Readiness
Where do you go to check system/application access?
My apps page
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
Where do you access call procedures?
Mentor
True or False
False
They come in green when fully Authed
You can give out member info without verifying identity first.
True or False
False
Where do you locate in network providers?
Find Care
You can make outbound calls.
True or False
True
What system do you have to open first everyday?
DIG Bot/Toolbar
What is the goal of every call?
First Call Resolution
You don't have to leave notes in Quickstart+.
True or False
False
You want to leave detailed notes in case the member calls back about the same issue.
Where do you access member ID cards?
ID card Center
What system do you use on every call?
CRM: Customer Relationship Management System
What system do you check when CRM can't display the info?
Customer Interface (CI)
What are negative stereotypes for the elderly?
Trouble Driving
Incompetent with tech
Hard of Hearing
Not Athletic or Active
What do you do if no one is on the line?
repeat greeting 2 times
Create unknown member
do the ghost call script and disconnect the line
OES and OMS are the same system.
True or False
False
What are 3 of the most common call types?
Plan status, ID card request
Update contact info/ address change
Find Drs, Change PCP
Verify Benefits, preapproval requirements
Quote Drug cost, covered medication info
What system sends the calls when on queue?
Softphone
All calls have to be under 5 minutes.
True or False
False
All calls have to be a minimum of 1 min but there isn't a high end as long as you are helping the entire time.
What are people that are trying to get sensitive member information?
Bad Actors
What is the last thing you do every day?
Sign out
What are the Key advocate qualities?
Active Listening, Patience, Empathy, and Understanding
What system do you use to create a case?
Quickstart+
What is the Greeting?
Thank you for calling Humana. My name is ..., your healthcare advocate. How can I help you today?
Humana ID, Medicare/Medicaid ID, Account number, Person ID Number
DOB, Address or Zip code
Group name/number, Contract/PBP, or product type (only if needed)