All Navigators are U.S.-based with prior experience in Customer Service and/or related healthcare roles.
Training is three weeks, followed by an introductory period of two weeks during which a new Navigator is partnered with a tenured one. Detailed team training points can be found below.
We have a rigorous QA process, randomly selecting calls and scoring them on a rubric that considers information accuracy, attitude & tone, and client satisfaction.
Team Training
Our U.S.-based Navigators receive 3 weeks of partnered hands-on training, which includes :
Training on Customer Service (best practices, handling complaints, intro/close of calls, managing difficult ethical questions, etc.)
Training on Medicare (HIPAA, Medicare101, Low-income subsidies, Evidence of Coverage, Enrollment periods, etc.)
Shadowing with a tenured Navigator calls/emails
Reverse shadowing for hands-on experience week
Detailed quality assurance review of calls in week 3
Sample Calls
Snapshot of our Learning Library
Client Services Protocols and Practices
HIPAA Verification
HIPAA Verification
Client Services is required to verify three pieces of identifying information from clients on inbound and outbound call interactions. This includes, but is not limited to name, address, DOB, phone number, email, etc.
Third-party/point of contact verification
Client Services is required to obtain verbal authorization from clients whenever a third party calls in to discuss their account, or when asked to reach out to a third party. This step can be bypassed by adding a copy of any Appointment of Representative forms or legal documents rendering that responsibility to the third party to the client’s profile.
Client Services can email AOR forms to clients and third parties upon request.
Client Services will only bypass this step if there is an imminent safety threat or in instances where clients are incapacitated.
Third-Party/Carrier/ Provider Conference Calls
Third-Party/Carrier/ Provider Conference Calls
There will be times when Client Services needs to liaise with providers, insurance carriers, and third parties to resolve certain client issues. To expedite the handling of support requests, Client Services will make an initial attempt to do so without members if they’re unavailable or listed as DNC (Do Not Contact).
If we are unable to do so without a member due to HIPAA compliance, we will make the necessary amount of attempts to reach the client to conduct a conference call.
If clients are unreachable, listed as DNC, or do not have active contact information, Client Services will respond to the requests, either requesting updated contact information when available or in an effort to coordinate the next steps with the agent of record.
Support Request Assignment & First Response
Support Request Assignment & First Response
Client Services will review and assign support requests daily, marking them as in progress, or responding to them with a comment within 1 business day.
When able, they will also work to resolve the most straightforward requests within 3 business days. Note: we anticipate some requests will require longer handle times during AEP.
To expedite the handling of support requests, timely agent responses are essential and appreciated when requested by Client Services, especially during AEP.
Resolving Support Requests
Resolving Support Requests
Client Services will take the necessary steps to close out each request efficiently and promptly. Once a support request is submitted, we’ll take the following steps before marking the support request as “Resolved.”
If a support request requires follow-up (with a member or third party), Client Services will make the following attempts:
Navigator will make 2 outbound call attempts (always updating the support request with attempt details) before marking the support request as complete.
Navigators will send follow up emails after the second call attempts if there is no contact and the member has an email address on file.
If members have an email address on file, Navigators should make 2 outbound call attempts and leave an email with resolution before resolving the request
If 2 attempts have been made to contact the member with no response we resolve the support request. If the agent would need to create a new support request and provide alternate means of communication.
If the member is unresponsive after the second consecutive support request, subsequent support requests will be resolved upon receipt.
If a Navigator calls member to close out a support request and reaches the members voicemail, the Navigator can leave all pertinent information on the recording and then complete the support request
Navigators will update the support request after each attempt to reach the member and after every interaction with the member.
Guide to Client Services
Service Limits
We operate this service at no cost — and agents love it! To ensure that we’re able to serve all agents, we have a maximum annual limit of 50 free support requests (we start counting on Jan 1).
You will be notified by Spark upon reaching 45 support requests.
You will have the option to add another batch of 10 support requests for $300.
You cannot buy partial support requests, such as purchasing 5 for $150; however, you may purchase in increments of 10 (e.g. 50 for $1,500).
Note: If a client calls Spark and the issue cannot be resolved on the phone and requires a follow-up, we will create a support request that counts towards your 50-limit balance.
If the issue can be resolved on the phone, we do not count the support request regardless of the length of the call.