Warm Transfer Protocol
Steps and strategies to take when transferring, escalating and de-escalating a call in-progress
Index
When to Warm Transfer
| Transfer Group | When to Transfer |
|---|---|
| Group Benefits | ● Group policy is referenced ● Escalated issues in lieu of a supervisor |
| Mental Health Benefits | ● Mental/behavioral health benefits request ● Substance abuse benefits request |
| Agent Services | ● Compensation, commissions, bonuses ● Appointments and licensing questions |
| Short Term Medical Sales | ● Assistance purchasing a policy online |
| Health Care Management | ● Requests to pre-notify a service ● Requests for status on a pre-notification |
| Employer | Don’t transfer here as a level 1! |
| Elite Experience | Don’t transfer here as a level 1! |
| Level Funded Advantage | Don’t transfer here as a level 1! |
| Sales | Don’t transfer here as a level 1! |
| Health Care Assistant | Don’t transfer here as a level 1! |
Warm Transfer Script
To Caller
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Say:
“Since this is a question regarding ______, I will need to transfer you to a ______ representative. I’ll speak to them first, so you won’t have to repeat that information again.”
To Senior Rep
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Say:
“Hi, ____. This is ____. I have a member/provider on the line calling regarding ____.”
Wait Time
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Wait a total of 1 minute for a rep to answer.
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If no answer: cancel the transfer and return to the caller.
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Say:
“Hi, ____. Are you still there? Thank you for holding. It looks like they are currently experiencing higher than usual call volumes. Do you mind if I transfer you without speaking to them first?”
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After receiving caller permission, blind transfer the call.
De-escalation Action Steps
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Concrete Actions
| Claim Denial | IT Issues | Review Delays | No Network |
| Contact the patient advocacy services. | Advise to check the WSS portal regularly for claim updates. |
Complete requested items to close review. | Suggest the provider call for benefits & elig. |
| Call the provider and request a payment plan. | Advise to watch for emails regarding new EOBs available. | Advise to contact provider for needed info. | Offer to verify in a 3-way call with provider.
|
| Send policy documents for review on how to best utilize the plan. | Call the provider and advise of the tech delay. | Send med records requests to the member. | Advise they can self-submit a claim. |
| Appeal the claim determination. | Set up a call back to inform them of the progress. | Offer to follow-up with updates of review progress. | Assist them with finding a different provider. |
Strategies for De-escalating Hot Calls
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Low & Slow: Speak with a low tone and slow speed.
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Name It to Tame It: Name and validate the emotion the caller is feeling. Project empathy.
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Regulate Over Educate: Avoid educating the caller while they are in a heightened state.
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Swift Shift: Say, “Here’s what I would like to do,” to refocus the conversation.
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Pause with Purpose: Wait for a full three-second pause before asserting yourself.