AccountId: 011433970860
ContactId: 1cbfb5df-dd47-4c2f-908a-db0fe6dfdc33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 682119 ms
Total Talk Time (AGENT): 328175 ms
Total Talk Time (CUSTOMER): 351180 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/1cbfb5df-dd47-4c2f-908a-db0fe6dfdc33_20250310T20:42_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. How are you? This is [PII].
[AGENT][NEUTRAL] Hi [PII], how's it going?
[CUSTOMER][NEUTRAL] Uh, it's going. It's Monday.
[AGENT][NEUTRAL] I hear that.
[CUSTOMER][NEUTRAL] Yeah, uh, well, I have, uh, I have a special call. I got Ms [PII]. She's in the broker. She works, uh, directly with the agent, which is Mr. [PII].
[CUSTOMER][NEUTRAL] And um she is um broker. Well, she said she sent this claim to [PII] sent it to us, so it seems like a big deal. Um anyways, um, the claim, it seems to be um waiting for some information, um, which I checked and it looks like it it's not completed or completely filled out, but I cannot tell which part because I checked the highlighted information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't see exactly what we're needing. So I don't know if you can see and maybe figure it out and see what is missing. It's a disability.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, it's 214567-9.
[AGENT][NEUTRAL] Is she on the phone with you?
[CUSTOMER][NEUTRAL] Yeah, yeah, she is. Mhm. Yeah.
[AGENT][NEUTRAL] OK, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK, let's take a look here. I'm gonna pull up the documents and just see if I can.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Help figure out what's going on.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because usually I'm able to see like, oh it's missing a signature, oh it's missing this, but not this time. I don't know why we're missing.
[AGENT][NEUTRAL] Says it's missing the employer information so let me just take a look here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we got the claimant statement of insured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We got the disability portion.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And we got number 8, at page 8, which is stand for. I'm, I'm, I'm confused.
[AGENT][NEUTRAL] OK, so that's the doctor.
[CUSTOMER][NEUTRAL] Policy holders' payment?
[AGENT][NEUTRAL] Uh, page 8, I was looking at the physician. So it does say we do have page 8 here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, uh yeah, so I'm really confused exactly what, what I need to tell Ms. [PII], what exactly we need.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Probably I'm thinking I'm not sure, but it looks like instead of the employer completing that form he completed the form, the insured.
[AGENT][NEUTRAL] The employer portion that's missing the claim form is incomplete in order to have consideration, uh, have your employer complete the employer portion of the claim form in its entirety.
[AGENT][NEUTRAL] So it looks like he completed that claim form. Do, do we know if he.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was sent by Ms. [PII], so I'm not really sure how it went. And do you want me to put her in and maybe you can figure this out together.
[AGENT][NEUTRAL] Yeah, I mean, I'll be happy to to try to talk to her because like I said that's what it looks like to me. We got the form however it was completed by the insured and not the person at uh [PII]'s AC yep, the organization itself. I, I believe that it has to be completed by someone in that organization.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I see that. Mhm, yeah, yeah.
[CUSTOMER][NEUTRAL] Got you. OK. OK dokey. Well, let me give you her callback number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and everything's been verified thus far, correct?
[CUSTOMER][NEUTRAL] I did verify everything from the member. She provided me the social, that's how I pull it up, so I did verify the information, OK?
[AGENT][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] All right, here she comes.
[AGENT][NEUTRAL] And it's Miss [PII] correct? and she's the broker.
[CUSTOMER][NEUTRAL] Miss [PII], yes, mhm. She's with the Berson. OK, here she comes. Very good. You're welcome. You too. Oh, give me, give me just a second. You're welcome. OK. You know what, my brain just went dead. What's your name?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, thank you so have a good day.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, you're fine.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, and I, I know I'm like, I know she told me, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's Monday. Oh, it needs to be 5, it needs to be 5.
[AGENT][NEUTRAL] It's OK. It's Monday, it's Monday, and it's the day after we change time, so everybody's just out of sync.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, yeah, and there's like a lot of calls today, so I don't know why.
[AGENT][NEUTRAL] Yeah, well, that's why.
[CUSTOMER][POSITIVE] They decided today, OK, yeah, OK, here she comes. Have a good afternoon. Thank you.
[AGENT][NEUTRAL] It's [PII].
