Special Enrollment Outbound Call, Answer ID#
Authenticate outbound call, primary contacts, answer ID # 1481
1. Review/Create the incident in RightNow (CRM)
2. Identify consumer’s request
3. Call consumer via the phone number listed in the incident record or application
4. IF the consumer answers: "Hello, this is <insert SCR first name> calling on a recorded line from Covered
California. May I please speak with (consumer’s first and last name)?”
a. Note: You must repeat the above script to the consumer if somebody else answers the phone. The
consumer must be aware that the phone call is being recorded.
5. If the consumer does not answer: Leave a message. Say, "This is <SCRs Frist Name> from Covered California,
please call us back at (855) 312-8161 between 8 am to 5pm, Monday thru Friday”.
6. Identify the person who answered the call.
7. Is the primary contact okay with their call being recorded?
a. If yes, go to step 9.
b. If no, say, "I'm sorry for the inconvenience, if you prefer you can call us back via our toll free Covered
California phone number at (800) 300-1506." Go to Step 8
8. Begin call wrap process. Document that the primary contact did not want their call recorded.
9. Is the primary contact okay with releasing their personal information over the phone?
a. If yes, go to Step 10
b. If no, say "I'm sorry for the inconvenience, if you prefer you can call us back via our toll free Covered
California phone number at (800) 300-1506." Begin call wrap process.
10. Authenticate the following four pieces of information for all outbound calls. Consumers must authenticate their
own accounts. If necessary, remind them that we are authenticating what was noted within consumer’s
application. Check CalHEERS, Right Now, or the paper application for:
a. First and Last name
b. Complete residential address including street name, city and zip code
c. Date of Birth
d. Last four digits of SSN
i. Note: If the reason for the outbound call to the consumer is any or some of a. – d. are missing
on their paper application, authenticate based upon a. – d. that is available to you).
11. Did the primary contact authenticate correctly?
a. If yes, go to Step 14
b. If no, go to Step 12
12. Say, "I'm sorry, I am unable to authenticate your account information, so unfortunately I am unable to assist you
with account specific information. Do you have any general questions that I can assist with?”
a. If yes, do not provide hints or account-specific information. Go to Step 15.
b. If no, go to Step 13.
13. Advise primary contact to call back with the correct account authentication information (i.e. correct address,
date of birth, etc.). Do they insist on speaking to someone else?
a. If yes, go to Contact CRT article within
b. If no, begin call wrap process.
14. State the reason for the call back.
a. Say, “I am processing your application and understand you have a ‘qualifying life event’. Can you tell me
what the qualifying event is or do you want me to read you a list of the common types of qualifying
events? “
i. If the consumer knows what their event is, obtain the missing information in order to complete
the application process.
 Please see the Application Key-In User Training Guide_v9 for processing directions.
ii. If the consumer is unsure of their qualifying event or asks you to read the list of common types
of events, read the below list to the consumer:
 Lost health insurance, including Medi-Cal
 Permanently moved to/within California
 Had a baby
 Adopted a child
 Got married or entered into a domestic partnership
 Retired from active duty military service
 Released from incarceration
 Gained U.S. citizenship/lawful presence
 Other qualifying life event
iii. If the consumer is still unsure, read the below list of the less common events to the consumer:
 Misconduct of a Certified Enrollment Counselor
 Loss of a Family member
 An exceptional circumstance
15. Identify primary contact’s request.
16. Search Knowledgebase to answer primary contact’s question(s).
17. Follow end of call wrap procedure
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Content Last Updated 10/03/2014