FCR Improvement Software for Call Centers
Studies Designed to Improve FCR and Provide Great CX
Awards Recognizing Excellence in FCR, CX, and EX Delivery
The Resources You Need to Improve FCR, CX, and EX
Improve FCR, CX, and EX - One Individual at a Time
There’s Still More I Can Do
“I was able to give her the good news we had been wanting.”
When I first took my role as a customer service representative, I knew the job wasn’t going to be easy. Working in a call center for health insurance I knew I was going to have to handle a lot of emotions, challenges, and difficult situations among our customers. While the main purpose is to resolve the customer’s problems, I strive to make sure that every customer I interact with knows I genuinely care and are an advocate for them. I want to show empathy and support for our customers, especially those who feel hopeless and that they have run out of options.
One experience that I handled a few months allowed me to do just that, as it showed me that even though in the moment, a situation for a member can be difficult, working with them day after day to finally find a resolution is one of the most rewarding things I think I have ever experienced.
It all started when a woman had called in to me; shortly after answering the phone I could hear the frustration and sadness in her voice as she explained to me her story. She had told me that about five months ago, she had broken her foot and it never healed. She hadn’t been able to walk or hardly get around, and she had been living in constant pain. She had become depressed as a result of never being able to go out, and nearly in tears she explained that she had been trying to get a bone stimulator for months from a durable medical equipment supplier to aid in the healing of her foot – yet had been unsuccessful due to not meeting the requirements. She explained that she had an upcoming vacation that she wanted to go on, but was reluctant to travel without the bone stimulator, and was worried insurance wouldn’t be able to approve this in time.
Eagerly wanting to help, I researched what it would take for her to be able to get a bone stimulator. I was able to confirm that as an insurance company we would require a prior authorization request form and clinical documentation proving medical necessity to be on file for it to be eligible. I went over what our guidelines were for the bone stimulator to be medically necessary, and the member assured me over and over that she met all of the criteria.
As I continued to look through her account, to my surprise, I was able to find some clinical documentation that had been sent in by the supplier that morning. After reviewing the documentation, I did notice that the supplier had failed to send in an actual prior authorization request. I explained to the member that the supplier had sent in the clinical information that to ensure this didn’t take any more time than it needed to, I would outreach to the supplier on her behalf and get the prior authorization form filled out as well and sent in so we could review everything.
I called over to the supplier, and I explained to them that we would need a prior authorization request form filled out and sent in to us to go with the clinical information they had sent in. They agreed to send it out as soon as possible. Actively monitoring for the form to come through, I saw about a day later that we had received it. Even though the request wasn’t marked as urgent, due to the member’s situation, I sent the request as a high priority for review. I called the member to let her know, and she was overjoyed that this was being taken care of.
Still continuing to monitor the review, after about 48 hours I found that a decision had been made on the request, and not the one I had been hoping for. I saw the request had been denied as not medically necessary. I called the member that morning, and I explained the denial to her. She was understandably upset when I told her the news, telling me over and over that this was medically necessary and she needed this equipment to heal. I then told her, “I believe you, and we aren’t out of options, there’s still more I can do.”
With that statement alone calming the member down, I then explained to her that we can conduct what is called a Peer-to-Peer review, where her doctor and our clinical team here at the insurance company can have a phone conversation discussing the medical necessity of the bone stimulator that wasn’t included in the clinical documentation. I told the member I could call her doctor’s office and advise them of this option and verify if they would be willing to do the review. The member agreed, and I assured her I would keep her updated with what was happening.
After my conversation with the member, I went ahead and did my part by contacting the doctor’s office. After being transferred to multiple places, I finally reached someone who took down the information regarding the denied authorization request and forwarded it off to the member’s doctor so the Peer-to-Peer review could be scheduled.
