Call Flow
After verifying HIPAA, what is the first thing agents will discuss with the member?
Triaging Issues
What information should always be documented in your CAREConnects/OMNI ticket?
Interaction ID, Number call made to, Team Code, All Actions taken and information discussed on call
True or False: Logging into screen capture is not required and should only be done so if your leader tells you to?
False. Agents should log into screen capture every day prior to logging into I3 and/or Scripter
If a member does not answer the phone, or does not verify HIPAA, what ticket will agents be documenting in?
Research
True or False: Leaving voicemails is optional
FALSE. Voicemails are required to be left anytime the voicemail picks up and allows you to do so
Will agents be completing HRA's on this call?
No
What is your team code for this campaign and when is it used?
STARCare - Welcome Back SC
Results - Welcome Back RS
Team codes are documented within the CAREConnects tickets to ensure calls are routed back to the correct team.
What dialing strategy is the campaign set to and how many minutes do agents get to view the account?
Managed Preview - 3 Minutes
What strategy of building rapport did we discuss in todays training?
Acknowledging the members recent or upcoming birthday
What is a Medical Home?
The name of the practice/facility where the PCP practices
What are the three actions taken within the "Medical Home" portion of the call?
1. Verify members PCP
2. Attempt to schedule a PCP appointment
3. Offer transportation services (if applicable)
Prior to completing your interaction with the Mr. Smith he indicates that he is not happy with his medication formulary and will need to think about continuing his converge with the plan.
What temperature action code would you choose?
Member Temperature – Member dissatisfied
How many action codes are agents required to choose within the dialer?
All action codes that are applicable (up to 6)
If a member indicates having trouble paying for a medication, what action should the agent take?
Educating member on LIS process
Walk me through how I would find the Welcome Back Campaign Resources
Navigate to STARCare site, locate "STARCare program resources"
What are the four actions completed within the "OTC Benefits"
1. Verify if members current pharmacy is in network
2. educate on mail order pharmacy benefit
3. Offer to check formulary for members current medications
4. If member had OTC benefits, educate on details of this benefit
True or False, A CAREConnects/OMNI ticket is required for EVERY interaction. (Dropped Call, Busy Signal, Hang up, Voicemail, Fax Machine, Dead Air)
True. A ticket is required to be documented for every single interaction
True or False: If you make an outbound call and receive dead air, the agent should move on to the next lead without documenting
False, an additional call should ALWAYS be made.
If a member expresses dissatisfaction with anything during the call, what are we required to offer?
Grievances
What digital tool will agents be discussing with members?
Can you tell me the call flow from start to finish?
Greeting -> Privacy Statement & HIPAA Verification -> Introduction -> Triage Issue -> Confirm PCP -> Appt Scheduling -> Transportation Services (if applicable) -> Member digital tools -> Pharmacy, formulary, OTC Benefits -> Closing
What call driver, 1st level reason, 2nd level reason, 3rd level reason and action code will be used
In what situation should an agent use the "No answer" disposition
When the phone rings continuously without ever picking up a voicemail
What membership does this campaign target? (Who are we calling and why?)
Members that have been identified within an at-risk model. These members have decided to continue their coverage with the plan but have been identified as being at risk for leaving.
Why are we facilitating this outbound campaign?
Retain membership
Improve member experience
Build a foundation of trust with our members
Positively impact CAHPS Scores