Call Quality Audit
GEHA Scorecard — Voice Channel
Interaction Details
1. Member/Provider Experience
Max: 20 pointsSincere and helpful tone
Actively listening/engaged
Expressed empathy
Willingness to help
Polite and Professional Interaction
Use the caller's name
Incorporate Please and Thank you
Used "I"/"we" vs they (not laying blame) when appropriate
2. First Call Resolution
Max: 20 pointsAddress all questions, issues and concerns
Include complete details and information specific to inquiry
Completed all internal and external actions needed for resolution (Create Tickler, Update OI, Update address)
Set expectations/timeframes when applicable
Proactively offered options/solutions/next steps
Educated with relevant information
Asked probing questions (what/why/when/how)
3. Accuracy
Max: 20 pointsAccurate — Benefits
Accurate — Eligibility
Accurate — Network Status
Accurate — Prior Auth Requirement
Accurate — Medicare Coordination
Accurate — Claim/Pre-Determination
4. Policy and Procedures
Max: 15 pointsDocumentation
Used Hold Procedure/Dead Air (thank you for holding, checking back in, 3 minutes)
Releasing Callers / Robo Calls
Transfer Procedures followed / External Number provided
G.E.H.A Greeting/Closing
Additional Assistance Offered
Survey
Answer Call within 10 Seconds
5. Advocacy
Max: 15 pointsMention the G.E.H.A website
Member Advocacy provided
External Call offered if applicable
6. Security and Compliance
Max: 10 pointsVerified 3 pieces of information
Provider FTIN/NPI
Reviewed ARF on file to speak on behalf of the member when applicable