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Questions and Answers

What is the primary purpose of allowing a caller to vent during a call?

  • To create telephone silence
  • To impose your own viewpoint
  • To acknowledge the caller's frustrations (correct)
  • To end the call as quickly as possible

Using a calm tone is important when dealing with difficult callers.

True (A)

What does the 'E' in L.E.A.P.S stand for?

Empathize

Match the communication techniques with their descriptions:

<p>Active listening = Repeating back issues to ensure understanding Empathy = Understanding and acknowledging feelings Acknowledgement = Using phrases to recognize frustrations Positive language = Using uplifting and encouraging words</p> Signup and view all the answers

In the strategy for handling difficult callers, the 'P' in L.E.A.P.S stands for ___

<p>Positive</p> Signup and view all the answers

Which of the following is NOT a component of the L.E.A.P.S strategy?

<p>Advocate (C)</p> Signup and view all the answers

It is important to focus your attention on the caller during the conversation.

<p>True (A)</p> Signup and view all the answers

To convey a positive message instead of saying 'Sure', one might say '___'

<p>Absolutely</p> Signup and view all the answers

Constituent services are not crucial for building and maintaining relationships with constituents.

<p>False (B)</p> Signup and view all the answers

Which of these is NOT a hard skill?

<p>Empathy (C)</p> Signup and view all the answers

What are the three C's of constituent services?

<p>Communication, Consistency, Caring</p> Signup and view all the answers

Satisfied constituents are more likely to ______ the dental benefits offered.

<p>use</p> Signup and view all the answers

What is the primary objective of constituent services?

<p>To build and maintain positive relationships with constituents (D)</p> Signup and view all the answers

A satisfied constituent is less likely to be patient with the organization.

<p>False (B)</p> Signup and view all the answers

Give one example of a hard skill relevant to constituent services.

<p>Computer knowledge</p> Signup and view all the answers

Which of the following is NOT a conflict resolution method mentioned in the provided text?

<p>Problem Solving (B)</p> Signup and view all the answers

Keeping spaces clean and tidy is an example of being organized.

<p>True (A)</p> Signup and view all the answers

What are two benefits of having a good memory?

<p>Improved ability to learn and enhanced mental health</p> Signup and view all the answers

Adaptability includes being willing to ______ and taking on new responsibilities.

<p>learn</p> Signup and view all the answers

Which of the following is NOT a tip for being adaptable at work?

<p>Avoid challenging tasks (E)</p> Signup and view all the answers

Adaptability includes being willing to change physical locations at work.

<p>True (A)</p> Signup and view all the answers

What are two examples of empathy statements?

<p>&quot;I can see how that would be really difficult for you.&quot; and &quot;I understand how you feel.&quot;</p> Signup and view all the answers

A good memory can ______ stress and increase resilience.

<p>reduce</p> Signup and view all the answers

Which of the following is NOT a benefit of having a good memory?

<p>Reduced ability to focus (A)</p> Signup and view all the answers

Which of the following is NOT a tool for time management?

<p>Utilize distractions (B)</p> Signup and view all the answers

Knowledge does not contribute to building confidence.

<p>False (B)</p> Signup and view all the answers

What is one barrier to clear communication?

<p>Poor listening</p> Signup and view all the answers

Transparency ______ trust and rapport.

<p>builds</p> Signup and view all the answers

Which of the following is NOT a benefit of knowledge?

<p>Increases procrastination (C)</p> Signup and view all the answers

Emotional barriers can be avoided by considering all situations objectively.

<p>False (B)</p> Signup and view all the answers

What is one benefit of taking scheduled breaks?

<p>Increased productivity</p> Signup and view all the answers

Which of the following is NOT a benefit of humor at work?

<p>Causes confusion (D)</p> Signup and view all the answers

One of the keys to providing white-glove service is to ensure timely and accurate service.

<p>True (A)</p> Signup and view all the answers

Name one tool that can improve constituent service skills.

<p>Confidence</p> Signup and view all the answers

Humor helps to _____ stress in the workplace.

<p>reduce</p> Signup and view all the answers

According to Warren Buffett, what should companies aim for beyond customer satisfaction?

<p>Delight customers (A)</p> Signup and view all the answers

The phrase 'no wrong door' implies that constituents should have a seamless experience throughout their journey.

