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iRubric: Consulting and Needs Analysis rubric

iRubric: Consulting and Needs Analysis rubric

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Consulting and Needs Analysis 
This performance assessment involves compliant consulting and needs analysis with Medicare beneficiaries via telesales with the purpose of enrolling the beneficiary in a Medicare Advantage health plan.
Rubric Code: C248582
By jfrubric
Ready to use
Public Rubric
Subject: Health  
Type: Assessment  
Grade Levels: (none)

Powered by iRubric Expectation
  Non-Performance

0 pts

Below Expectations

1 pts

Basic

3 pts

Proficient

2 pts

Distinguished

4 pts

Needs Analysis

Non-Performance

Agent fails to conduct a thorough needs analysis in order select the plan that is most aligned with the beneficiary's needs and eligibility. Agent misses all of the needs analysis categories: current coverage, ancillary needs, and coverage utilization.
Below Expectations

Agent conducts a needs analysis that only partially uncovers the beneficiary's needs. Agent misses two of the three needs analysis categories: current coverage, ancillary needs, and coverage utilization.
Basic

Agent conducts a needs analysis that only partially uncovers the beneficiary's needs.
Agent misses one of the three needs analysis categories: current coverage, ancillary needs, and coverage utilization
Proficient

Agent conducts a thorough needs analysis that uncovers what the beneficiary needs from their health insurance in order to match the most aligned plan that fits their needs and eligibility. Agent inquires about current coverage, ancillary needs, and coverage utilization.
Distinguished

Agent conducts a thorough needs analysis that uncovers what the beneficiary needs from their health insurance in order to match the most aligned plan that fits their needs and eligibility. Agent inquires about current coverage, ancillary needs, and coverage utilization.
Agent researches all providers and medications beneficiary uses and recommends plan alternatives if provider is not in network or prescription not on formulary.
Eligibility/Current Coverage/Special Enrollment

Non-Performance

Eligibility: Agent fails to determine if beneficiary's has both Medicare Part A (Hospital) & B (Medical). Current Coverage: Agent fails to identify additional coverage ex. other health insurance LIS, Medicaid ,etc. SEP: Agent fails to determine if beneficiary has a valid special enrollment period if enrolling outside of the annual enrollment period.
Below Expectations

Eligibility: Determines if caller has Medicare Part A (Hospital) & B (Medical). Current Coverage: Agent identifies additional coverage ex. other health insurance, LIS, Medicaid, etc.
SEP: Agent asks 3-8 eligibility questions to determine valid special enrollment period if enrolling outside of the annual enrollment period.
Basic

Eligibility: Determines if caller has Medicare Part A (Hospital) & B (Medical). Current Coverage: Agent identifies additional coverage ex. other health insurance, LIS, Medicaid, etc.
SEP: Agent asks 9-14 eligibility questions to determine valid special enrollment period if enrolling outside of the annual enrollment period.
Proficient

Eligibility: Determines if caller has Medicare Part A (Hospital) & B (Medical). Current Coverage: Agent identifies additional coverage ex. other health insurance, LIS, Medicaid, etc.
SEP: Agent asks 14-18 eligibility questions to determine valid special enrollment period if enrolling outside of the annual enrollment period.
Distinguished

Eligibility: Determines if caller has Medicare Part A (Hospital) & B (Medical). Current Coverage: Agent identifies additional coverage ex. other health insurance, LIS, Medicaid, etc.
SEP: Agent successfully asks all possible 19 eligibility questions to determine valid special enrollment period if enrolling outside of the annual enrollment period.
Benefits Review/Minimum Necessary

CTM Drivers: Plan name, premiums, PPO disclaimer, medications (formulary presence, tiers, cost/deductible), providers (primary care physician, specialists, hospital)
Non-Performance

Agent failed to provide a clear and concise benefits review.
Does not give most enticing plan benefits and needed benefits uncovered during needs analysis. Agent failed to review all CTM drivers prior to proceeding with enrollment.
Below Expectations

Agent gives clear and concise benefits review of 2-6
Provides most enticing plan benefits and needed benefits uncovered during needs analysis. Agent ensures all top CTM drivers are reviewed prior to proceeding with enrollment.
Basic

Agent gives clear and concise benefits review of 7-12
Provides most enticing plan benefits and needed benefits uncovered during needs analysis. Agent ensures all top CTM drivers are reviewed prior to proceeding with enrollment.
Proficient

Agent gives clear and concise benefits review of 13-19
Provides most enticing plan benefits and needed benefits uncovered during needs analysis. Agent ensures all top CTM drivers are reviewed prior to proceeding with enrollment.
Distinguished

Agent gives clear and concise benefits review of all 20 compliance benefits.
Provides most enticing plan benefits and needed benefits uncovered during needs analysis. Agent ensures all top CTM drivers are reviewed prior to proceeding with enrollment.
Objection Handling

Non-Performance

Agent does not attempt to provide an objection response or attempt to follow the sales funnel process.
Below Expectations

Agent makes at least 1 attempts to provide a response to any objection from the beneficiary to close the sale.

Agent does attempt to follow the sales funnel process when the beneficiary objects to the sales offer.
Basic

Agent makes at least 2 attempts to provide a response to any objection from the beneficiary to close the sale.

Agent follows the sales funnel process when unable to overcome objection to enroll telephonically.
Proficient

Agent makes at least 3 attempts to provide a response to any objection from the beneficiary to close the sale.

Agent follows the sales funnel process when unable to overcome objection to enroll telephonically.
Distinguished

Agent provides a response to all objections from the beneficiary to close the sale.

Agent follows the sales funnel process when unable to overcome objection to enroll telephonically.
Script Compliance

Non-Performance

Agent missed one or did not ready any applicable compliance elements marked in red on the Talking Points script.
Below Expectations

Agent reads all applicable compliance elements marked in red on the Talking Points script.

Agent speaks in a robotic tone while following call guideline, does not engage in a conversation about anything other than insurance , and reads call script verbatim.
Basic

Agent reads all applicable compliance elements marked in red on the Talking Points script.

Agent speaks in a friendly tone while following call guideline, does not engage in a conversation about anything other than insurance , and reads call script verbatim.
Proficient

Agent reads all applicable compliance elements marked in red on the Talking Points script.

Agent speaks in a friendly tone while following call guideline, but does not engage in a conversation about anything other than insurance.
Distinguished

Agent reads all applicable compliance elements marked in red on the Talking Points script.

Agent speaks in a friendly and conversational tone while following call guideline.




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