Knowing the member was wanting to get the bone stimulator before she left for vacation, I tried to make this process as expedited as possible as we were running out of time. I was given a date of when the review would take place, which was just a day before the member was set to leave. I called the member to let her know. When the day came for the review to take place, I checked the request very frequently throughout the day so I would know as soon as I saw a decision was made. Finally, I was able to find that the Peer-to-Peer review had been a success, and the prior authorization request had been approved. I was so happy I almost jumped out of my seat! I quickly called the member, and very excitedly I was able to give her the good news we had been wanting this whole time.
The member was so happy, and so thankful, as not only was she able to pick up the equipment to start her healing process and have the ability to now go on this vacation, but she was thankful to have had someone who stuck with her throughout this whole process of getting the equipment approved; someone who advocated for her, and someone who was able to get this resolved in a timely manner. This time around with the member, she spoke to me through tears of joy rather than tears of frustration. To me, that meant everything. It was a conversation I will always remember, and a conversation that reminds me of why I do what I do every day.
Abigail Fifield – BlueCross BlueShield of Vermont
A Time of Change
“A customer who left very appreciative.”
In addition to his CSR role, Allistair participates in the training of our new hires and works as a peer coach. He truly exemplifies our approach to providing outstanding quality service and resolution for our customers. He is well regarded by all employees in the contact center and brings a positive attitude and big smile to work each day. Although many of his interactions are not face to face, I know our customers can always feel his always joyful spirit through the phone. The specific customer experience that I believe makes him a top candidate for this award is the following:
Allistair received a call one day where a customer was inquiring on why they received an invoice. This is a common inquiry in our industry. Customers receive international packages and customs charges may be assessed after the package is received, which results in an invoice being mailed to the customer. The customer explained the invoice was overdue as she had recently moved and had it packed up. The customer went on to advise Allistair that her mother recently had a fall and was being moved into a care home, which is why she hadn’t been able to inquire regarding the invoice. She included details that her parents had lived in this home she was moving from for many years, it was a home they had built together and that her father had recently passed away. Before getting into any details about the invoice, Allistair immediately recognized and responded to her with extreme empathy, noting this sounded like a very significant time of change for the family.
Allistair was able to explain the reason the invoice was received and explained the charges in detail. The customer said that she would settle the invoice but could not pay the entire amount at once due to personal circumstances and wasn’t aware when the package was sent that there could be additional fees assessed. Allistair was quick to respond that he would like to see what he could do to help the customer given the situation she had described. In this case, some of the charges were assessed by Canada Customs and could not be waived, but he saw the opportunity to provide a one-time waiver of the FedEx fees to help the customer. The customer expressed how extremely grateful she was and began to cry. She told Allistair how wonderful he was, and he responded humbly in saying it was the least he could do. While he was processing the credit, he continued a conversation with the customer in which they both shared some family history and connected with each other. The customer expressed that she couldn’t believe how kind Allistair was and that it was so helpful to her current situation. The call ended with a customer who left very appreciative and a representative who was satisfied with the empowerment they had to truly help.
Allistair received internal recognition for this call in 2018 where outstanding calls are nominated nationally and then a winner is selected by the Vice President of Customer Experience. We were so proud that his skills were showcased to our Executive Team and that he was chosen as the winner. This call was shared with other employees to demonstrate how a small gesture of goodwill, coupled with taking the time to truly listen and make them feel valued as a customer can make a world of change when it comes to providing an outstanding and memorable experience.
Allistair Cockrell – FedEx Express Canada
Life Was Happening
“Now she had the knowledge and tools to avoid these headaches in the future.”
Brittany Pitts is not an accountant. I feel like I need to tell you that before we get into this amazing story. She is a health insurance representative. But Premera also helps administer the Flexible Spending Account (FSA) program for many of our customers. For those who aren't familiar with an FSA, it lets you deposit pre-tax money from your paycheck into a spending account. You can then spend that money on eligible healthcare expenses, but the IRS has two important rules for FSAs: 1) You must prove that every expense is eligible, and 2) Any amount that you don't spend in that year is forfeited. Our customer ran into both of these rules, and she needed some serious help. This is the story of how Brittany took ownership of an issue, empowered a customer, followed through to resolve everything, and made a real connection with someone in need.