<p>True (A)</p> Signup and view all the answers

A key aspect of white-glove service is exceptional care, attention, and _____ towards customers.

<p>attitude</p> Signup and view all the answers

Which type of transfer involves placing the caller on hold and then connecting them without the recipient's knowledge?

<p>Cold transfer (C)</p> Signup and view all the answers

It is important to use industry jargon when communicating with constituents.

<p>False (B)</p> Signup and view all the answers

What should you do before transferring a call?

<p>Ask for permission before placing the constituent on hold or transferring.</p> Signup and view all the answers

When dealing with difficult constituents, it is important to set clear ______.

<p>expectations</p> Signup and view all the answers

Match the following tips for dealing with difficult conversations:

<p>Use simple language = Avoid industry jargon Keep a professional tone = Maintain a friendly demeanor Smile over the phone = Create a positive atmosphere Don’t take it personally = Focus on the issue, not the person</p> Signup and view all the answers

Which of the following is NOT a recommended practice when handling difficult constituents?

<p>Ignore the caller's questions (C)</p> Signup and view all the answers

Taking a break is considered a good practice when dealing with difficult conversations.

<p>True (A)</p> Signup and view all the answers

What should you provide to the caller about timeframes during difficult conversations?

<p>Give realistic timeframes.</p> Signup and view all the answers

Which of the following is a benefit of maintaining phone etiquette?

<p>It shows professionalism (B)</p> Signup and view all the answers

It is easier to mirror emotions during a phone conversation than in person.

<p>False (B)</p> Signup and view all the answers

What should you do as soon as possible when answering a phone call?

<p>Introduce yourself</p> Signup and view all the answers

Phone etiquette tips include minimizing distractions and paying attention to your __________.

<p>language</p> Signup and view all the answers

Which of the following is NOT a tip for effective phone etiquette?

<p>Ignore the caller's tone (D)</p> Signup and view all the answers

Name one reason why phone etiquette is important.

<p>It helps make a good first impression</p> Signup and view all the answers

It is more challenging to pay attention over the phone compared to in person.

<p>True (A)</p> Signup and view all the answers

Which type of teeth are specialized for cutting?

<p>Incisors (B)</p> Signup and view all the answers

The crown is the part of the tooth that is below the gum line.

<p>False (B)</p> Signup and view all the answers

What are the two sets of teeth we get during our lifetime called?

<p>Deciduous teeth and permanent teeth.</p> Signup and view all the answers

The primary role of a _____ is to clean teeth and provide preventative care.

<p>Dental Hygienist</p> Signup and view all the answers

Match the following dental terms with their definitions:

<p>Prophylaxis = A preventive dental cleaning Crown = A cap placed over a tooth Root Canal = A procedure to treat infection in the tooth pulp Denture = A removable replacement for missing teeth</p> Signup and view all the answers

Which of the following is NOT a surface of a tooth?

<p>Cervical (A)</p> Signup and view all the answers

The maxillary arch refers to the lower jaw.

<p>False (B)</p> Signup and view all the answers

Name one clinical position held in a dental office.

<p>Dentist, Dental Hygienist, or Dental Assistant.</p> Signup and view all the answers

Which type of dental X-ray is specifically used for assessing the condition of fillings and root canals?

<p>Periapical X-ray (C)</p> Signup and view all the answers

Dental implants are a temporary solution for tooth loss.

<p>False (B)</p> Signup and view all the answers

Name one branch of dentistry that focuses on the aesthetics and appearance of teeth.

<p>Cosmetic dentistry</p> Signup and view all the answers

To maintain good oral health, it is essential to brush teeth twice a day with __________ toothpaste.

<p>fluoride</p> Signup and view all the answers

Match the following dental conditions with their descriptions:

<p>Toothache = Pain in or around a tooth TMJ = Disorder affecting jaw joint Sensitivity = Pain when consuming hot or cold Gum disease = Infection of the tissues supporting teeth</p> Signup and view all the answers

Which X-ray type provides a comprehensive view of the entire mouth?

<p>Panoramic X-ray (C)</p> Signup and view all the answers

Regular dental check-ups should be conducted once a year.

<p>False (B)</p> Signup and view all the answers

What is one common dental procedure used for treating cavities?

<p>Fillings</p> Signup and view all the answers

Which dental services are included for MassHealth members over 21?

