Question

A health insurance call center associate receives a call from a customer who seems upset. The customer reports having called many times about a claim, and it is still not settled. The customer speaks loudly and becomes more upset by the minute. Which of these should the representative say FIRST?

Answer 1

A health insurance call center associate should first listen calmly to the upset customer, express empathy, and use open-ended questions. The associate should avoid blaming language and focus on understanding and solving the customer's issue.

Step-by-step explanation:

When a health insurance call center associate receives a call from an upset customer with an unresolved claim, the representative should first ensure that they are following communication best practices to effectively address the customer's concerns. The representative should:

• Stay as calm as possible and actively listen to the customer.
• Express empathy and acknowledge the customer's frustration.
• Use open-ended questions to gather more information.
• Avoid any language that might suggest blame or create further conflict.
• Restate the customer's concerns to demonstrate understanding and validate their feelings.
• Focus on identifying and working towards a solution.
• If needed, consult with a supervisor or the HR department for assistance.

By carefully choosing their words, showing respect and a willingness to solve the problem, the representative can help to de-escalate the situation and work towards a satisfactory resolution for the customer's issue.