"Hello, how are you today?" Brittany always answers the phone with an upbeat greeting. Customers can tell right away that she's enthusiastic and ready for anything. The customer got right to the point. "I'm a little frustrated. I'm trying to get information together for my Flexible Spending Account. This is the first time I've used an FSA. I am so worried that I'm going to lose all these hundreds of dollars." Brittany responded confidently, saying "That's okay. Let's see what I can do to help you." She started by asking some probing questions and then reviewed the account. It turned out that the customer’s frustration was warranted. Brittany discovered that the customer was at risk of losing over $1,000. The first problem was that her dentist had charged hundreds of dollars to the account without providing a proper receipt. That meant there was no way to prove the expense was eligible. The second problem was that her remaining account balance was over $500, and the FSA deadline was only two weeks away! If she couldn't find a way to use that money, it would all be forfeited.
Brittany came up with a plan. If the dentist had submitted a claim to the customer’s dental insurer, then she could just ask the insurer for an explanation of benefits (EOB) to prove it was an eligible expense. Instead of making her do that work, Brittany called the dental insurer herself. She got the EOB. But it turned out that the dentist's claim only accounted for $200 in expenses. So why did the dentist charge well more than that? It was time to call the dentist's office. They seemed helpful and promised to fax a detailed receipt to Brittany. But as days went by, the fax never arrived and a large amount of money was still unaccounted for, as well the FSA deadline was quickly approaching. Brittany called the office again to explain the urgency of this request.
There was still the other problem of the $500 remaining balance. Brittany explained to the customer that she could use that money to reimburse herself for any out-of-pocket medical expenses from earlier in the year. Together they reviewed all her family's doctor bills. They found that she had indeed paid a few bills on her own, instead of spending her FSA money. Brittany used the EOBs that we already had on file as proof that the expenses were eligible. The amount forfeited would now be less than $100. It was at this point that Brittany discovered the customer didn't know about our FSA website. No wonder everything seemed so complicated to her! If she had been using the website, she would have known about her remaining balance, and could have easily done all of this months ago. Brittany helped her sign in. Then she patiently walked her through the process of checking her balance, requesting a reimbursement, and even making a payment to a doctor. Now she had the knowledge and tools to avoid these headaches in the future. She could finally experience the tax savings and convenience that make FSAs so popular.
The customer and Brittany had built quite a rapport while working together. As the frustration faded, she started opening up about her life and her family. They talked about their dogs. They laughed together about the joys of parenting and their kids' shared love of dinosaurs. The customer’s outlook had changed drastically since that first call. She was starting to feel empowered and hopeful. It might be tempting to think that this is a story about an insurance representative helping someone save a few bucks, but it was much more than that. What Brittany didn't know is that, while she was working to resolve this FSA issue, the customer had been preparing for surgery. The frustration that she mentioned when they first spoke wasn't just about money. Life was happening, as it always is. This is the real reason why Brittany's customers rave about her. She talks to them like a family member would. She listens, empathizes, and treats everyone with dignity. And then she takes ownership of issues until they are resolved. Her customers are constantly telling us how much this means to them. Because Brittany took ownership of this FSA issue, the customer had been able to focus on her own health while getting ready for her surgery.
After that conversation, the customer called Brittany's Team Leader to share her appreciation. "I've been working with Brittany. She's been helping me reconcile my flexible spending account. I had surgery yesterday, so I'm really grateful for her help. So many times, customer service representatives are short and not patient. But she's been really helpful with me. She is a perfect employee. She did an amazing job, and she followed up every time when she said she would!"
A few days later, Brittany called the customer with a final update, "I got that fax we've been waiting for." She could now account for the entire amount that was paid to the dentist. With Brittany's help, the customer had used most of the remaining FSA balance to reimburse herself for previous doctor bills. The customer expressed her relief. Then she casually moved to a lighter subject. "I was just thinking about you," she said. She told Brittany about a big dinosaur exhibit at the fairgrounds that weekend. She had seen a flyer and thought it would be a fun experience for Brittany's family. Brittany said they were definitely going. After a few minutes, it was time to say goodbye. "Thanks for everything Brittany,” she said. “I really appreciate it. And have fun this weekend!"
