Notes

OPENING SPIEL:

Thank you for calling Ambetter Member services, this is DETTE, how may I help you today?

(after knowing what customer's concern provide EPA)
-alright, thankyou for reaching out today. dont worry, since you got me on the line, I can certainly assist u with that. ( call reason).

Empathy statement- Dissatisfied members: Frustrated, repeated callers, billing issues, denied claim/authorization, provider not accepting Ambetter:
-"I'm sorry to hear that..." "I apologize for the inconvenience."
Empathy statement-Cancellation: "I'm sincerely sorry to hear that you are cancelling with us since u got me on the line i will process with that.

* before anything else/ we proceed. May I have your first and last name?* is it okay to call you on by your first name or last name? or how would you like to be address?

PROBING QUESTIONS;
-Are you the calling for urself or on behalf of a member? if YES
- IS THIS THE FIRST TIME YOURE CALLING ABT THIS INQUIRY. if no say ( I'm so sorry to hear that, but since u got me on the line i can certainly assist you with your concerns.


HIPAA VERIFICATION
-For verification and security purposes may I have your Date of Birth and as well as your member ID?(NAME OF THE CALLER)



PROPER HOLD PROCEDURE:
MAY I PUT THE CALL ON HOLD JUST TO 1-2 minutes, I just need to get the information correctly, is that okay mr. member, just please stay on the line and I'll be right back.

*Lemme just go ahead and check my resources
*Lemme just pull up your account
*Allow me a few moments to pull up your account and look through it
*Ill scroll through some of the details on your account so ensure you have everything you need.
*Allow me a few seconds to take note of these details

AFTER HOLDING THE CALL/ RESOLUTION:
-hello are you still there? thankyouu for patiently holding on the line and upon checking here that ( CALL REASON).



CLOSING SPIEL
-would you like to get the interaction id of this call( callers name)?
-By the way, Mr. Member for your reference the id number of this call is U 123456789

-Ms./Mr. Member if you have a concern or questions you can visit our official website (WWW. Ambetter health.com)where you can see the list of PCP, pay bills and review coverage information.

*OFFERING SELF SERVICE OPTION*
-And is there anything else that I can further assist you with? FURTHER ASSISTANCE?

JUST A QUICK RECAP (CALL REASON).

SURVEY;
-And if you have a few minutes, after this call you'll be offered the option to complete a survey and I would sincerely appreciate any feedback from the service I have provided you today. Thank you for calling Ambetter, again this dette, bye for now and have a wonderful day./ have a good one.










CSAT AND CAHPS
(AHT - AVERAGE HANDLING TIME) ITS 12 MINUTES.
*FCR- FIRT CALL RESOLUTION FOR QUESTION 3
FCR - Was your issue or request resolved the first time you called your Health Plan?

CSAT - Would you recommend your Health Plan to friend or family member? ( question 4)

CSAT- IF HOW YOU HANDLE THE CALL AND HOW YOU HANDLE THEM. IF YOU MEET THE CUSTOMERS EXPECTATIONS. HOW SATISTIED CUSTOMERS WITH US.

HOW CSAT WOULD AFFECT US?
-ALOWS COMPANIES TO LOOK INTO HOW TEHIR CUSTOMER EXPERIENCE.

CENTENE SURVEY QUESTIONS.
- WERE YOU TREATED WITH COURTESY AND RESPECT?
- WAS OUR TEAM MEMBER ABLE TO RESOLVE YOUR ISSUE OR REQUEST WITH THIS CALL.
- WAS YOUR ISSUE OR REQUEST RESOLVED THE FIRST TIME YOU CALLED HEALTH PLAN?
-WOULD YOU RECOMMEND YOUR HEALTH PLAN TO A FRIEND OR FAMILY MEMBER.

HOW TO IMPROVE CSAT
*SMILE*
S- STAY CALM- SO THAT THE MEMBER WILL TRUST AND HAVING GOOD COMMUNICATION WITH THEM.
M- MAKE SMALL INQUIRIES- SO THAT WE CAN GET WHAT ARE THERE CONCERNS AND UNDERTSAND THEM
I- ITS NOT PERSONAL - SO THAT IT WONT AZFFECT YOUR PERFORMANCE AND THE NXT CALL.
L- LISTEN ACTIVELY- SO THAT WE CAN ACKNOWLEDGE THEIR FRUSTRATIONS AND CONCERNS, WILL ASK BY THE CUSTOMERS/ MEMBERS.
E- EMPHATIZE/ APOLOGIZE - IT DEPEND IN THE SITUATION. LIKE DENIED CLAIM,DIED, HAVE PROBLEMS.


CAPHS
-CONSUMER,ASSESSMENT OF HEALTHCARE PROVIDER AND SYSTEMS
- STARTED IN 1995
-ANNUAL SURVEY ADMINISTERED TO AN ANONYMOUS, RANDOM SAMPLE OF MEMBERS.( FEBRUARY to month of June

WHY CAPHS IS IMPORTANT
_MEMBER EXPERIENCE IS BECOMING INCREASINGLY IMPORTANT IN THE HEALTHCARE INDUSTRY.
-
THIS IS AN OPPORTUNITY FOR THE HEALTH PLANS TO RECIEVE ANONYMOUS FEEDBACK FROM MEMBERS.
-THE CAPHS SURVEY HAS BECOME THE NATIONAL STANDARD FOR MEASURING AND REPORTING MEMBER EXPERIENCE WITH HEALTH PLANS.
- HOW SATISFIED THEY ARE
-EVALUATE THERE OVERALL SERVICE.


WHY ARE THE QUALITY RATINGS IMPORTANT ?
- RATINGS ACROSS ALL PRODUCTS ARE PUBLICLY REPORTED, SO OUR MEMBERS CAN MAKE INFORMED DECICISONS ABT THEIR CARE.
ENTERPRISE STAR GOAL
- MEDICARE 4 STARS
- MARKETPLACE QUALITY RATING SYSTEMS- 4 STARS

PROVIDE EXCELLENT CUSTOMERS SERVICE.
- GOOD CUSTOMER SERVICE IS ESSENTIAL
-FOCUS ON PUTTING THE NEEDS OF OUR MEMBERS FIRST.

BUILD RAPPORT
- ARE MEMBERS ARE ALL UNIQUE
-BE ADAPTABLE
- SHOW EMPATHY
- MAINTAIN A POSTIVE ATTITUDE.

COMMUNICATE CLEARLY
- USE REINFORCEMENT OF COMMENT OR CONVEY UNDERSTANDING
-DO NOT INTERUPT
- ASK OPEN ENDED QUESIONS.

BE HONEST
- EXPALIN TO THEM WHAT U ARE DOING LIKE PUTTING THE CALL IN HOLD.
- OFFER NXT STPES
- WHAT ARE U DOING TO HELP
- NEVER BLAME THE OTHERS.

CLOSE GAPS
- YOU AHVE MET ALL THEIR NEEDS
- CONFIRMED SATISFACTION
- FOLLOW THROUGH ON WHAT YOU'VE SAID.
DO NOT USE JARGONS LIKE PCP( PRIMARY CARE PHYSICIAN)
NOT THE ABBREVATIONS.



MOCK CALL GUIDE
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