Medicare calling on a recorded line, may I please speak with "member first and last name" and then just to verify I have the correct person, can you also confirm your member ID for me?
What plan details are to be provided for a MAPD plan prior to starting enrollment?
Plan name/network, Premium, medical deductible, PCP/Specialist copays, inpatient hospital copays, dental vision and hearing copay/network, worldwide coverage, drug deductible, tier 1-5 copays, pharmacy network, drug phase verbiage, utilization management/tier info for medications
Even if your member has extra help/enrolling into a $0 premium plan, you must read what verbatim prior to selecting payment method?
PART D IRMAA/LIS verbiage
How can you earn exceeds in category D3 Followed Scripting and Utilized call control?
Agent follows logical call flow, agent encourages member to have pen and paper, agent stays on topic, avoids dead air
Who are the only two people that we are allowed to complete an enrollment application with?
Auth Rep/POA or Member