When the customer first called Premera, she was feeling pretty frustrated. Her FSA was a mess, she was about to lose over a thousand dollars, and she didn’t know what to do about any of it. On top of that, she was supposed to be preparing for surgery in a few days. Brittany rose to the challenge! She took ownership of the FSA issue, allowing the customer to stay focused on her own health. She empowered her customer through education, so she will never have these account problems again. And she followed through on her promises until everything was resolved. But she did even more than that. Years from now, when the details have faded and life has moved along, I can imagine the customer looking back to that moment when everything was crazy. I think what she’ll remember is that someone cared about her and made a personal connection. That’s the real impact of what Brittany does for her customers. And that’s why I’m extremely proud to nominate her for this award.
Brittany Pitts – Premera Blue Cross
Sleepless in Seattle
“Advocating on behalf of the member.”
Carmen has been a World Class Advocate for several years in a row for BlueCross BlueShield. She is one of our most consistent Customer Service Advocates. Over the past three years her resolve rate is 88%, and her CSR Satisfaction is 93%. Even though Carmen is an at-home worker, she keeps in constant communication with her team and management.
Earlier last year Carmen received a call from a member that needed a specialized procedure done. When the member called, she stated that the provider they were referred to was unable to perform the service. Carmen also realized that the provider that the member was referred to was out of the member’s network, so even if they were able to perform the service, it would not be covered. Carmen had a choice to let her know the benefits and that it was not covered, or to advocate on behalf of the member and see how we as a company could assist her. Carmen took the member-centric approach.
Carmen started calling providers in and around the member’s area to see who could perform the specific procedure. Since this was so specialized, she had to call multiple providers and see who could perform the service. In her initial research she determined that no providers in the member’s network could perform the service. She then started researching all providers in the area that may be able to perform the service. Finally, after long days and nights, Carmen was able to find a provider that was able to perform the service, the issue was that the provider was out of network. Knowing this, Carmen did not stop there. She had an exception granted for the member that would allow the member to receive the service from this provider even though they were not in the members network. The member was very appreciative and wowed of the extra care she received.
Carmen worked tirelessly on this case, and from start to finish she resolved this case in one day. Customer service is something you must be passionate about, and Carmen is passionate about it every day in her job. She loves helping people and you can see her smile on each and every one of her calls.
Carmen Storey – BlueCross BlueShield of South Carolina
Placed Herself Completely in My Hands
“What could two hours of your day mean to someone else?”
If someone asked you what two hours of your day means to you, what would you say? Would you spend it on laundry or housework? Reading with a cup of tea? Watching your child’s school play? What if I asked you what two hours of your day could mean to someone else?
To set the stage of this story, it was mid August, on a warm summer day when Vermont was at the peak of its stunning natural splendor. I was about to leave my desk for lunch and a brief respite from the busy phones and my hectic training schedule for a new position as a Team Leader when my phone rang and I opened the door for a member who needed some serious guidance.
The woman I was speaking to had been in a car accident the summer before and had been left with injuries requiring months of treatment. The other party had been responsible, but claims were being put through her Medicare and Blue Cross Blue Shield of Vermont (BCBSVT) policies. She had finally been able to work towards a settlement with the insurance covering the other driver and was trying to get numbers on how much both of her insurers had paid out to reimburse us both. The issue she was facing was that she simply had no idea how to tell what had been related to the accident and what had not and hadn’t a clue how to begin finding out. She stated that she had received documentation from BCBSVT detailing all of her claims dating from the previous June to her most recent services, but she needed more detail than was available on the documents. I could tell this was going to be a long call and I could feel my stomach growling, but I also knew this member needed me and I was not going to leave her hanging. I told her we could go through every single claim on her account and find the ones she was looking for; her needs were more important than my own in that moment.
