System
What system is use to check if the Agent/Agency is the AOR/WA
Display Group AOR and WA Information
Once agent is registering for the first time we will need to fully authenticate the call using what information and what tool should be used to validate the information?
PMT
Strong Evidence:
- Agent SAN/HAN
Adequate Information:
- Agency Name
- Date of Birth (broker only)
For a softheon member its showing "Suspended" however caller want to make a payment. What does Suspended mean and can the caller really make a payment in that status?
Yes and payment can be made . Suspended mean Member has active coverage, however they are past due on their premium payment. Claims can be held for processing until member's premium due is up to date. Premium payments can still be processed.
Caller called in because is commissions is not correct, how can you help
Transfer to Agency Management
Go to Maccess and located EMPCHG202604210002584 and let us know what changes was done.
Group name was change
Which MAIN system should be used to validate the OE/Contribution/Domestic partner coverage?
MTVX
If a PAA is no longer with the group/agency and they have multiple SAA what can be done?
1.Revoke the account which will remove everyone who has access OR
2.Submit a PAA and PCA change form if a PAA is no longer with the group and a SAA will be replacing the same PAA.
In PBS, the group is eligible for RI however you are not seeing the $50 for RI, what does this mean and what should be done in PBS?
Mena the group doesn't have a fee, and we should just add a regular comment
The group is term and in PBS there is no comment surrounding RI, what should you do?
Call Billing
Using MTV, for group number 853062 what change was done 06/07/2023?
Address change
Which system should be used to check to see who is the PAA on the account?
IT management
The group is missing from under the Agent; the group is active and should be listed under the agent because the agent is the AOR. What can you do to assist the agent for the group to reflect?
Retrigger
What must be validate in Ebilling when doing a payment call?
Communication preference (Email address)
Once providing the Commandspec email, what information should be provided to the caller?
How to successfully send the email which also can be email to the caller
The Employer called in to get information on group billing base on checks in MTV group is terminated from 05/31/2024. In PBS group is active and the last payment we got was on 1/21/2026.
Group number 844227
Group name SCOTT BAIRD PLUMBING & HEATING CO INC
What cause this and how would you proceed to assist caller?
Kentucky (KY) and Florida (FL) (Florida Insurance Trust - aka FIT) Chamber and Association groups are small groups that can request a large group medical association/chamber plan. All association/chamber plans are written as large groups and have their own group ID number. If a group elects small group specialty products, they have a separate group ID number that is then tied together for billing and web purposes.
Which system should be used to get a copy of the portability form that was sent out to the member?
Macess
True or False
If a GA called in and is not seeing the group, should we do a Retrigger?
False
Follow up question: - If the caller logged in and is seeing a different name what should you do?
Create a ticket and route to SRE_Opensystem_Enrollment
True or False
I must advise the caller that it will take 7 days for the payment to be removed from their account? (A payment transaction number doesn't mean that the transaction will go through)
True
What does Return check mean in PBS when an ACH was done?
UNABLE TO LOCATE The ACCOUNT OR INSUFFICENT FUNDS
What are some of the main things we constantly getting markdown for in quality which is unacceptable and we will fix it?
Empathy
HIPPA
Active Listening
Incomplete information
What's the difference between Portability and Conversion?
Life portability is the option to elect continuation of employee or dependent contributory voluntary term life insurance
Which system is used to view group proration method?
PSB
If the group proration is "D" and the employee start on the 12th of April what will the employee be charge for?
The group have 3 division and 3 different billing profile however they are only seeing 1 after doing your checks you are only seeing 1 listed under access Identifiers. What should be done?
Create a ticket
Using this group number 425330
The caller wants to know what the rate for an employee who would be is a female and their age is 50.
75,000 as the volume amount
Want voluntary Life
20.25 Vlife
2.25 Ad&D
A Cobra member call in advised that her dental should not be termed, upon checking the caller is not Ibilled however she explains that she has a TPA that she works with. What can you do to help?
As a group generate the dental and Vision plan summary
Group Number# 423291
We will validate if its correct
We must validate