Call Flow
These two fields need to be completed in the Interaction Log prior to accessing the Member's account.
What is Interacting With and Interacting About?
PART ___ covers inpatient hospital, skilled nursing facility, hospice and home health
What is A?
TRUE or FALSE: You should sign in to Genesys Softphone using DIG Toolbar or the desktop icon every morning at the start of your shift.
What is True?
What is the Medicare Advantage Prescription Drug (MAPD) Document Index?
To fully authenticate the Member's identity, we need the Member's name and these 3 most commonly used elements: ____, ____, and ____.
What are Member ID, DOB and Zip Code?
PART ___ covers prescription drugs.
What is D?
When Consult/warm transferring a caller, this button should be pressed in CRM under the policies section.
What is the Call Transfer button?
TRUE or FALSE: Setting the Classification and Intent does not change the recommended Mentor docs in QuickStart+.
What is False?
When the caller identifies themselves as the Power of Attorney (POA), we can verify using one of these 2 systems.
What are CRM Service and Customer Interface (CI)?
This web address has information about Medicare as well as the Medicare & You Handbook.
What is medicare.gov?
The Member Resources section of humana.com includes this commonly used feature.
What is Pay my premium?
What are Helpful resources?
What is Find a form?
This aux is used when going on lunch.
What is Meal?
This Mentor document is found on the MAPD Index and referenced when the Member says they received an automated call from Humana.
What is Automated Calls or Letters for Medicare and Medicaid Overview?
Using the 8-Step Call flow delivers the Perfect Experience, which consist of these 4 principles.
What are Know Me, Show Me You Care, Make It Easy, and Help Me?
This is the yearly time period in which a Medicare-eligible individual can enroll in a new plan for the upcoming year.
What is AEP or Annual Election Period?
The Member must be signed in to view this, which is also helpful at the doctor's office.
What is their Humana ID card?
This aux has to be selected before logging out for the day, but should otherwise never be used during the working day.
What is Available?
This specific Mentor document is a job aid that tells us what we can and cannot tell a caller who is not the Member.
What is the HIPAA Job Aid Reference Medicare and Medicaid (aka HIPAA Job Aid)?
These are the 8 steps of the Call Flow.
What are Greet, Show Empathy, Understand the Issue, Resolve the Issue, Explain Next Steps, Offer Additional Assistance, Recap the Call, and Close?
A caller that wants to enroll in a new Medicare Advantage plan would speak with this person.
What is a licensed sales agent or DMS agent?
True or False: Members can submit claims through Humana's websites.
What is False?
This Mentor document has everything you would want to know about Genesys Softphone (aka CECP).
What is Customer Experience Center Platform (CECP) Document Index?
These two filters need to be set on the main Mentor home page to ensure you only locate documents relevant to your role/department.
What are the Function and Sub-Function filters? (or What are the Customer Service RSO and Individual Medicare filters?)