Project Description

PacifiCare implemented their SecureHorizons Customer Service Associates training to train new call center staff on all aspects of medical coverage through PacifiCare/SecureHorizons.

The training was an intense, three-week program covering PacifiCare’s policies and procedures, claims processing, Medicare Parts A and B, Federal government plans, and all customer care computer systems for PacifiCare and SecureHorizons.

IDA’s Role: IDA was contracted to develop a number of training modules for the program. Each module consisted of an instructor’s guide, student guide, and overhead materials.

IDA worked closely with subject matter experts to design and develop the training material in accordance with the company’s business practices, and with the Customer Service Department to ensure accuracy.

IDA designed and developed 15 modules over an 8-month period:

• Customer Care modules
  • Introduction to the HMO
  • Processing HMO enrollment
  • Educating the caller to help them better understand HMO procedures
• Subscriber Billing modules
  • Understanding premium and billing options available to subscribers
  • Processing subscriber billings
  • Processing subscriber receivables
• Eligibility, Benefits, and Coverage modules
  • Determining pharmacy eligibility and coverage
  • Determining product benefits and coverage
• Health Care Finance Administration (HCFA) modules
  • Processing the HCFA edit
  • Processing the Litton/HCFA reply
  • Understanding HCFA special status receivables
  • Tracking HCFA special status receivables
• Work Environment modules
  • Using the InfoCare system (company’s internal communications/data access system)
  • Organizing your work area
  • Managing workloads and open cases

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