Member Services Call Center. The Contractor must maintain and staff a toll-free dedicated Member services call center to respond to Members’ inquiries, issues, or referrals. Members will be provided with one (1) toll free number, and the Contractor’s automated system and call center staff will route calls as required to meet Members’ needs.
Member Services Call Center. The CONTRACTOR shall operate a call center with a toll-free telephone line (Member services information line) to respond to Member questions, concerns, inquiries, and complaints from the Member, Representative or the Member’s Provider. The call center and its staff must be located and operated in the State of New Mexico. With prior written approval from HCA, the CONTRACTOR may locate specially-trained call center staff in other locations outside New Mexico so long as calls can be transferred with a Warm Transfer during the hours delineated in Sections 4.16.1.6 and 4.16.1.9 of this Agreement. With prior written approval from HCA. The CONTRACTOR may also allow Major Subcontractors that are providing Covered Services to Members to operate a call center specific to those Covered Services being provided. The CONTRACTOR shall develop Member services information line policies and procedures that address staffing, training, hours of operation, access, and response standards, transfers/referrals, including referrals from all sources, monitoring of calls via recording or other means, translation/interpretation, and compliance with standards. The CONTRACTOR’s call center shall have the capacity for HCA or its agent to monitor calls remotely. The Member services information line shall be equipped to handle calls from callers with LEP, as well as calls from Members who are hearing impaired. The CONTRACTOR shall have bilingual representatives based on the threshold of a prevalent non-English language specified in Section 4.15.2.5 of this Agreement. The CONTRACTOR shall ensure that the Member services information line is staffed adequately to respond to Members’ questions and meet -specified call center metrics at a minimum, from 8 a.m. to 5 p.m., Mountain Time, Monday through Friday, except for New Year’s Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day on the actual day on which the holiday falls. The call center staff shall be trained to respond to Member questions in all areas, including but not limited to Covered Services, including the ABP, the Provider network, and Member enrollment issues. The call center staff shall receive ongoing training, at least quarterly, through instructor-led trainings and staff meetings. The call center staff must receive training immediately following changes to service delivery and Covered Services. The Member services information line shall be staffed twenty-four (24) hours a day, seven ...
