CALL FLOW
Call readiness- The opening statement must be given within how many seconds?
- Agents are expected to greet members within 5 seconds of the call beginning.
Member Engagement- Each instance of dead air cannot be longer than ____
30 seconds
When verifying contact details, what needs to be verified?
phone number
email address
ePHI consent
If we make an outbound call, this is required
Recorded line disclaimer
When wrapping up a call in TD, what needs to be done?
Link the call to SF
What are the 5 things that must be included in the opening statement?
Each call should begin with us providing a standard greeting to the caller. Your greeting should include the following items:
Thank the member for calling
Brand the greeting by saying SmithRx
Introduce yourself by your first name or preferred name
Ask who we are speaking with
Offer assistance
If verbal collisions occur, what is expected of us to do?
Apologize and yeild to the member
- Internal transfers should be warm.
- Transferred to the correct location
- External number provided prior to transfer/conferencing another number with the member
If we end the call abruptly and without proper justification or we fail to respond to a member in a timely manner, resulting in member disconnect, you will get a fail for this question
Member Abandonment
What do we do if the member states they did not hear or understand our greeting?
We should restate the greeting
What is the purpose of clarifying questions
Relevant questions asked of the member, at the correct points in the call, to create a cohesive and comprehensive support experience
Enough probing questions should be asked to get an accurate picture of the member’s issue or reason for calling.
If a caller expressed dissatisfaction or brought up a negative experience, or if a difficult message was delivered,what should be given?
an empathy and acknowledgement statement
In order to follow the hold procedure, what must be done?
- We asked for the member's permission beforehand
- Agents should state a definite timeframe ("2 to 3 minutes") for Research holds. Avoid usage of "a moment" or "brief."
- When returning back from hold, the agent should thank the caller for holding
- Full name (as it shows in our system)
- DOB
- Member ID
(in lieu of member ID, the following is acceptable)
- Full address (as shown in our system)
- last 4 of SSN
When adding an AA we need to ensure we document the following:
Full name, relationship, and expiration date
What are the closing statement requirements?
- Offer additional assistance
- Thank the member for calling
- Brand by saying SmithRx
If we make inappropriate or disparaging comments towards SmithRx or to its Partners, Plans, Competitors, or other 3rd parties, you get counted off for _____
Professionalism
What information needs to be included in your documentation?
- Case chatter notes documenting the interaction, including the following:
- Who called
- Reason for call
- Medications and Dosages discussed
- Copays, Coinsurance, Deductibles, and other monetary amounts discussed.
- Resolution Provided
- Follow-ups Promised
The TPA field in SF, to ensure that they are actually calling from the listed TPA
Remaining on the line for more than 10 seconds after the interaction ends or we transfer the member is considered this
Call Camping/Riding
What are the reasons that we should pitch self-service on member interactions?
-if checking the price or which pharmacy to use- mention FMM
-if checking coverage or covered alts- mention Formulary in Portal
-if member needs a replacement ID card, direct to Portal to access
To sound confident and positive in our communication with the caller, we should avoid or limit these-
- Agents should limit words with negative connotations such as "unfortunately" whenever possible, and instead focus on what can be done.
- Avoid terms or phrases that make you sound unconfident such as "I'm not sure" as this leads members into feeling doubtful regarding our resolution.
The following is all a part of which question on the QA rubric?
-avoid giving the caller homework when possible
-make external calls as necessary to resolve the member's issue
-proactively provide all relevant information regarding the member's issue
-One call resolution when possible. If an external call is needed, first offer to have the member hold while we make the call
Accurate and Complete Resolution
If a parent calls in for their child (under 18 years old) but they are NOT on the plan are we able to speak with them?
no- UNLESS the primary account holder calls in and adds the other parent as an AA on the account
We should be using C3 for which scenarios?