Tracking Client Calls
Customer service inquiries and resolutions are tracked internally, including issues related to eligibility, benefits, and decision outcomes. The number of calls, hold/call times, and dropped calls are also recorded.
Customer Service Representatives
Our staff is trained to handle a variety of customer service calls, including claim status, eligibility, and benefit inquiries. Our staff has:
The authority to reprocess and make adjustments to claims, as appropriate. This higher level of authority increases the first call resolution rate and level of customer satisfaction.
Note: Significant requests are overseen by management.
The ability to view scanned images of provider claims, Explanation of Benefits (EOBs), scanned correspondence, and processed payments.
The ability to view client plan provisions and important documents such as SPD, SBC, and amendments.