Empathy
You get a call from a member's spouse. They are wanting to disenroll their partner from Humana because they are in hospice.
How would you respond and display empathy? What would your word choice be knowing that Hospice is not a valid SEP?
A member starts a call like this: "You are the fourth person I have talked to and no one knows what they're doing! I don't want to repeat myself again. Transfer me to a supervisor!"
How would you take control of the call? What would you say to de-escalate the situation?
A member is calling you after the pharmacy refused to refill their prescription. After checking RxNova, you notice the denial code is 069: Exceeds Allowed Days Therapy By Plan
Explain next steps to the member while validating their frustration. How do you balance being empathetic and solution-focused?
You just received a blind transfer. The member is yelling because their PDP has been termed under ERC 012 - Termed for Nonpayment. Member says, "the previous rep promised me that my policy would be reinstated immediately after paying and that did not happen!"
What can you say that shows ownership even though you were not the one who gave the wrong information?