Call Handling Quiz

What is the purpose of authentication in phone calls?

• To ensure member information is only given to authorized individuals

• To provide a friendly greeting to callers

• To resolve all questions and issues on the call

• To offer outbound calls to providers

What should agents demonstrate for every call?

• Ownership

• Authentication

• Multiple resources

• Greeting

What is a repeat caller?

• A caller who has made multiple calls within 10 days

• A caller who has made a call regarding a PA request

• A caller who has made a call to the provider

• A caller who has made a call to leadership

What should agents do when handling a repeat caller?

• Resolve all questions, issues, and concerns on the call

• Offer outbound calls to providers

• Verify case(s) were reviewed properly

• Check INET and Trial claim for discrepancy

What should agents do when a case is pending review?

• Offer to make an OBC to the provider to complete the review over the phone

• Notify the member of the failed attempt and suggest they reach out to their provider

• Notify the member that the case is currently undergoing review

• Provide members with the approval dates and run a trial claim

What should agents do when a case is approved?

• Provide members with the approval dates and run a trial claim

• Offer to reach out to MD to initiate a review for alternative

• Advise the member that their provider can switch to another medication

• Notify the member that the case is currently undergoing review

What should agents do when discussing a denial?

• Review the case notes to determine why the case was denied

• Advise the member that their provider can submit a new request

• Offer to reach out to MDO for new review

• Advise the member that they or their provider can initiate an appeal

When should the appeals phone line be utilized?

• When the caller wants to initiate an appeal request

• When there is a pending APP case on file

• When the denial letter has the OptumRx address

• When the denial letter lists other phone numbers

What should agents do when alternatives have been identified?

• Ensure medication does not require review

• Offer to reach out to provider and/or initiate MPA

• Provide copay based off copay tiers

• All of the above

What should agents do when handling escalated calls?

• • Acknowledge the situation and/or problem. Be empathetic and show the caller that you understand their frustration.

• • Let the caller know that you will look into the issue and attempt to find the solution.

• assure them that you want to help them resolve their issue and that you will notify your leadership of the previous interaction for further investigation/resolution

• All of the above