SSC
Claims/OTT/BC Quality
Service/SHBP/FEP Quality
KM/ISD/DR&M
Training
100
We received from Service Agents 4,137 of these in January and 3,017 of these in August
What are Incoming Requests for Assistance (IRA)?
100
In this year, the 10 OTT databases were consolidated into one database.
What is 2010?
100
These are the two types of enrollment offered to FEP members ?
What are Standard Option & Basic Option?
100
Zelus has developed 38 modules in this alternative learning style
What are Web Based Trainings (WBTs)?
100
Number of training hours the Service Trainers have logged between Janury 2, 2013 - August 30, 2013
What is 5,671 hours?
200
Coaches have been charged with assisting the Service Division improve the member’s experience by increasing this specific agent metric
What is the Call Resolution Rate?
200
Service Division OTT Audit reviews all claims in the enterprise with the exception of these two departments
Who are SHBP (State Health Benefit Program) & FEP (Federal Employee Program)?
200
This system  houses all enrollment information exclusively for SHBP members?
What is SHIPs?
200
These two steps are the most important in the data reporting process
What are reconciliation and analysis?
200
The last 3 BPI training sessions that were rolled out by Service Training
What are Virtual ID Cards, Member Online Services- Claims Inquiry and Skill Consolidation?
300
The Coaching Hand Book suggested 15 agents; but the National Accounts currently averages 22 agents per what
What is the Coach Profile?
300
An OTT Auditor has this many hours to review a high dollar claim
What is 72 hours?
300
Name the SHPB plan where the member has a $75 emergency room copay.
What is NJ Direct 1525?
300
Also found on clothing, these can be used in addition to the Table of Contents to access larger sections on OLI.  
What are buttons?
300
Number of miles the Service Trainer have traveled during the month of August 2013
What is 8,967? Roderick - 1490 miles round trip Roderick - 180 miles one way Kevin - 1320 miles round trip Liza - 5573 miles one way (she does not return until 10/11) AJ - 404 miles round trip
400
We create these documents as reference tools and distribute to the business teams and their agents/processors
What are “Q-Tips”?
400
This new Claim Quality Audit Tool has the ability to generate a scorecard and claim evidence from Image, Cognos, NASCO and more
What is BPM (Business Process Management)?
400
The percentage of calls auditors are required to complete as live monitors.
What is 50%?
400
Zelus has created modules covering topics including the provider directory, claim inquiry, virtual ID cards, PCP and ID Card changes and the mobile application in support of the member online service business process improvement initiative to achieve what call center goal
What is to reduce call volume?
400
The new enrollment system that will be utilizied for all new members who enroll on the exchange effective 10/1/13
What is Members Edge?
500
In July 2013, this was the top Incoming Request for Assistance reason. 
What is Claims Adjudication Explanation?
500
This audit review helped Horizon BCBSNJ to achieve Optimum results by minimizing penalties paid to groups with this type of special contract
What is PG (Performance Guarantee)?
500
A documented process for sampling guidelines used by Quality to ensure agents receive consistent and timely feedback
What is Uniform Sampling Guidelines?
500
This program was developed to provide a formal process to assess the effectiveness of training programs delivered by the Shared Services Training Department
What is TMEP? (Training Measurement and Evaluation Program)
500
Horizon opted to go with this vendor for our mental health services
What is Value Options?
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