I started at the beginning, right after the accident in June the previous year. We looked through each claim together, researching the details to determine which ones contained the diagnosis related to her injuries. I would then give her the doctor or hospital name, the services rendered, and the diagnosis, and she would let me know if it was one of the relevant claims or if we could move on. It took just over two hours for us to go through them all, and we even found a couple in our hunt that had not processed correctly so I made a new task for myself to have them adjusted to be accurate. The complexity of our challenge was increased by the fact that Medicare was primary for her, so they processed her claims before BCBSVT. We had to account for what Medicare had paid on each claim and then look at BCBSVT’s payments as well. This was a labor intensive yet important task.
Once we had gone through all the claims, I reassured her that we have specialists who work with other insurance in cases like her car accident that would be able to assist with any new questions that may arise as she goes through the settlement process. I promised to follow up with her to provide the direct contact information of the analyst familiar with her case. We wrapped up on a confident note. She even laughed and said, “Thank you, you should go eat your lunch now!” I let her go about the rest of her day and I got busy working on the claims I had identified that had not processed correctly. I started by finding the root cause of the problem and worked with our network management team to have the provider’s specialty corrected in our system. Once that was completed, I had the claims adjusted and made sure they went through correctly this time. I then connected with the analyst in our Other Party Liability department, filled her in on the member’s situation, and she let me know the member could contact her any time with questions about her settlement. I called the member back and advised that the claim issue I had identified had now been corrected and she would receive an updated Explanation of Benefits in the mail. I also provided her with the name and phone number of the subrogation specialist assigned to her case. The member was very appreciative of our time together and of my follow through.
I found myself thinking about the conversation for several days after the fact, even when I wasn’t directly working on it. The member had placed herself completely in my hands, looking to me to help her navigate a difficult and confusing situation. About a week later upon arriving at work for the day I found a Thank You card, hand written, waiting on my desk. The member had been so touched by the time that I took with her that she wrote me a kind, heartfelt note to tell me how much it really meant to her. She said she did not think she could have ever gotten through the information without my help and that she was SO thankful for my taking the time with her. It was not until that moment that I realized just how much my two hours with her had meant, and I keep her note on my desk to this day to always remind me of what your time can mean to someone, even when you don’t realize it.
Cerridwen Moser-Bertsche – BlueCross BlueShield of Vermont
Numbers Don’t Lie
“It made her cry in a good way.”
Charles joined Blue Cross Blue Shield in November 2014. He supports our Student Blue Concierge Service. Day after day, one interaction at a time, Charles continues to lead the pack by providing stellar customer service. With this mindset Charles was able to make great strides in his 2018 World Class Recognition and was ranked number one with a 97% World Class Certification. He continues to consistently exceed his quality metrics. In 2018, he ended the year with 58% Experts and 96.30% Issue Resolution. Charles has not only set the high bar for himself but for our team as well. He brings awareness to call trends and proactively offers solutions which allows our team to drive both Issue Resolution and FCR.
One day, an authorized mom of a student called in to get information about gender reassignment/hormone benefits for her transgender child. The mom stated the way Charles treated her was amazing as this was a very sensitive topic for her. Charles was so sensitive when it came to using the correct gender when speaking about her child, that it made her cry in a good way, she said. She added that she wanted to make sure that Charles was nominated for something and that the entire Customer Service team knew what he did for her.
Charles Sanders – BlueCross BlueShield of North Carolina
He Was What Needed to Change
“No member was going to get a “cookie-cutter” experience.”
There is little which can compare to the anguish which comes when your child is in need of medical care. You want to be by your child’s side. You want to comfort them and advocate for them. You want to understand every decision being made and why. You don’t want to waste time arguing with medical providers about whether or not your son’s out-of-pocket insurance maximum has been satisfied. Our member’s mother was in just that position. She was going around-and-around trying to convince the provider her son’s insurance would pay and she should not be charged up front. Finally, she reached out to her son’s Nurse Case Manager with BlueKC, who knew to call Eric Ashby in Customer Service.
