Healthcare
New Hire QuEST
Quality Enhancement and Skills Training
Call Flow
Opening + Issue Identification + Verification
• “Thank you for choosing United Healthcare, my name is ______________;
3-Part Start (Ask, Acknowledge, Reassure)
Ask: • “How may I help you today?” (Allow the caller to speak and give the reason for the call).
Acknowledge: • “I know that this is tough for you to look for a physician that won’t charge you so much”
• “ You must feel so hopeless in this situation. “
• “I understand that it is difficult to go about daily tasks when we feel a lot of pain”
Reassure: • “I will be happy to provide you options.”
• “Don’t worry; we will sort this out together.”
• “I will do everything I can to assist you with your concern.” (Offer empathy when applicable)
Verify information/ customer identity. Obtain the following information:
• Member’s name “Before I begin, I need to verify a few things,
• Member’s ID number “May I have your name and member ID number, please? (Wait for response)
• Member’s birth date “ Thank you, (state the caller’s name). How about your date of birth?” (Thank the caller for each piece of information).
• Member’s callback number “ Just in case our call gets disconnected, may I please have the best phone number to contact?”
Common issues
Issue Confirmation Probe Resolution
Medication • “I understand that it is difficult to go about • Ask for the drug name and form. (Tablets / Provide information based on the Drug
Options daily tasks when we feel a lot of pain. Don’t Capsules / Solution) Coverage Table
worry. I will look for other options so that you - Thank you. In order for me to give you accurate - “Here is the information I gathered for
can get your medication without paying for too information, I will be asking you a couple of you, <Customer’s Name>. I have checked
much. questions. First may I have the drug name and the generic brand of <drug name> and it
form please? (Wait for response) will only cost you <amount> for 30days.
This will help you buy the exact supply of
• Ask how many milligrams. medication without paying for too much.
- May I know the dosage you would need? (Wait
for response)
• Ask how many days’ supply. (30 / 60 / 90 days)
- Lastly, May I have the number of days of
supply you were given? (Wait for response)
Physician • I know how urgent it is for you to locate a Determine the following: Refer to the PCP Information table
Options doctor right away. I will make sure to look for all • Customer’s location - <Customer’s Name> for a doctor who
the options we have so you can get the best • Doctor’s specialization specializes in <specialization> We have
doctor without paying a lot. here someone who accepts Medicaid and
is also covered under your plan. Instead of
paying for <amount> from your other
doctor, you only need to pay for
<amount> .
Healthcare New Hire QuEST | September 2021
Add short phrases that will help you establish a connection with the person you are talking to. The idea is for the caller to feel that he/she is your focus and that you are
taking personal responsibility for them in the conversation. Personalize your talking points by adding phrases like:
• “Please give me a moment while I look into this for you. Here is the information I gathered…”
• “You are absolutely correct. Let’s look into this.”
• “I would love to walk you through the process.”
• “What I’m doing for you now is…”
• “I would suggest / I recommend…”
• “A simple way / method to change it will be to:
Recap
“That is fantastic! I’m glad to hear that you feel much better after. As a quick recap, you called to. (state the reason of their call and the actions you took).”
Closing
“Is there anything else that I can help you with today, <Customer’s Name>?
“I am happy I was able to assist you. Thank you for calling United Healthcare!
Drug Coverage Table
Amount for a supply Amount for a supply of
Drug Name Form Dosage Generic Brand
of 30 days 30 days
Lipitor Tab 10mg $184.00 Atorvastatin $17.50
Ambien Tab 10mg $101.82 Zolpidem $26.79
Prilosec Caps 20mg $33.04 Omeprazole $11.00
Lopressor Tabs 50mg $121.00 Metropolol $39.99
Zocor Tabs 40mg $154.00 Simvastatin $28.40
Member Information Table
Last Name First Name Birthday Contact Number Member ID
Fisher Patricia 4/16/1948 660-223-9225 26567573-0
Hall Marilyn 12/11/1964 334-420-0352 42228570-0
Lashley Jacob 01/25/1978 805-728-8595 84465732-3
Nichols Stanley 05/18/1954 317-255-1774 83694719-5
Jennings Gilbert 02/25/1941 267-940-1057 45699398-9
Perry Barbara 06/26/1963 240-864-5246 43112474-0
Brown Sandra 08/02/1976 336-727-7444 94798960-3
Johnson Frank 03/07/1956 818-530-1334 36879897-7
Name:_______________________________________ Trainer:___________________________________________
Program Name: _______________________________________________ Wave ___________________________
Healthcare New Hire QuEST | September 2021
PCP Information Table
In-Network or Out-
Last Name First Name Specialty Accepts Medicaid? Out-of-pocket Contact Details
of-Network
Family Practice, Urgent 2034 Linden Avenue
Taylor Robert Care Medicine, General Y In-Network $40.00 Orlando, FL 32810
Practice
Phone: 407-574-4041
1064 Cinnamon Lane
Stein David Nephrologist Y In-Network $30.00 San Antonio, TX 78217
Phone: 210-843-6382
455 Jim Rosa Lane
Cole Vincent Internal Medicine N Out-of Network $150.00 San Francisco, CA
Phone: 415-824-3612
1583 Goldie Lane
Holden Brenda Cardiologist Y In-Network $40.00 Cincinnati, OH 45236
Phone: 513-379-9068
4539 Jarvis Street
Obstetrics and Buffalo, NY 14202
Lewis Emma Y In-Network $50.00
Gynecology
Phone:716-845-3601
982 Oakwood Circle
Adams Lisa Internal Medicine In-Network $30.00 Irvine, CA 92614
Phone: 949-302-3627
4744 Twin House Lane
Morgan Robin Cardiologist N Out of Network $100.00 Springfield, MO 65804
Phone: 417-447-8790
Name:_______________________________________ Trainer:___________________________________________
Program Name: _______________________________________________ Wave ___________________________
