Enter Title

Grievance Catagorization

100

The Member is dissatisfied because their ride  never came. The Member checked the ride status and it showed canceled by the driver , The Member is trying to get to their doctors office for appointment

Transportation/Transportation late or no show

200

 Member called in stating he is unable to create an online account.

Customer service/ Technology 

300

Member  called in upset that he has received another member's mail. 

fulfillment/HIPAA Breach 

400

Member called in states he always experiences delays or issue with their rewards credits

OTC, Healthy Food and Utilities/OTC, Healthy Food and Utilities

500

Member called in stating they received a bill from a provider they never saw or received services from.

Provider / Facility / Hospital /Fraud Allegation 

UHG

100

what is Team Payne  current UES goal

1 a day or 20 per month

200

What is the name of the IVR 

Avery

300

who is eligible to become a service Hero

• Are a part of UnitedHealthcare Operations & Experience, UnitedHealthcare Clinical Services, UnitedHealthcare Networks or other participating organizations*
• Are grade levels 21 to 28, or equivalent
• Are individual contributors or people leaders
• Have at least twelve months of service in a full-time role with UnitedHealthcare
• Are high performing team members

Program Timeline

400

When does AEP start 

October 15 thru December 7

500

When can we begin to discuss 2025 plan options 

October 1st 

VG or QOC ?

100

The Member is dissatisfied because their ride  never came. The Member checked the ride status and it showed canceled by the driver , The Member was able to get a ride from a relative  

 Standard VG 

200

Member called in stating the pharmacy dispensed only 25 Oxycodone pills, Member states her prescription is for 30 day supply. 

QOC

300

Transportation Vendor calls member within 24 hours of the scheduled ride to advise a driver could not be located.

QOC

400

Member went in for an appointment and was told she  cannot be seen until the outstanding balance is paid.

VG

500

Member called in upset that she was not able to enroll into a aqua aerobics class that her Doctor recommended for her back pain. 

VG

TRUE or False

100

Should you always contact the provider regarding the allegations / issue.

False

200

It is required to create separate intents if the grievance falls under multiple dropdowns.

TRUE 

300

Is the customer service number to safe ride 866-244-2331.

False(866-244-3123.)

400

 Some members with certain plans living in certain counties with ModivCare can exceed their mileage limit due to the rural nature of the area.  

TRUE

500

If an appointment is available within the Access to Care timeframe, it is not a QOC.

True

Abbreviations

100

DSNP

`Dual special Needs Plan 

200

COB 

Coordination of Benefits 

300

VBC

Value Based plan 

400

MIOD

Member initiated organization determination 

500

PPO

Preferred provider organization