<p>Exams &amp; cleanings (B)</p> Signup and view all the answers

MassHealth Limited provides coverage for both routine check-ups and emergency services.

<p>False (B)</p> Signup and view all the answers

What is the yearly cap for services under CMSP?

<p>$750</p> Signup and view all the answers

Health Safety Net Partial is similar to Health Safety Net but has a ______.

<p>deductible</p> Signup and view all the answers

Match the following MassHealth categories with their services:

<p>MassHealth Under 21 = Includes orthodontia with prior authorization MassHealth over 21 = Exams, fillings, and extractions MassHealth Limited = Only covers emergency services CMSP = Yearly cap of $750 for various services</p> Signup and view all the answers

Which of the following is NOT part of BeneCare's vision value proposition?

<p>Aesthetics (A)</p> Signup and view all the answers

The term 'Producer' refers to a type of Dentist in BeneCare's nomenclature.

<p>False (B)</p> Signup and view all the answers

What is the core criteria satisfied by the BeneCare outcomes-based model?

<p>Documenting success</p> Signup and view all the answers

Match the following terms with their respective definitions:

<p>Member = Individual enrolled in the benefit plan Sponsor = Entity providing the benefit plan Dentist = Dental professional providing services Constituent Services = Support services for beneficiaries</p> Signup and view all the answers

What is a component of a dental plan?

<p>Participating practitioner network (D)</p> Signup and view all the answers

MassHealth provides benefits to all individuals living in Massachusetts without any eligibility requirements.

<p>False (B)</p> Signup and view all the answers

What year was BeneCare's value-based model created?

<p>1979 (C)</p> Signup and view all the answers

BeneCare focuses on providing access to oral health care.

<p>True (A)</p> Signup and view all the answers

What are two benefits of access to oral health during childhood?

<p>Longer, healthier lives and higher educational attainment.</p> Signup and view all the answers

A dental plan may include member out of pocket costs such as deductibles, copayments, and/or ______.

<p>co-insurance</p> Signup and view all the answers

Name one of the daily responsibilities mentioned for BeneCare.

<p>Helping navigate benefits or scheduling appointments or helping find a dental provider.</p> Signup and view all the answers

Match the following terms with their descriptions:

<p>Deductibles = Amount paid before the insurance covers costs Copayments = Fixed amount paid for a service Annual benefit limitations = Maximum amount covered by insurance in a year Exclusions = Items or services not covered by the plan</p> Signup and view all the answers

BeneCare aims for _____ % of first call resolutions.

<p>75</p> Signup and view all the answers

What percentage of calls is expected to be answered within 45 seconds?

<p>80% (A)</p> Signup and view all the answers

What significant event in dental history occurred in 1840?

<p>Opening of the first dental college (A)</p> Signup and view all the answers

Match the following services with their respective descriptions:

<p>Customer Services = Assisting constituents with inquiries Claims Administration = Processing claims for dental services Prior Authorizations = Obtaining approvals before services Quality Assurance = Ensuring service standards are met</p> Signup and view all the answers

Sick time is considered a type of paid time off (PTO).

<p>True (A)</p> Signup and view all the answers

The American Dental Association (ADA) was formed in 1841.

<p>True (A)</p> Signup and view all the answers

What is the role of BeneCare in relation to the MassHealth Dental Programs?

<p>BeneCare acts as the administrator that helps manage the MassHealth Dental Programs.</p> Signup and view all the answers

The BeneCare customer service model has two distinguishing characteristics.

<p>False (B)</p> Signup and view all the answers

Who is credited as the Father of Modern Dentistry?

<p>Pierre Fauchard</p> Signup and view all the answers

What is one key performance identifier mentioned for provider calls?

<p>90% of call receiving a passing quality of rating.</p> Signup and view all the answers

The first three dental benefits organizations were formed in ________.

<p>1954</p> Signup and view all the answers

Match the following years with their corresponding events in dental history:

<p>1840 = First dental college opened 1841 = Alabama enacts first dental practice act 1867 = Harvard University Dental School founded 1873 = Colgate mass-produces toothpaste</p> Signup and view all the answers

Which entity was formed in 1966 to provide dental benefits?

<p>Delta Dental Plans Association (A)</p> Signup and view all the answers

The Oregon Dental Service was founded in 1955.

<p>True (A)</p> Signup and view all the answers

What was the name of the first dental college?

