Stage 1: Fulfillment Intake
Intaking- Completed by the front line HCCs taking calls and chats from customers. Stage 1 HCCs are responsible for
- Actively listen to the customers expressed needs/concerns
- Assessing the customer's account (insurance plan, HJ plan, health profile)
- Considering the customer's concern & account analysis before determining the best course of action to have those needs addressed and resolved.
- Submitting a request (ticket) identifying the customer's issue and what needs to be done, to the Fulfillment team for completion
In this stage, it is important that all front line employees be an expert at Healthjoy's products and services along with a critical expertise in knowing and understanding insurance and people.
Stage 1: Needs Assessment: Fact Finding
There are 3 key competencies that a Stage 1 HCC must possess in order to act in the best interest of the customer and show the most value in the magic of Healthjoy.
As HCCs, our role is to fact find to the root of the customer's needs through a series of clarifying questions and statements. This requires HCCs to have a working knowledge of Healthjoy's products/services, insurance expertise and the art of understanding people.
Below are questions and statements that Stage 1 HCCs should be asking, in addition to analyzing a customer's account, to get to the root of a customer's need.
Understanding the Customer
Do you currently have insurance?
Is there a specific concern that you'd like to address with the doctor?
Are you taking any medications?
How often do you visit your doctor?
Are you seeing any specialists?
Do you have a medical condition that you're needing treatment for? (diabetes, high blood pressure, COPD)
Are you aware of the free preventive services included with your major medical plan?
Have you already chosen a physician to manage your healthcare needs?
What services are looking to make sure you have coverage for?
Are you aware of the differences between dental insurance and dental discount plans?
Do you know how much your medications will cost you under your current insurance plan?
Are you aware of the penalties for not having insurance coverage?
It looks like you may be Medicaid eligible. Have you already applied?
Understanding the Product/Services
- We have Board Certified Physicians on staff that can treat that for you over the phone
- What dental services were you looking to have performed?
- If you send us a copy of your bill, we can review it and determine if any errors have occurred
- We will follow up with the billing dept of that hospital to see if we can negotiate the cost of that bill
- We can designate that PCP, with your carrier for you
- Even without insurance, we can locate a low cost physician who bills according to your income.
- If a customer is calling for assistance with locating a provider, HCCs should be using fact finding questions to determine what their need is and assess how we can assist in the interim and on a continued basis. Is there any particular issue that you'd like to address with the doctor?
- If a customer is looking to cancel their service, HCCs should use fact finding questions to get to the root of their needs and assess how we can assist from there. Why are you looking to cancel today?
- If the customer is on the line and you pick up on a possible need that the customer may not have mentioned, we should address their immediate questions first, then add value by addressing the needs that weren't stated.I heard you coughing. Although I know that wasn't the reason for your call, keep in mind that we have Board Certified doctors on staff that can treat cold and flu symptoms over the phone and prescribe you medication, if needed, right over the phone.
Fact Finding Result: We add value to the Concierge service that Healthjoy offers while advocating for the best interest of the customer.
Applying Your Knowledge: Scenario 1
Value in Fact Finding
- On a short term plan, if a customer is seen for anything other than a new injury or illness, the intended visit will not be covered.
- The customer may have some minor concerns that can be treated using Healthjoy's Telemed/Health Chat service, instead of paying for a visit.
Had no additional fact finding been done and we sent the customer to an in-network physician, there is a possibility the customer may have initially been happy with the service, until they later received a bill for a visit they thought was covered.
It's best to eliminate any potential for unexpected costs, wherever possible. This can only be done through an assessment of the customer's needs.