OSCAR

A crash course on changes in HealthJoy OTRS ticketing system, otherwise known as Oscar.

Queue Management & Skilling

Queue Managment

 

Queues have been organized by Channels, Campaigns, and Skill Levels.

What does that mean for HCCs?

  • Customized Queue by Individual Skill Levels
  • ONE (1) Queue to manage, rather than searching each individual subqueue for tickets.

If it's in your Queue, you work it.

 

 

PROVIDER SEARCH

What you need to know:

 

 

 

Generalist (PCP), Specialist, Facility, Other Providers

 

Low Cost Clinics for those who do not have insurance.

 

 

Dental Providers

 

Vision Providers

PROVIDER SEARCH Process Ticket routes them all.

 

BENEFITS NAVIGATION

ASK THE EXPERTS!

  • Benefits: Not your typical benefit questions...a bit more complex, nuanced, or simply something new we've never come across before.
  • Medical Bill Review: Requires more time and understanding of how to negotiate lower medical bills.

Create a Benefits Navigation Ticket for more complex benefits questions.

MEDICAL HCC

Currently, ticket creation is only available for Rx Review.

Don't forget to use the Note Template for Personalized Medication Review!

MD


HINT: On any given ticket, no matter how it was originally created,

if it looks like it is a question that requires MD Review,

HCC can MOVE the ticket to the MD Review subQueue.

Just don't forget to add Notes!

LICENSED AGENTS

 

 

 

 

Create an Insurance Need Process Ticket when user has dropped insurance coverage.

MANAGER

Manager

 

Billing Issue

Refund Escalation

User Feedback

Create a Manager Process Ticket for things that need Manager Review.

MESSAGE

 

 

 

Messages during Out of Hours Chat or User Feedback.

 

 

 

 

These messages are time sensitive because we do not know what the urgency of the user Messages are to begin with.

Morning and Weekend Shift HCCs should be checking for Message Tickets every morning when they come in, and handling them appropriately.

  1. Address the ticket if it is Urgent.
  2. Otherwise, move to the appropriate subqueue.

Standalone Queues

Standalone Queues are those that are not associated with any specific Campaign.

Set Insurance is the only one HCCs need to pay attention to, outside of their personal Queue. 

When [Group] users go through JOY onboarding, they verify insurance plans and a Set Insurance ticket is created. Users go directly into chat after this journey.

Look at the SET INSURANCE Queue to quickly locate the user's insurance information that was provided during the Onboarding Journey.

Moving Queues

If a ticket needs to be moved to a different Queue:

  1. Add a Note.
  2. Move to the appropriate subQueue.

Ticket Ownership

What You Need to Know:

  • By default, tickets will have Admin OTRS as owner when created.
  • The last person to make a change to the ticket becomes the Ticket Owner.
  • If the Ticket is Locked, the Owner is the person currently working the Ticket.
  • If the Ticket is Unlocked, anybody can work the ticket, regardless of Ticket Owner.
  • If a ticket has not been updated in at least 12 working hours, the ticket will automatically be Unlocked. Anybody can work these tickets, regardless if someone else already started work on it.

 

If it's in your Queue, you work it.

Improvement Suggestion

Due to Improvement Suggestions, 

You'll notice Dental/Vision subqueue looks different.

They are now separate sub-Queues, so easier to distinguish in CRM Workspace.

  • GHA::Dental
  • GHA::Vision

Keep those ideas and suggestions coming....Use Service Desk!

 

....now back to our regular scheduled training...

Ticket Titles

Ticket Titles

You can learn a lot from Ticket Titles.

  • GHA::Benefits (manually created ticket)
  • BOT::NORVAX::Rx Review
  • Autodeliver::NORVAX::Provider

 

1. BOT means the ticket was created by JOY. Any responses to the customer must be manually sent through CRM.

 

2. AUTODELIVER also means the ticket was created by JOY. However, responses to the                                     customer will be automatically delivered within the ticket.

 

When HCC indicates they are ready to Deliver Response, the text in CARD RESPONSE will deliver to the user automatically.

REMEMBER:  Because these card responses are being sent directly to the customer, it is very important to review content you're entering in the CARD RESPONSE!

Currently includes:

  • GoHealth Access (GHA)
  • SecureAssist (SA)
  • Groups (NORVAX)

 

  • Note: Queues/SubQueues are subject to change as skills and needs change.
  • Good thing you only have one Queue to manage:  YOUR Queue

Phone Follow Up

PHONE

Phone call?!

Yes, phone call.

We have to talk to our customers....(sometimes).

What's there, besides fulfillment Phone Follow Ups?

  • Bank Dispute
  • Telemed Follow Up (Completed consultation) [Priority 3]
  • Telemed Failure (Incomplete consultation) [Priority 5]
  • Outbound Campaigns

Create a Phone Process Ticket for things the require Phone Follow Up.

Phone Follow Up?

Split tickets?  Linking?                       Those days are over! No more split tickets.

  • Simply add a Note and move the ticket to the appropriate Queue for follow up, whether Phone Follow Up, Benefits, HealthQA, etc.
  • Ticket Title will remain the same, based on original request. 
  • So before you wonder why a ticket is in your Queue, open it up and read the notes!

Notes, Notes, Notes

Notes! Notes! Notes!

Learn to use Notes in OTRS well.

  • Add Titles to your Notes!
  • Add Notes when you need to change Priority.
  • Add Notes when you need to move to a different subQueue.

 

 

  •  Add Notes when you need to add Provider Notes.

 

  • Add Notes when customer needs phone call. Remember, we're an online company. Why do they need a phone call?

Scripts

Image result for script

What...there's more? 

  • Use Notes to find the right outbound script or template for your customer.
  • But don't forget to review and edit your notes!

Priority Levels

Priority Levels

Most tickets are NORMAL priority.

  • GROUP tickets will have Priority 4 or higher.
  • Phone Follow Up (Telemed Failures) are URGENT.
  • HealthQA tickets are URGENT.
  • Outbound Phone Campaigns are LOW.

  • If a ticket needs to be upgraded to URGENT, Priority needs to updated in ticket manually, with Note and Reason.

 

Oscar Review

Provider Search Queue has which sub-queues

  • Dental
  • Low Cost Clinic
  • Provider
  • Specialist
  • Vision

How to create a Provider Search ticket: place each step in order from top to bottom.

  • Select new Process Ticket
  • Select Provider Search from the drop down
  • Choose the correct Source, Campaign, and User/Customer
  • Choose the type of Fulfillment needed and what type of provider or specialty.
  • Complete the rest of the mandatory questions and submit.

Phone Tickets contain all of the following:

  • Bank Disputes
  • Phone Follow-Ups
  • Telemed Follow-Up
  • Telemed Failure Follow-Up
  • Outbound Campaigns
  • Appointment Follow-Up

Choose correct steps to create a Personalized Medication Review ticket

  • Create new Process Ticket
  • Choose the Rx Review process
  • Select the correct Source, Campaign, and User/Customer and then Submit
  • Select Note in the ticket
  • Choose the Personalized Medication Review text template
  • Enter in medication names, dosages, quantity, and condition

True or False

  • The BENEFITS NAVIGATION queue contains the Benefits and Medical Bill Review sub-queues.
  • The BENEFITS NAVIGATION queue is for more situations that are more complex than usual.

True or False

  • If any type of ticket looks like it needs to be in the Health Q&A queue, you can move it there as long as you make a Note.

True or False

  • The MESSAGE queue contains both the Email and Message sub-queues.
  • A ticket in the Message sub-queue means that a user chatted in during Out of Hours or is a User Feedback.
  • A ticket in the Message sub-queue is always set at Urgent Priority.
  • Weekend and morning shift HCCs should check the Message queue first thing when they come in.
  • You can move a Message ticket to the appropriate queue and do not need to make a new ticket.

Choose all that apply when working a Set Insurance ticket.

  • Open the user's Houston profile and update all demographic information from the ticket.
  • Update user's Houston profile with the plan ID's for the UMR, Guardian, and VSP plans if they indicated they enrolled into them.
  • Add any member IDs into the user's Houston profile if they supplied them.

True or False

  • The last person to make a change to a ticket becomes the ticket owner.
  • If a ticket is UNLOCKED, only the owner can work the ticket.
  • If a ticket has not been worked within the last 12 hours, it will be automatically unlocked and anyone can work the ticket.

How many queues do you have to work?

  • Benefits and Phone Follow-Up
  • Just My Queue
  • Provider Search and Phone Follow-Up

Which button would you hit to go to your Queue View?

Match the ticket to the description

  • BOT::Norvax::Provider Search
    Ticket created by JOY. Response to customer must be manually sent.
  • Autodeliver::Norvax::Provider Search
    Ticket created by JOY. Response to customer will be automatically delivered through the ticket.
  • GHA::Provider Search
    Manually created ticket. Response to customer must be manually sent.

What is the default priority for all Norvax tickets?

What is the default priority for all Norvax tickets?

True or False?

  • When updating Priority of a ticket, you need to add the reason why you updated Priority.
  • Health QA and Telemed failure Phone Follow-Up tickets are HIGH priority.

True or False

  • Add a Note when you are adjusting Priority of a ticket.
  • You do not need to add a Note when moving a ticket to a different queue.
  • You always have to add a Title to your Notes.
  • When updating provider information, you need to add a Note and select the Provider Search Notes template.

Fill in the blanks

Use a to find the right outbound chat script.  After selecting you need to then select the correct for the provider search you are completing.  REMEMBER to review and edit your Notes!

Instead of linking and splitting tickets what is the appropriate action when you need to move a ticket to a different queue?

  • Add a Note and Move the ticket to the correct queue.
  • Create a new ticket for follow up in the queue you want to move the ticket to.