Afternoon, Good evening, Good morning, where ever in the world you are.
I am in need of some assistance here -
FIRST - I have been tasked to crate a tool for our customer service department.
This tool has two purposes - the first is to keep track of escalated issues that are in various stages of resolutions. Part of the problem is when an issue is sent to an insurance carrier to confirm transactions sent over night the response time from them can vary from 1 day to 7 days. Meanwhile if the member calls in for a status update the issue is not in the work queue of the Representative working the issue.
So in order to keep track of the work and status a simple database is easy...
Capture the Escalaton Number
The Date that it was pulled into the work Queue
The Last name of the Individual
The insurance Carrier
The Reason for the Escalation
First Call made to the Member
Second Call Made to the member
Date issue was closed
For QA purposes review check list <---
That is the easy part, and can be done in EXCEL however
The Quality Assurance team has asked if a "CHECK" list could be added to assist the Team with ensuring that they are meeting certain built in requirements to pass the QA review on a monthly basis.
Some Actions that are taken to resolve an issue are more complex than others for example
Member was effective from 01/01/2023 and Termed 03/31/2023 due to a Non Payment
the CSR sends a request to the carrier to confirm eligiblibility for reinstatement - Carrier in this example says YES
A transaction is sent with re-enrollment effective 04/01/2023 -12/31/2023
This triggers a mandatory confirmation of Carrier
Note the Plan Name and Rates and Number of Members enrolled
A more complex issue would be
Member effective 01/01/2023 - 04/30/2023 member should have a $0 premium however the transaction failed to be transmitted correctly and the member was billed $1200 and subsequently termed
for non Payment 04/30/2023.
In this Case A DATA sheet is completed to reflect the correct premium rates from 01/01/2023-04/30/2023 and the carrier updates manually on their end and confirms the enrollment
Next the CSR needs to complete a Manual Correction Ticket , Update the Members enrollment in our system, and send a new transaction to enroll member 05/01/2023 - 12/31/2023
So some Issues need no further action and are closed for various reasons, member not eligible for re-enrollment
My thought process on this -
Keep the data separate -
Once this question was answered For QA purposes review check list <--- was entered as YES
then bring up another entry form to answer the questions to keep track of what was completed and as a reminder of what
may still may need to be completed to ensure that the work is done correctly, and to boost QA scores for the representatives
I don't think that an EXCEL spreadsheet is the answer, but it could be as the CSR members are very familiar with the program in filtering data
and completing Manual Correction sheets to the insurance carriers. I have looked into this and the only way to get this really going is using VBA code and I am
not that familiar with VBA to pull off inside Excel. Add to that Xcontrols with in excel are not an option as the IT department has banned its use.
Access is a weak point however I know enough to start to work with it and design something that would be useful.
So the Question is
Is it possible to have an Entry Form Triggered based on the question as seen above and have that data tied to the original entry form which would just keep
track of the CSR work flow and where issues are currently?