HIPAA for Health Plan Customer Service & Member Services
25 min
5 sections
10 quiz questions
HIPAA training designed specifically for member services representatives and customer service staff at health plans. Covers identity verification before disclosing PHI, handling calls from family members, spouses, attorneys, and employers, authorized representative documentation, the Minimum Necessary standard applied to live phone calls, social engineering defense, voicemail and callback risks, and call documentation requirements. Built for the highest-risk role at any health plan.
Course Content
1
The Front Line: Why Member Services Is the Highest-Risk Role
4 min
2
Identity Verification: Confirming Who You're Talking To
5 min
3
Third-Party Callers: Spouses, Family, Attorneys, and Employers
6 min
4
What You Can and Cannot Disclose on a Call
5 min
5
Social Engineering, Pressure Tactics, and Protecting Your Members
5 min
What You'll Learn
Core HIPAA regulations and requirements
Protected Health Information (PHI) handling
Privacy and security best practices
Breach notification procedures
Real-world scenarios and applications
Compliance documentation requirements
Administrative SafeguardsPhysical SafeguardsTechnical SafeguardsAudit ControlsEncryptionIntegrity ControlsTransmission SecurityMobile DevicesLaptops & WorkstationsRemote Access / VPNePHI (Electronic)Paper RecordsVerbal DisclosuresMinimum NecessaryDe-identificationLimited Data SetsDesignated Record SetPHI Disposal / DestructionPHI in Photos & VideoRight to AccessRight to AmendRight to AccountingRight to RestrictRight to Confidential CommunicationsNotice of Privacy PracticesAuthorization RequirementsPhone ConversationsFamily & VisitorsLaw Enforcement RequestsMedia InquiriesWorkers' CompensationPublic Health ReportingResearch UsesMarketing & FundraisingDeceased PatientsMinors & GuardiansUnauthorized AccessBreak RoomParking Lot / Public AreasHome Office / Remote WorkConference RoomsShared Workstations