Eric listened patiently to the caller and the Case Manager explain the situation. He heard about the struggles the caller had gone through with her son already including multiple transfers, care denial, and now, being charged more than the maximum limits on her policy. He took down the information for the medical provider and pledged to the caller he would contact them and explain the policy maximums.
For Eric, this was not a commitment he took lightly. Not long before receiving this call, Eric had rededicated himself to his work. He was frustrated with his performance as of late and it seemed like no matter what he did, his survey satisfaction numbers were not increasing. Eric decided HE was what needed to change. He wanted his clients to feel how genuinely passionate he was to help. This meant keeping his promises, staying positive, and making real connections. He vowed no member was going to get a “cookie-cutter” experience.
It was with those renewed eyes Eric was able to view the caller’s story. He told her he wanted her to focus on her son’s care, saying “You don’t have to worry about it. Let the ball be in our court for now. We will go ahead and try to take care of some of this legwork for you and try to do as much as we can as possible; that way it can be a smooth process for you.” Eric’s words brought the caller to tears. She stated Blue Cross was a saving grace but made sure to clarify to Eric and the case manager, “It’s not just having insurance. It’s YOU guys.” After the call, Leigh Anne agreed, explaining she could tell how relieved the caller was to hear Eric’s commitment to help. “When you’re on the phone long enough, you can hear the frustration and the tension drain from somebody’s voice, just like in person when you can see it drain from their face.”
From here, Eric called the medical provider. He learned they thought of themselves as out-of-network because they were out-of-state. The representative told Eric because of their non-participation status, the member would be financially responsible for more than the in-network policy maximum. Eric was not convinced. He was polite with the provider, but pushed for their National Provider Identifier so he could do some further investigation. After the call, he updated the case manager and the member on his progress so far and assured them he was not finished yet.
Eric then researched the provider with his Lead to confirm. The representative he had spoken with was indeed incorrect. The provider was in-network for our member’s plan. For the member and his mother, this meant thousands of dollars in savings. It meant their back-and-forth calls with the provider were over. It meant they could move on from this battle and prepare themselves for the next one.
One of our company initiatives is to address the needs of the caller the first time they contact us by owning their problem. Eric’s actions on this call embody the spirit of that initiative. He owned this problem from beginning to end. In his own words, he kept “driving through the storm.” Eric stepped up to help this family and represented BlueKC’s core values and his own. His eagerness to help is a wonderful attribute and this is just one example of the fantastic job he does to support our entire community of members.
Eric Ashby – Blue Cross Blue Shield of Kansas City
The Rewards of Going the Extra Mile
“Moments like this bring everything back into crystal clear focus.”
Hailey Steele recently converted from a consumer facing role to a B2B role within Marchon/Altair. A recent customer interaction has shown her the personal and professional rewards of going the extra mile. For Hailey, it was a revelation that interacting with a doctor’s office, instead of directly with the end patient, can end with an exceptional and sometimes life-changing experience for the patient. In the grip of the day-to-day it is easy to forget that what we do matters, and moments of exceptional customer service like this bring everything back into crystal clear focus.
Customer service is a very challenging but rewarding career. Being in the B2B group changes the customer you speak with but does not change your ability to make a difference. One of the first calls I received was from an optical office that needed to order a replacement eyeglass frame for one of their patients. This is a very common call type and usually goes seamlessly. Unfortunately, these frames were no longer available. They were a discontinued model and all sizes and colors were sold out. Our role as customer service representatives is to be problems solvers and always find a solution. When no solutions were immediately apparent, I began to fear that I would have to deliver bad news to this customer.
The woman I was assisting at the doctor’s office explained why this was so critical. The frame belonged to a young disabled boy that could not go without his glasses, he had limited access to transportation and was going to be in their office the next day. It was the only time they could replace his frame. I now realized why she was desperate to make this happen, and now I was even more determined to find a solution. We had less than 30 minutes before our overnight shipping cut off time. I began to ask some probing questions to see what alternate solutions could work. One of the questions I asked was if she had a lens cutting machine in her office and I was thrilled when she said she did. I remember thinking to myself, “This is it! We are going to make this work.” All I had to do is find something that was very similar in measurements. I found the perfect frame for the patient, similar in style and shape and almost identical in measurements. I provided the good news to the office and she was ecstatic. I ordered the frame and upgraded the shipping to guaranteed overnight delivery at no charge. The woman from the office, who I had been working with on and off that entire day, was so appreciative that I was able to locate an option for her and thanked me more than 10 times on our short phone call. I remember feeling so good about myself and so proud that I was able to really make this customer happy. This great feeling lasted a long time and I even spent the car ride home telling my spouse the story and about how good it made me feel.