<p>Baltimore College of Dental Surgery</p> Signup and view all the answers

What is an aspect of Person Centered Care?

<p>Prioritizing patient preferences (C)</p> Signup and view all the answers

Name one component of oral health literacy.

<p>Understanding dental terminology</p> Signup and view all the answers

Utilization Management focuses on the ____ of healthcare services.

<p>efficiency</p> Signup and view all the answers

Match each organizational aspect with its description:

<p>Oral Health Literacy = Understanding health information Person Centered Care = Focus on individual patient needs Prevailing Community Standard of Care = Established norms in healthcare Utilization Management = Management of healthcare resource use</p> Signup and view all the answers

Which of the following is a key focus of Utilization Management?

<p>Assessing the necessity of healthcare services (A)</p> Signup and view all the answers

Oral health literacy primarily involves knowledge of nutritious food.

<p>False (B)</p> Signup and view all the answers

What does prevailing community standard of care refer to?

<p>The accepted practices in healthcare within a community</p> Signup and view all the answers

Match the following concepts with their descriptions:

<p>Person Centered Care = Customization of care based on individual needs Oral Health Literacy = Knowledge and understanding of oral health Third-Party Admin = Agency managing insurance claims Prevailing Community Standard = Common practices accepted in healthcare</p> Signup and view all the answers

Standard ________ is the name of terminology used by all BeneCare employees? Where is it found?

<p>Nomenclature – page 2</p> Signup and view all the answers

What is the name of the fully integrated dental benefit, plan/policy, accounting/payment, network, claims and enrollment administration platform?

<p>PACE – Plan Accounting Claim Eligibility</p> Signup and view all the answers

What does KPI stand for?

<p>Key Performance Indicator</p> Signup and view all the answers

How do you dispose of PHI/PII?

<p>Shred Bin</p> Signup and view all the answers

When should you open files or macros attached to an email from an unknown, suspicious, or untrustworthy source?

<p>Never</p> Signup and view all the answers

What does HIPPA stand for?

<p>Health Insurance Portability and Accountability Act of 1996</p> Signup and view all the answers

Flashcards

Handling Difficult Callers

Managing challenging phone conversations effectively through soft skills.

Allow Venting

Let the caller express frustrations without interruption to calm them down.

Appropriate Tone

Adjust your tone and pace to reflect calmness and empathy during calls.

Acknowledge Issues

Show understanding of the caller’s concerns through active listening and empathy.

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Be Natural

Show your personality and confidence while focusing entirely on the caller.

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L.E.A.P.S. Method

A technique: Listen, Empathize, Apologize, Positive, Solve for better communication.

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Positive Language

Use upbeat and affirming phrases instead of negative ones to improve the conversation.

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Final Tips for Calls

Focus on the caller, use their name, and stay present without pre-planning responses.

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Constituent Services

Building and maintaining relationships with service users through support and communication.

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The 3 C’s of Constituent Services

Essential elements of constituent services: Communication, Consistency, Caring.

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Communication in Services

Involves both verbal and non-verbal interactions to convey messages effectively.

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Hard Skills

Specific technical abilities needed for a job, like data analysis and project management.

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Soft Skills

Interpersonal attributes that enable effective communication and interaction with others.

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Essential Skills

Fundamental abilities that are necessary for effective communication and service delivery.

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Nurture Skills

Skills that involve supporting and developing relationships through empathy and understanding.

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White Glove Service

Providing premium, personalized service that exceeds standard expectations.

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Time Management

The process of organizing tasks effectively to maximize productivity.

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Setting Goals

Establishing clear, actionable objectives to guide your efforts.

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Prioritizing Tasks

Deciding the order of tasks based on importance and urgency.

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Barriers to Communication

Obstacles that hinder clear communication between parties.

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Transparency in Communication

Openness that builds trust and accountability in interactions.

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Knowledge Importance

Knowledge enhances creativity and adaptability, improving communication.

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Avoiding Multitasking

Focusing on one task at a time to improve effectiveness.

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Scheduled Breaks

Taking planned pauses to refresh and maintain productivity.

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Empathy Statements

Statements expressing understanding of another's feelings or experiences.

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Conflict Resolution Methods

Techniques used to resolve disagreements or disputes effectively.

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5 W's in Problem Solving

A method involving Who, What, When, Where, Why for analyzing problems.

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Analytical Thinking

A problem-solving approach focused on breaking down complex information.

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Creative Thinking

The ability to think outside the box and come up with innovative solutions.

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Good Memory Benefits

Advantages of having a strong memory, like improved learning and mental health.

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Adaptability

The ability to adjust to new conditions or changes effectively.

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Steps to Be Adaptable

Tips for enhancing adaptability in the workplace, like seeking feedback.

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Organizational Skills

The ability to keep spaces tidy and resources accessible for efficiency.

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Collaborative Problem Solving

Resolving issues by working together with others for a solution.

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Cold Transfer

Transferring a call without introducing the next agent to the caller.

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Warm Transfer

Transferring a call after briefing the next agent about the caller's needs.

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Setting Expectations

Communicating what the caller can anticipate regarding timeframes and solutions.

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Use Simple Language

Avoid industry jargon to facilitate understanding during calls.

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Professional Tone

Maintaining a friendly and respectful voice throughout the call.

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Summarize/Paraphrase

Restating what the caller discussed to ensure understanding and validation.

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Proactive Service

Anticipating the needs of the caller and addressing them before being asked.

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Importance of Smiling

Smiling while on the phone can positively affect your tone and the call's atmosphere.

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Differences in Interaction

In-person allows for body language, while over the phone lacks visual cues.

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Importance of Phone Etiquette

Phone etiquette shows professionalism and helps create a good first impression.

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Trust and Loyalty

Good phone etiquette increases trust and loyalty in relationships.

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First Impressions on Calls

Making a good first impression over the phone is crucial for success.

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Active Listening

Taking notes and being engaged ensures effective communication.

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Voice Monitoring

Projecting voice volume, tone, and pace is key for clear communication.

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Minimizing Distractions

Reducing distractions during calls improves focus and understanding.

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Benefits of Humor at Work

Improves productivity, reduces stress, and boosts connections.

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Preventing Burnout

Using humor to keep energy up and stress down.

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Engagement in Service

Actively connecting with customers to enhance experience.

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No Wrong Door Policy

A system that ensures every interaction addresses customer needs effectively.

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Customer Feedback

Gathering and adapting based on customer surveys to improve service.

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Personalized Experiences

Tailoring services and interactions to meet individual customer needs.

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Willingness to Learn

An essential skill for improving customer service and interaction.

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Dental Implants

Artificial tooth roots placed into the jaw to support crowns or bridges.

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Branches of Dentistry

Different specialized fields within dentistry, including 8 main types.

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Periapical X-ray

An X-ray that captures the entire tooth and surrounding bone structure.

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Bitewing X-ray

An X-ray used to detect decay between teeth and assess bone levels.

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Panoramic X-ray (PANO)

A broad view X-ray that shows the entire mouth area in one image.

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Dental Cleaning/Prophylaxis

A professional cleaning to remove plaque and tartar from teeth.

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Common Dental Conditions

Frequent issues people experience related to oral health, like toothaches and sensitivity.

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How to Maintain Oral Health

Tips like brushing, flossing, and regular check-ups to keep teeth healthy.

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Dentistry

A branch of medicine focused on oral diseases and conditions.

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Types of Teeth

Four types: Incisors, Canines, Premolars, Molars.

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Teeth Surfaces

Teeth can have 5 surfaces: Facial, Lingual, Mesial, Distal, Occlusal.

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Deciduous Teeth

Also known as baby teeth, typically sets of 20.

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Prophylaxis

Preventive dental cleaning procedure.

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Scaling & Root Planning

Dental procedure to treat gum disease by cleaning teeth and roots.

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Crown

A cap placed on a damaged tooth to restore its shape and function.

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Root Canal

Procedure to remove infection from the tooth's interior.

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Dental Plan

A coverage option including services, costs, and exclusions for dental care.

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MassHealth

A program in Massachusetts providing healthcare benefits to eligible individuals.

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Children's Oral Health

Access to dental care in childhood impacts long-term health outcomes.

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Annual Benefit Limitations

Maximum dollar amounts covered by a dental plan per year for treatments.

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Participating Practitioner Network

A group of dentists that provide services at agreed rates under a plan.

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Covered Dental Services

Specific procedures and treatments included in a dental plan's coverage.

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PTO/Sick Time

Paid time off available to employees for personal or health-related reasons.

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Attendance Policies

Guidelines regarding employee presence at work and expected timekeeping.

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MassHealth Under 21 Services

Dental services for those under 21 include exams, cleanings, and orthodontia with prior authorization.

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Emergency Services under MassHealth Limited

Coverage limited to emergency services like exams and extractions, with 7 specific codes.

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CMSP Benefits

Offers up to $750 yearly cap for dental services including exams, fillings, and crowns.

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Health Safety Net (HSN)

Provides support similar to HSN but includes a deductible for eligible members.

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Public/Private Partnerships

Collaborations aimed at delivering quality healthcare to underserved populations while ensuring fiscal responsibility.

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Value Proposition

A statement summarizing why a consumer should choose a product or service based on its benefits.

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BeneCare’s Vision

The overarching goals of BeneCare emphasizing usability, affordability, flexibility, predictability, and stability.

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Standard Nomenclature

Common terms used in the context of dental care and services, including roles like member and practitioner.

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BeneCare Origin

BeneCare created its value-based model in 1979 focusing on oral health.

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Goal of BeneCare

The main goal of BeneCare is to improve oral health outcomes.

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Key Performance Indicators (KPIs)

Metrics to evaluate performance, such as call quality and resolution rates.

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Service Level Agreement (SLA)

A commitment defining expected service performance metrics.

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Customer Satisfaction Rate

Percentage of customers reporting high satisfaction with services.

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Scope of Services

Range of services including administration, customer support, and quality assurance.

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Constituent Services Model

BeneCare's approach to support that emphasizes communication, consistency, and caring.

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Dental Provider Network

A system of dental professionals participating in BeneCare's services.

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Oral Health Literacy

The ability to obtain, process, and understand oral health information.

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Person Centered Care

Healthcare that respects and responds to individual patient preferences.

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Prevailing Community Standard of Care

The level of care that is accepted as appropriate by healthcare professionals.

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Utilization Management (UM)

Processes that determine the appropriateness of healthcare services.

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Third-Party Administration

Management of employee benefit programs by an entity other than the employer.

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History of Dentistry

The evolution of dental practices from ancient civilizations to modern day.

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Father of Modern Dentistry

Pierre Fauchard, who published the first dental book in 1723.

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First Dental College

Opened in 1840, the Baltimore College of Dental Surgery was the first dental school.

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American Dental Association (ADA)

Founded in 1859 to promote dental health and education.

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Delta Dental Plans Association

Formed in 1966, this organization provides dental service plans.

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Study Notes

Handling Difficult Callers

  • Agenda:
    • Building confidence when dealing with challenging calls
    • Reinforcing "soft skills" for better call handling
    • Group tips, tricks, and feedback

Tips for Gaining Control of a Call

  • Allow callers to vent their frustrations
  • Maintain a calm and appropriate tone
  • Acknowledge caller concerns and issues
  • Utilize "soft skills" naturally

Allowing Venting

  • Utilize telephone silence
  • Allow the caller to express frustrations
  • Use acknowledgement techniques
  • Refocus on problem-solving
  • Do not take the issue personally

Appropriate Tone

  • Calm your tone
  • Adjust the communication rhythm
  • Slow down speech
  • Mirror the caller's emotional state and show empathy

Acknowledge Caller's Issues

  • Use empathy
  • Acknowledge caller frustrations
  • Engage in active listening
  • Repeat issues back to the caller to show active listening

Be Natural

  • Let your personality shine through
  • Maintain confidence and show no fear
  • Utilize your soft skills
  • Focus your attention on the caller
  • Don't necessarily strive to "win" the call

L.E.A.P.S.

  • L: Listen; allow the caller to vent
  • E: Empathize; acknowledge their feelings
  • A: Apologize if appropriate
    • Even for problems not your fault, express remorse
  • P: Remain positive
  • S: Solve; suggest solutions and find common ground or compromises / help if possible

Positive Language to Use

  • Instead use positive substitutes for "sure", "yep" etc
  • Examples:
    • Absolutely
    • Excellent
    • You are correct
    • I can help with that
    • My pleasure
    • I understand

Final Tips

  • Listen attentively without preconceived responses
  • Be present in the moment
  • Personalize calls with caller's name
  • Prioritize the human aspect of the call before business
  • Focus on what you can do, not what you can't
  • Recognize triggers and manage them effectively
  • Prevent a negative call from affecting subsequent calls

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