Eligibility
Relate to the customer and their emotions
Reassure, and relieve frustration or discomfort.
All these falls under what category of customer service
Empathy
Where to go if you needed to handle an automated call and the information is not in the Communication panel of CRM?
I need to know if my provider is inn with my plan, where can i verify this information.
Physician Finder
Name two reasons a member may need to change their demographics
Member is moving
Member has new Medicare ID
Incorrect Spelling
Email Address Hacked
Gender Marker Change
Marriage/name Change
What does PCP means?
Primary Care Physician
I am required on all calls to alert my fellow coworker.
What other system can be used to check for Commumication sent?
EMME
What is a provider that has a contract with the insurance company called?
Participating (Par)/ In Network (INN
Why would a member choose to change their PCP
Not satisfied with care from their current doctor
Office location may be too far away.
New preferred doctor joins the area.
Approach me as person
Meet me where i am
Anticipate my needs
Don't make me repeat myself
What part of the perfect experience requirement am i.
. KNOW ME
Where can you view recent letters or automated calls?
Communication Panel in CRM
I am an oncologist, what an i referred to as in Physician Finder
Specialist
Verify if PCP is inn
Confirm if the PCP is accepting new patient.
Honor change request from authorized callers
Process the change in Humana system.
What are the first 4 steps of the call flow
1.Greet
2Show Empathy
3.Understand the Issue
4.Resolve the Issue
What are some reasons a member might received an automated call?
I am a secondary system used to locate providers information.
PAAG
Who are the persons that can update demographics?
Member
POA or EOC
Agent
Who can request PCP change?
Member or POA
What is the name of the Mentor document that guides you as to what information you can provide to a caller.
What is the C/I for A member receiving a letter?
C: Communication
I: Got a letter/call
What does the heart and badges below the doctor's name mean?
Hearts represent Clinical Quality
Badges represent cost-efficiency ratings.
What do you need to do if a member demographic update shows them OSA?
Advised of the timeframe that their plan will remain active and also, they will need to speak with sales to get a new plan for the area they will be in.
What is the mentor document used for PCP Changes?
Primary Care Physician Change for Medicare Overview