I saved the customer’s information and set myself a reminder to follow up with the client the next day just to make sure everything went well. When I called, I spoke to the same woman I had worked with. I was excited to hear how everything went with the patient and was crossing my fingers that it went well. She said that he absolutely loved the frame and he couldn’t stop looking at himself in the mirror. He was very happy, and in turn, that made me very happy. This was such a special experience in my career because I was able to help our customer and in turn see how they were able to help their customer. I realized that these are real people wearing our glasses and that’s why I work for a company where our mission statement is “We Help People See.” Our company does make a real difference in people’s lives and I was able to witness it with this interaction. Experiences like this remind me why I love what I do.
Hailey Steele– Marchon/Altair
A Financial Burden
“I look for a way to make a positive impact.”
I am thankful to work for a company that is consumer focused and truly cares about the member and their experience. In Customer Service we are given the ability, tools, and encouragement to help members and I am thankful for that as well. I was especially thankful for this the day I spoke with one of our member’s husband.
This individual called in and explained he was calling for his wife, who had recently passed away. He had been trying to submit paperwork to appeal claims but was unable to get the fax to go through, so he wanted to send it another way.
I noticed there were only a few previous calls on her account and felt the need to review further to see why the member was appealing and if there was anything I could do to help. I found that his wife had many claims for the same brief timeframe and of these claims, there was an ambulance, emergency room, life flight, and inpatient hospital stay. Some of the claims were processing to their out-of-network benefits, leaving the member’s responsibility to be well over $20,000.
I pieced together that the member must have gone to the emergency room via ambulance and been life flighted to the inpatient hospital where she later passed. I called the hospitals to verify this and found I was correct. I gathered all the claims that processed out of network and requested an exception to process them as in network. Once approved, I called the hospitals that would be able to “balance bill” the member. I explained the situation to them and asked if they would be willing to take insurance payment and write off the rest to which they agreed.
This was all done in less than a week and I was then able to call the husband to inform him he no longer needed to complete what had already been a lengthy and exhausting appeal process. I let him know he no longer owed the large sum of money, and I had managed to bring the cost down to $0 for him.
Being able to help him with such a large financial burden while he was going through one of the most difficult times in his life is why I love being a part of Regence. With each member I have the opportunity to speak with, I look for a way to make a positive impact on them and I was especially happy to be able to do so for this member.
Hannah Morphis– Regence Blue Cross Blue Shield Plans
They Wanted Independence
“The client’s morale had made a 180 degree turn.”
As a member of Scotia iTRADE's High Net Worth Desk, there are high expectations for providing a memorable client experience. We provide white-glove service to our most highly active and affluent clients when it comes to servicing their accounts. As many in the customer service industry know, it is hard to earn a client's trust yet very easy to lose it. Therefore, it is important to focus on showing empathy and patience, understanding the client's needs, and making difficult concepts easy to understand.
One morning I received a call from a new client who had called in and requested to transfer out their assets and close their accounts. This is not the ideal beginning to a conversation and as such, deeper probing had to be done to find the root the of the issue. I informed them that I would be able to assist them with their request but also asked why they wanted to close their accounts. The client stated they were overwhelmed by self directed investing as they were not familiar with trading on their own and using the tools we had available. They felt that they had made a mistake. I probed further and asked what their original intention was when they decided to open an account. They stated that they had previously been with an advisor and were not getting the advice they needed, and as well, they wanted independence in making their own investment decisions. I now had a better understanding of why the client was calling. