Upload
austen-terry
View
214
Download
0
Embed Size (px)
Citation preview
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Welcome
Customer Care Training Presenter: Barbara Howrey
Next
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Next
Lesson:
Our Customers
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Next
Objective
Describe who our customers areIdentify the customers you
will serve
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Next
What you will learn
Five Customer Classifications
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Types of Customers
As a Customer Care Associate, you will be responsible for working with a variety of customers.
There are five unique types of customers.
Select a Customer Classification in the menu on the left to learn more.
Types of Customers
As a Customer Care Associate, you will be responsible for working with a variety of customers.
There are five unique types of customers.
Select a Customer Classification in the menu on the left to learn more.
When you have completed the training . . .
Click to Play Game
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
ProviderA provider is anyone who is licensed to render medical services to a patient.
There are two types of providers:
Professional ProvidersFacility/Institutional Providers
Learn more . . .
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Professional ProvidersAnesthesiologist Chiropractor Dermatologist Family PracticeGastroenterologistInternal MedicineOB-GYN Otolaryngology Pediatrician Physical Therapist Primary Care Physician Psychiatrist Radiologist Surgeon
Next
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Facility Providers/InstitutionalAmbulatory Surgical Center Hospice Center Hospital Imaging Center Laboratory Residential Treatment Center Skilled Nursing Facility
Menu
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
MembersA member is a person who has an active membership with an insurance company. They may be insured by their employer as part of medical benefit or they may have purchased the insurance through a broker to obtain an Individual Policy.
Types of Members:There are five types of members.
Learn more . . .
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Next
Type of MemberSubscriber
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Next
Type of MemberSubscriberSubscriber’s Spouse
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Next
Type of MemberSubscriberSubscriber’s SpouseSubscriber’s Children (Dependents)
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Next
Type of MemberSubscriberSubscriber’s SpouseSubscriber’s Children (Dependents)Subscriber’s Grandchildren
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Menu
Type of MemberSubscriberSubscriber’s Domestic Partner
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Brokers and AgentsBrokers and agents are people who are licensed to sell insurance. What is the difference between a Broker and an Agent?
Learn more . . .
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
BrokersA broker sells the policy to the member. If the member has any question with a claim or service, the Broker will also call on behalf of the member to resolve a concern that the member has.
Next
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
AgentsTheir main role is to develop business relationships with new companies. They also keep the relationship they have by continuously offering innovative products and caring service.
Menu
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Employer GroupsAn Employer Group health plan is established or maintained by an employer or by an employee organization that provides medical care for participants or their dependents.
Benefit Coordinators often represent the Employer Group when interacting with their insurance company.
Learn more . . .
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Benefit CoordinatorsBecause most companies have a Benefit Coordinator that acts as a liaison between the group member and the insurance company, employees of the company often enlist help from the Benefit Coordinator in resolving concerns.
When calls are received from these coordinators, certain guidelines apply about what can be discussed with the Coordinator about a member.
Menu
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Internal CustomersAn internal customer is one that usually works within the insurance company. They may or may not be in your department but it is important that you understand that they are also your customers
Learn more . . .
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Examples of Internal CustomersOperations Experts Managers Claims Processors/Adjusters Grievance and Appeal Associates Enrollment and Billing Representatives
Menu
Name That CustomerMatching Game
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
InstructionsOn the next slide is a matching game.
Look at the Classification term on the left and find the correct customer that belongs to that classification.
Good luck!!
Next
Claims Processor
Has a Benefit Counselor
Hospice Center
Sell Insurance
Domestic Partner
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
Name That CustomerMatching Game
Providers
Members
Brokers & Agents
Employer Groups
Internal Customers
XYZ Insurance
Thank You!!