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

Welcome

Customer Care Training Presenter: Barbara Howrey

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Providers

Members

Brokers & Agents

Employer Groups

Internal Customers

XYZ Insurance

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Lesson:

Our Customers

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Internal Customers

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Objective

Describe who our customers areIdentify the customers you

will serve

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What you will learn

Five Customer Classifications

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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

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Members

Brokers & Agents

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Internal Customers

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Professional ProvidersAnesthesiologist Chiropractor Dermatologist Family PracticeGastroenterologistInternal MedicineOB-GYN Otolaryngology Pediatrician Physical Therapist Primary Care Physician Psychiatrist Radiologist Surgeon

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XYZ Insurance

Facility Providers/InstitutionalAmbulatory Surgical Center Hospice Center Hospital Imaging Center Laboratory Residential Treatment Center Skilled Nursing Facility

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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 . . .

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Type of MemberSubscriber

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Type of MemberSubscriberSubscriber’s Spouse

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Type of MemberSubscriberSubscriber’s SpouseSubscriber’s Children (Dependents)

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Type of MemberSubscriberSubscriber’s SpouseSubscriber’s Children (Dependents)Subscriber’s Grandchildren

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Type of MemberSubscriberSubscriber’s Domestic Partner

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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.

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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.

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Providers

Members

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Employer Groups

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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

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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.

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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 . . .

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Members

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Examples of Internal CustomersOperations Experts Managers Claims Processors/Adjusters Grievance and Appeal Associates Enrollment and Billing Representatives

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Name That CustomerMatching Game

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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!!

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Claims Processor

Has a Benefit Counselor

Hospice Center

Sell Insurance

Domestic Partner

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Internal Customers

Name That CustomerMatching Game

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Thank You!!