Policies
Overtime must be flexed the next day by coming in late, unless over time is on what day?
Friday
What is our goal for Online Rate?
80%
We all know documentation is important, where do we need to add our notes in maestro?
Summarized in the intent and adding additional information if needed in wrap up
No. We can access rally for the member and send the list to her e-mail. We can wait for member to confirm that she received the list.
Member does not want to discuss the issue in the chat and is demanding to speak to someone on the phone. Do we send to ORQ?
We can give member the option to reach out to member services or get transferred to our outreach department.
When can you go into wrap up during your shift?
Lunches/breaks & at the end of your shift if you are still working on chats.
What is our goal for Average Response Time?
60 seconds
When member states the reason for chat, what greeting do we use?
“Hello and thank you for contacting UnitedHealthcare. My name is XXXX and I'm here to assist you today with your (reason). How can I help you?”
Member is trying to refill a prescription and needs urgent assistance as that is her medication for diabetes. The pharmacy states that the prescription exceeds quantity for the limit that insurance will approve. She has been trying to reach the doctor and is not getting a response. Do we send to ORQ?
Yes, as the member needs her medication urgently and she is having issues reaching the doctor. We would first confirm the claim information then send to ORQ.
Member needs assistance finding multiple specialists and she has not been able to find specialists that are in network. Do we send to ORQ?
No, we have to ask probing questions and find out if she is calling specialists in rally, if so, which specialists has she called and go over the rally list with member. If specialists have been contacted, advise does member want to search in a different zip code and also the primary care providers work with specialists and can refer member.
Who do you need to notify to get approved for same day PTO?
Our supervisor, Ana.
What is our goal for Quality in chat to meet QVC?
100%
When we need more time to gather information for member after we set hold expectation for 2-3 minutes, what is the next step?
“Thank you for your patience, I am still reviewing your plan benefits. Please allow me another 2 to 3 minutes.”
What template do we use in the summary notes for ORQ?
Member ID
What is the issue?
What steps did you take to help the member?
Please provide contact info applicable to the situation (Example: PCP name, PCP phone number, etc)
Is it mandatory to add the summary notes before transferring to ORQ?
Yes. You would use the ORQ template to ensure the next advocate has enough information to assist member.
What step do you need to take to get approval for flex time?
There needs to be a 48 hour notice and approval needs to be granted
What is our goal for First Response Rate?
45 seconds
Member asks for assistance in navigating the digital Ucard via MyUHC portal. Do we transfer to healthy benefits or assist member in navigating the digital Ucard?
We would assist member in navigating the digital Ucard
What process should we follow before sending to ORQ?
Ask probing questions and show empathy
Exhaust all of our resources
Then we can transfer to ORQ
Member states he keeps getting disconnected when he calls member services. Do we send to ORQ?
Yes, we can confirm member has the correct member services phone number then we can offer to transfer to ORQ.
If you need to use the bathroom outside of your break/lunch, What is the process to do so?
You will use Personal in Genesys and Log out of LP
If metrics are missed for 2 months consistently, what process will start?
Performance Management Process (CAP Process)
DSNP member needs a Direct Reimbursement Form. What system would we use?
Member Materials in Maestro
Member has been calling healthy benefits multiple times and she is unable to reach them. Member states she needs help with an issue. Do we send to ORQ?
No, we must first ask probing questions and attempt to resolve the issue for the member
What are the reasons to transfer to ORQ after exhausting all resources?