MEMBER

OPENING SPIEL
- "Thank you for calling Cigna Healthcare, my name is ____. Who do I have the pleasure of assisting today?"
- "Are you calling for yourself or on behalf of someone else's account?"

IF 3RD PARTY CALLER
- Ask the caller's relationship with member and 3rd party caller's full name
- Ask if member is around, then inform member monitoring disclosure, ask member for verification and consent, then back to 3rd party
**"Do you authorize (3rd party caller name) to access your account on your behalf?"**

MONITORING DISCLOSURE (if 3rd party caller or background is noisy)
- "Hi (member), this is _____ from Cigna Healthcare. Because quality is important to us, this call may be monitored or recorded for quality and training purposes. Is it okay with you?"

VERIFICATION
**member full name + 2 additional verification elements**
⦁	phone number
⦁	member id # or medicare id #
⦁	date of birth
⦁	customer's complete address (street, apt #, city, state, area code)
 
(if member can't verify, suggest contacting SSA)
"It seems here that there's a discrepancy with your information in our system, we suggest that you contact SSA first for verification or updating of your information then you can call us back after. Thank you for calling Cigna Healthcare, we anticipate for your call soon."

"How can I assist you today?"

PREFERRED LANGUAGE SPOKEN *ask if there's no indication*
- "Mr/Mrs, what is your preferred language?"

APPROPRIATE RESPONSES
⦁	acknowledge
⦁	empathy
⦁	reassure

DEAD AIR (strictly 30 secs only)
- inform customers what you're doing

HOLD (refresh within 2 mins)
- "Mr. customer, I would need to check my resources to answer your question. may I place the call on hold for 2 mins?" 
- "Thank you for patiently waiting"

RESOLUTION *complete and accurate*

RECAP
 "Just a quick recap, you called in today to check on (premium/plan/member ID)"

COMPLETE CLOSING
"Is there anything else I can help you with and have I answered all your questions and reasons for calling today?"
"If you want to participate in a quick survey after this call, you can stay on the line. Again, this is ____, thank you for calling Cigna Healthcare. Have a great day."

.

.

THIRD PARTY CALL FLOW
 
Thank you for calling Cigna Healthcare. My name is _____, who do I have the pleasure of assisting today?

If caller mentions that they are calling for someone else's account, verify their full name and the relationship with the member. "For a quick verification, may I know your last name and your relationship with the member?"

If caller says full name and relationship to member at first, reiterate the relationship. "Just for quick verification (Miles), you're the member's brother/husband/etc, is that right?"
 
Once asked, proceed to verify the member by asking if they can pass the phone to the member or do an outbound call. "Is the member available for account verification? Can you pass the phone him/her please?"

 NOTE: Prior getting the full name of the member, provide the Monitoring disclosure spiel.
"Hi, (Timothee), this is ______ from Cigna Healthcare. Because quality is important to us, this call may be monitored or recorded for quality and training purposes. Is that okay with you?"

Once speaking with the member, ask to still verify the full name of the member even though it was mentioned by the 3rd party.

Once provided, proceed to verifying Full Name, Phone number, DOB, member ID or Medicare ID, complete address as listed in the PDP system.
 
NOTE: It is considered as fully HIPAA verify once you verify 3 out of 5 verification information

Can you please verify your full name? How about your DOB and phone number? Can you help me as well with the member ID, address or Medicare ID number?

Once completing verification, ask for verbal authorization from the member if we can proceed with making any changes and discussing the account? If yes, then proceed to speaking with 3rd Party and resolve the concern.

"Do you authorize (Miles Morales) to access your account on your behalf?"

"Can you pass the phone to Miles please?" "Can I speak to Miles please?"

"Thank you for your coordination (Miles), how can I help you today?"

 GENERAL INFORMATION ALLOWED FOR 3RD PARTY CALLER BUT NO MEMBER AROUND
- Outstanding balance, premium amount, type of plan

For recap:
"Just a quick recap, you called in today to check on (premium/plan/member ID)"
"Is there anything else that I can help you with and have I answered all of your questions and reason for calling today?"

If Yes; "If you wish to answer the survey please stay connected on the line, again, this is ____, thank you for calling Cigna Healthcare, have a wonderful day!"
 
If no; ask the customer what we can help further.