Customer Service Management

Customer Service Representatives (CSR) get a web-based user interface for viewing claim details for a member. Details include service and payment information, claims data, provider specifics, notes, edits, MOOP history, and activity logging

CSR can view the Pre-authorizations for a member. Details include summary, notes, contacts, attachments, letters, status history

CSR can capture the caller details and verify the member details

CSR verify whether the caller is an authorized representative before giving any information about a member

CSR can add temporary/ permanent authorization for becoming member representatives basis member authorization

CSR can view information related to membership, claims, authorizations, quality, enrollment, fulfillment, tasks, materials requested, appeals & grievances for a member

CSR can capture the event details like description, category, notes, communication address, outcome. The event can be routed to other departments

CSR can see the details of the previous events, pending events in queues

CSR can edit the event from the queues and add relevant notes

CSR can view the provider basic details, members mapped to providers, claim details, pre-auth details

CSR can view the call logs, authorized member details and applicant details for an agent

CSR can view the application details, fulfillment (communication) and tasks for an applicant

Integrates with telephony system to capture caller information

Tracks the status of each event though color coding thus avoiding breach of SLA’s

Captures the RSVP data for webinars

Provides CMS reports on scheduled frequency

Users can generate real time reports