De-Escalation

Member complains or asks for the complaint department, the CSP needs to do a warm transfer them to the CSS line

• True 
• False

If the member asks to speak to a supervisor and the CSP have not attempted to use the De-Escalation Process to help resolve customer conflicts, that is a reason to escalate so you can take the call.

• No
• Yes

Member Is unhappy with a medical, eligibility or enrollment decision supported by our rules and guidelines, the CSP should not escalate the call.

• True
• False

If the member does not like how we do things as a company, it is ok for them to escalate the call.

• True
• False

Member wants an exception related to a policy, benefit, exclusion, benefit limitation etc.; or the member is unhappy with the decision made on an exceptions request... this is a escalation.

• True 
• False 

The member  is dissatisfied and asks to speak to a supervisor.  AND The CSP has made attempts to de-escalate the call, you take the call.

• True
• False

If the member is escalating above you:
Always warm transfer the call to the CSS line. Be prepared to explain what the issue is and describe what steps have been taken.  Also, be able to describe what the customer expects as an outcome. Do close the inquiry when the call is being taken over by the next level. 

• True
• False

Reassure the CSP that It is important to take a member’s frustration or anger personally.  Remember the anger/frustration is not directed at them.

• True
• False

It is not ok to make up a resolution to get the member off the phone.

• True
• False

Keep your word: Explain that you plan to resolve their issue at some point. Let them know that you are there to help. Provide them with options. Do not end the phone call by saying you will get back to them. Instead, provide them with solutions. Ask which solution sounds the best, and after agreeing, provide them with a specific date or time when you will get back to them, if needed

• True
• False