AccountId: 011433970860
ContactId: 42f38a97-505f-475e-bff5-b95870eb1e6b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 674619 ms
Total Talk Time (AGENT): 115311 ms
Total Talk Time (CUSTOMER): 329321 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/42f38a97-505f-475e-bff5-b95870eb1e6b_20250227T16:18_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] So I just got an email forward to me from [PII], you know her?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] Alright, she's asking a question about an employee on a claim for one of my clients, a PEO client that we have.
[CUSTOMER][NEUTRAL] So she says the policy number with you guys is 01941770.
[AGENT][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] 23,000.
[AGENT][NEUTRAL] OK, and let me have your name.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Or [PII].
[AGENT][NEUTRAL] All right. OK.
[CUSTOMER][NEUTRAL] And she's asking to verify because the claim came in with [PII] but her last name is [PII] on the claim.
[CUSTOMER][NEUTRAL] And they want to verify the same person, but I need more information. I have the client on the phone to verify the last name.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] OK, OK, I understand. All right, and uh let me have a phone number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is, um, you say you have her on the line with us?
[CUSTOMER][POSITIVE] Yeah I'll go.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, hold on a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] At least I got [PII] on the line, um, alright, so, uh, so what basically I got, I got an email from [PII].
[CUSTOMER][NEUTRAL] Today at [PII] uh roughly, but it it says good morning we receive a.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Claim on a [PII] policy number, the number I gave you, and then on the group number 15185.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oasis Outsourcing Holding Inc. Our records indicate that her last name as [PII], but the claim indicates the last name of [PII].
[CUSTOMER][NEUTRAL] But to verify if it's the same person and we could find [PII], we need more like a social, date of birth.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. And uh what is the date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, that's why I'm asking you what you have.
[AGENT][NEUTRAL] Pro
[CUSTOMER][NEUTRAL] Because I can verify if she's on the payroll and with Oasis, but I, I need more information for her to look up because if I look up [PII] or Way there's thousands of them.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh boy.
[CUSTOMER][NEUTRAL] Yeah, I just looked up [PII] in Prism, and there are like 12 of them, so I don't know which, and I wait, there's two ways, so I, I need like a, like a social or you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A date of birth and a social.
[AGENT][NEUTRAL] Do you have a [PII]?
[CUSTOMER][NEUTRAL] I'm, I'm sorry, what? I'll wait, I wait.
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] Like the middle initial is [PII]?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, I do see one that has a middle initial of L, um, and it's an active employee.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He and [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's under [PII]? Yeah, there's, well, I don't know if this is actually her. There is a [PII]. So what's her date of birth that you have in the system? That I have um let me find it.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] [PII]. Is that what you have?
[AGENT][NEUTRAL] This is her. Yes, this is her.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That is her? OK, so got gaps. I just wanna, you know, look at her benefits for a second just to be sure she's part time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I don't know I mean she.
[CUSTOMER][NEUTRAL] He did have gap.
[AGENT][NEGATIVE] She did have, mm mm. No. Correct.
[CUSTOMER][NEUTRAL] But not since
[CUSTOMER][NEUTRAL] She had it for but it turned in 2023.
[AGENT][NEUTRAL] Mm, 2024.
[CUSTOMER][NEUTRAL] Do you still have it termed in [PII]. like she's a part time employee. I, I think she was.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Maybe she went to part time.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] She went to part time in [PII]. I, I don't know, it's just showing that her I'm sorry, her coverage, her gap coverage ended 5-31-24. That's what I show here. She's got no active benefits with us now. Is this an old claim? I mean, I don't need to get that far. We need to find out what claims she's trying to file.
[AGENT][NEUTRAL] OK, let me check on that. And yeah, the policy terminated the last day of [PII]. So let me check and see exactly what um claim is this.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And this.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean unless is that a uh how do you have cobra is this a cobra? I don't know is gap continued through cobra.
[AGENT][NEUTRAL] Which that's, yeah.
[AGENT][NEGATIVE] It is not active.
[CUSTOMER][NEUTRAL] Well, first of all, APL you show her active?
[AGENT][NEUTRAL] No, no. She was terminated.
[CUSTOMER][NEGATIVE] So then why would you pay the claim? Why would we even entertain this if you don't show her active?
[AGENT][NEUTRAL] I'm not sure why they're asking for that. Um, let me check the notes and see why they send that email.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII], the date of service was February. I mean, it, or was the date because that just when you received the claim because like maybe it was for a date of service in the past.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What I have in the system is indicating that they, like you said, they may have put the day they received the claim. Um, I'll have to check um more information about this. Um, let me check and see, let me check with [PII]. Let me send her a message really quick, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] You know what, let me call her. It's gonna be a lot quicker. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Yeah, it's fine.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Can you hear me, maybe?
[CUSTOMER][POSITIVE] Yes, I can.
[AGENT][POSITIVE] OK, perfect. Let me go ahead and put him in, OK. Thank you.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][POSITIVE] Have a good day. You're welcome. Thank you for holding and information for me, Mr. [PII]. I got Ms. [PII] on the line.
[CUSTOMER][NEUTRAL] Well at least they figured out who the person is.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, [PII], how you doing?
[CUSTOMER][POSITIVE] Hello, I'm doing good. How are you?
[CUSTOMER][NEUTRAL] Good good I know you sent the email to [PII] but he forwarded it to me because they normally send it to me but uh so I noticed just [PII]'s term.
[CUSTOMER][NEUTRAL] Yes, OK. Um, so what happens is that, um, the insured filed a claim, um,
[CUSTOMER][NEUTRAL] The document management team or the claims department they received it and there was a mismatch in her last name uh with customer service on my end, all I need to do is confirm if the um last name is correct or not so we can update it into the system so this claims get this claim um gets processed. I honestly do not. Mhm.
[CUSTOMER][NEUTRAL] Uh-huh, but is she turned in your system?
[CUSTOMER][NEUTRAL] Yes, she is termed so what happens is that sometimes insureds uh file claims on previous like they they can claim um something that was back in last year at the beginning. I got you I got you. I got that part. My question was, it was it a current claim. Alright, so what do you need from I have Oasis I have Oasis on the phone.
[CUSTOMER][NEUTRAL] So what do you need to verify?
[CUSTOMER][NEUTRAL] Um, we just need to verify yeah her last name because in the system.