Customer Service Fundamentals
Which statement best describes the typical living arrangement of American seniors aged 65+?
Most live independently with a spouse or alone
Which models offer universal coverage
Single payer & Multi-payer
In which phase of the call flow do you make sure you've addressed all the caller's issues and communicated the status of those issues?
Closing Phase
In which of the following circumstances would full free-text documentation be required in Quick Start+?
You were unable to close out the case.
Which of the following qualifies as an Eligibility Verification call?
"Hi. I'm at the heart clinic here, and they say my plan's not coming up in their system, but I know I signed up for a new one. Can you check that for me?"
When will a member’s plan terminate once CMS has received notification from SSA about the member’s death?
The last day of the month the member passed.
What system/tool will you use to verify a member’s date of death or a name change?
MARx/Wipro
In which phase do you clarify the caller's identity and authority to receive sensitive information about the plan in question?
Opening Phase
Where can you find the OMS link in CRM?
On the Plan Member page.
Which three pieces of information are key to resolving an Eligibility Verification call
Member's plan status / Member's plan type / Member's plan effective date
Which statement best describes a grievance?
When a member expresses dissatisfaction with any aspect of their plan or their experience.
What classification and intent will you use in QuickStart + to document a successful address change?
Demographics::Change
In which phase do you especially strive to remain engaged with the caller and keep them informed as you follow process guidance in Mentor?
Resolution Phase
On what page in CRM can you order new ID cards?
ID-Card Management page.
What is the first thing you should do before ordering any printed materials for a member?
Verify the address on file is correct.
What Classification & Intent should be selected for a Quality, Attitude, and Access to Care (QAA) Complaint call?
Always use the Complaints or Compliments - QAA
What Classification Intent & should be selected for a grievance call?
The C&I that you select should match the main reason for the call.
In which phase do you ask probing questions to clarify the caller's needs and set up documentation in Quick Start+?
Issue Identification Phase
Where would you go to view a letter a member is calling about?
The RTI section of CRM.
Does each individual member receive their own Smart Summary?
Yes. Smart Summaries are specific to the claims and coverage for each member.
Why is it important to leave your Grievance Case open in CRM after saving the documentation?
It ensures cases will route to the Resolutions team.
What template must be completed for all Quality, Attitude, and Access to Care (QAA) complaints?
QAA Complaint Template
Which statement best describes a QAA Complaint?
A member’s expression of concern regarding the quality of care received, the attitude of the provider, or a lack of access to desired or needed medical services.
Where in CRM do you access the template to make updates or changes to a member's demographics?
Case Edit page
Which option should you choose to update a member's phone number or email?
Contact Demographic Update