Reasons to Submit an Executive Response Team (ExRT) Case

The Executive Response Team is responsible for handling high priority escalations from Customers, Financial Institutions, & brokers.

[The primary trigger to submit an executive response (escalation case) should be that you have an irate caller using key trigger terms]

Trigger Terms: If customer states they will pursue further action if their situation is not resolved, it is an automatic escalation to ExRT via case (i.e., Attorney General, Lawyer, Better Business Bureau (BBB), Department of Insurance, etc.)

 

Reasons to NOT Submit an EXRT Case

Note that these are examples and do not represent a comprehensive listing:

  • Caller wants to receive a bill in the mail instead of paying by ACH or credit card – The caller needs to mail us a written request.
  • Caller wants to receive expedited confirmation; but the call is NOT an escalation.
  • Claims follow-up – all requests to follow-up on the status of a claim are to be directed to the Claims Department.
  • Expedited Beneficiary Changes / Corrections – these should be directed online where they can be made immediately by the caller with no waiting. (fmservice.com)
  • Reactivating a Cancelled Coverage – please follow the procedure to reactivate these policies. Reactivation/ Restart Coverage

Escalations That Should be Submitted

Identification of when to appropriately submit an EXRT cases is dependent on whether the servicing agent has system access or not.

Account Change Only

  • Escalate if the PI references that they have requested to change their account number multiple times but the money is still being debited to the incorrect account

Beneficiary Name Typo

  • Primary insured points out a typo in the beneficiary name

Billing-Related

  • Billing cycle changed (Used to be Quarterly and unexpectedly changed to Monthly)
  • Issue with Takeover (For example, a duplicate billing)

Cancellation

  • Primary insured cancelled in error (if same day)
  • Same day – We should be able to delete the letter
  • Coverage will not cancel when requested

Customer calls back to speak to an Executive Response Team Member (Lori Peterson, Nick Young, or Miguel Mannings)

  • If a customer is returning an Executive Response Team Member’s call, you can provide the customer with the team member’s direct phone number or enter a case for Lori, Nick or Miguel to return their call.

Nick      (844) 306-0762  x5001
Lori       (844) 306-0762  x5002
Miguel  (844) 306-0762  x5003

 Duplicate Certificate Request (Caller has requested several times and time frame has passed) (Envelope description)

  • 6 x 9 envelope; carrier name in the upper corner; left hand side large window
  • 10-15 business days
  • Confirm address
  • Check notes
  • 3rd request – escalate to ExRT

NOTE – Duplicate Certificates CANNOT be faxed 

Irate Callers

  • If customer states they will be pursuing further action if their situation is not resolved, it is an automatic escalation to ExRT via case (i.e., Attorney General, Lawyer, Better Business Bureau (BBB), Department of Insurance, etc.)

Power of Attorney (POA)   

  • Not updated and customer insisted they sent it to corporate, ExRT will request a fax directly from the caller upon working the escalation
  • POA only added to one coverage

Prepay   

  • Apply prepay – If the prepay has not been applied to the current billing period after the 17th of the month
  • Prepay refund

Refund

  • If refund has been issued, but has not been received and it’s 15 business days from paid date (date anticipated going back into account) on paper check

Repeat / Multiple Calls For the Same Reason

  • Customers calling back into customer service 3 or more times for the same reason (for example an account change not getting updated correctly) should be escalated and directed to the Executive Response Team for investigation and resolution.
  • Previous escalated issues for same concern (check the notes first, resolution will be noted).
  • Note that a caller that has called four times to do an account change; but keeps misplacing the form is not the same as someone that has mailed a form in four times and it’s not getting processed correctly.

Restart / Activation

  • If coverage was cancelled for any reason in error
  • System will not allow restart on eligible coverage
  • Note: Coverages with TransAmerica as the carrier cannot be restarted

Unauthorized Premium Deduction

  • Premium being deducted from someone else’s account
  • ExRT will request a fax directly as needed from the caller upon working the escalation

Urgent Requests – Fax/Email (No Cash Value/Cancellation Confirmation/Beneficiary Change/Age 70 Letter)

  • Emailing these 4 forms should be the ONLY kind of urgent requests and are typically at the request of Medicare or Hospice
  • Email should be priority
  • Fax in limited situations – Note in comments if customer does not have email
  • Note that policies CANNOT be emailed to callers

How to Submit an ExRT Case

Please be sure to include all information when submitting an EXRT case. It is imperative to include the following details:

  • All information for required fields
    • Contact information include email & telephone number [Be Sure to Read Back And Verify Spelling]
  • For Fields:
    1. Record Type ID: Leave this field alone.
    2. Reason for Escalation: Select from the drop down menu.
    3. Your Name: This should be the name of the Tier II agent submitting the case.
    4. Subject: At a high level, what is the escalation? Escalations that are the highest priority and require Urgent attention must have “URGENT” written in the subject line. Additionally, a team lead / unit manager must be notified in the event an URGENT escalation exists in order for Franklin Madison to be notified of the priority. In the event of a cancellation (not due to death), be sure to include the policyholder’s date of birth.
    5. Escalation Notes: Summarize the nature of the escalation (why did the person call)
    6. Caller’s Information: Contact Name, phone number, & email address of the caller.
    7. Primary Insured Information: Contact Name & Coverage ID of the primary insured. If the caller does not have the coverage ID, then enter 999999999.
    8. Requester Email: This is the email address for the person completing the form. Please do not use a generic email or the email of a lead / unit manager.
    9. Requester Notes: Please provide all relevant information in order to understand the nature of the escalation, as well as to make contact with the caller. Key factors to include would be if someone has passed away, detailed explanation if this is a billing concern, name of the person requesting a callback if different from the policyholder’s name, etc.
    10. Artemis Client ID: use the Client ID number from green screens
    11. Product: Select from the drop down menu

All information must be confirmed with the caller while still on the phone.

Once a case has been submitted, contact will be made within 2-3 business days.