[AGENT][POSITIVE] You too, thanks.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for this [PII]. I got Ms. [PII] on the line. She's in the claims department, the claims support department, and she's gonna assist you from here, OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Hello. Hi, Ms. [PII]. My, my name is [PII], and I'm in the um the claim support team. So, um, it looks like we were, um, pending this claim for some additional information, so we did receive all parts of the claim form, but it appears that we are asking for the employer portion of the claim form.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] To be completed by the employer, so it was that page 8 of the documents, um, and it's, it, it states the policyholder statement, but it's also um that employer portion of the claim form because at the bottom of the claim form it asked for the organization and then the person completing the organization and it looks like Mr. [PII] actually completed the form and then he signed it.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So it should be completed by the employer and that's what the um that's what the remark code is indicating that the employer portion of the form needs to be completed it's an entirety by someone from the employer organization.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So basically it needs the employer's signature. It's completed. Is there anything else missing? It just needs a sig.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Right, it doesn't appear so because I do see all the portions of the form are completed, but like I said because it was completed by the employee, they're asking for that employer form um to be completed so it does look like all parts of the form oh go ahead.
[CUSTOMER][NEUTRAL] It needs the
[CUSTOMER][NEUTRAL] OK, so what steps.
[CUSTOMER][NEUTRAL] What steps have been taken to get it?
[AGENT][NEUTRAL] Um, I believe at this point it was the explanation of benefits went out to the employee letting them know that they form, um, just give me one minute, let me check some other information.
[AGENT][NEUTRAL] Yes, so the, um, again, the, the explanation of benefits went out to the employee and that was on [PII], went out on [PII], it looks like it was completed and the indication from the adjuster that processed the claim is saying that the policyholder form was completed needs to be completed by the employer. The policyholder claim form was completed by the insured. So like I said that we don't see anything wrong with the form other than it needs to be completed by the employer.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, so the email that I forwarded to [PII] that was forwarded to the claims division came from the human resources manager.
[CUSTOMER][NEUTRAL] So would that not be enough of an assumption that she reviewed the documents or?
[AGENT][NEUTRAL] Well, it's just because of what's on the form at this point we need that completed it, yeah, it does have to be in writing just so that all of our paperwork lines up the way that it's supposed to for the claim uh that claim form being completed by the but you know we need the employee the employee portion, the physician's portion, and the employer's portion.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, so alright, so I'm just gonna tell you sending an EOB to that employee, he is not gonna understand a word of what you're asking for because even your customer service person didn't know what the story was.
[CUSTOMER][NEUTRAL] I looked at it while I was on the phone and I knew exactly what was wrong with it but had anybody in the claims department emailed the the HR manager directly whose name was on there or me we could have had this solved on [PII] instead of now being 310. So just I, I, I mean.
[CUSTOMER][NEGATIVE] I'm, I'm, I'm disappointed that for that one simple signature.
[CUSTOMER][NEGATIVE] Uh, we're, we're delaying this claim when you could have reached straight out to me, it came from me, came from the HR manager at the group, so I am right now I am.
[CUSTOMER][NEUTRAL] Sending it directly back to the HR manager telling her to make the correction on that final form and put her signature on it instead of the employee and she will send it back to me once that happens and I get it back today who do I send it to and where do I send it?
[AGENT][NEUTRAL] Well, it can, it can come, you can just submit it the same way that you did prior and the prior submission, but just so you understand that the instructions for that claim form are on that first page, uh, I'm sorry, for the, yeah, the claim form.
[CUSTOMER][NEUTRAL] I completely under I, I completely understand, but just so you understand, there's a 1000 instructions on there and this is such a simple simple thing that the wrong person signed it, but the right person sent it. The HR manager herself sent it, so it was a simple correction that we really shouldn't have had to make this employee wait for an additional 2 weeks when one email back.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] To [PII] or back to me, my name is on this. The HR manager's name is on it. It, it just, it's just.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Well, unfortunately.
[AGENT][NEUTRAL] Yeah, just so you're aware, unfortunately the the claims, the claims person that received this claim didn't have any indication that that's where the claim came from when we receive it, it goes through our mail department, so there's not any kind of um face sheet or anything on here to indicate that. So, uh, just for you know for all intents and purposes that that claims person probably didn't realize where it came from or where that where it initiated from um.
[CUSTOMER][NEUTRAL] I understood. I'll take.
[CUSTOMER][POSITIVE] OK. I'll take care of it today.
[CUSTOMER][NEUTRAL] I'll take
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] I'll take it. I'll take care of it today and I'll send it back to [PII] as soon as I have the correct signature on it.
[AGENT][NEUTRAL] OK, and I'll also, um, just for your information, I'll also give that feedback back to our management, um, you know, just so that they're aware, you know, because I am on the claim support team, so I will definitely reiterate that information to them.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK. Thank you so much. Take care.
[AGENT][POSITIVE] OK, you're welcome, Ms. [PII], and I, I, my apologies. Have a great day and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.