G&A Part II

Create a professional and informative image that represents customer service scenarios related to health benefits, featuring a customer service representative on the phone with a concerned customer in a healthcare setting.

G&A Part II Quiz

Test your knowledge on handling complaints and issues related to benefits with our engaging quiz! Whether you're a seasoned professional or just starting out, this quiz will help you understand the best practices for addressing caller dissatisfaction effectively.

Key Topics Covered:

Complaints and resolutions
Proper documentation practices
Understanding grievances and appeals
Pharmacy complaint procedures

5 Questions1 MinutesCreated by ResolvingIssues532

Caller expressed dissatisfaction regarding their benefits and you resolved their issue. Would you check "Yes" for complaint?

Yes, unless the caller voluntarily states that they did not wish to logde a comlaint then you would not.

2. Do not ask callers if they would like to file a complaint, if they express dissatisfaction you are required to clearly notate the complaint and send to the correct area according to process. True or False?

True, unless the complaint is related to a process the required you to ask permission first (i.e. QAA Complaint)

False

Examples of when to follow the Pharmacy Complaint Calls Overview process

Pharmacy address or telephone information is incorrect in Humana system or the web.

My Rx was denied

Member complaint about a non-Humana Pharmacy mail order issue

Caller states Pharmacy speaks poorly of Humana

Caller states they would like their Rx reconsidered because it should be covered

G&A Part II

G&A Part II Quiz

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