QA – ensures that CA’s and CSR’s are providing quality service
1 call, per person, per week, coaching session is done each time, good or bad
Also checking that identity verification is being performed

Ulysses behavior (pick 1)
Quality behavior (pick 1)
Cerf.net to view
Create cerf in assist

Call monitoring and coaching

Cert audits on documentation – each day all the cerfs that are created are moved over to a 
Making sure proper format is followed.  Suggesting SBAR edits.

Member surveys.  (find vendor)  3rd party calls members.  Looks at the positive results and provides feedback to staff CSR’s and Customer Advocates. (average of 30 a month, 1/3 of which are the positives ones, are emailed out to staff)

Grievances through anything that expresses dissatisfaction in CERF review.  Only for medicare advantage/Akamai advantage. To meet Federal requirement 


Roxanne - 


Customer Service Representatives

1 representative to 1 advocate

routine vs. intermediate
mapd (medicare advantage), plan-to-plan 

ashley visoria - business analyst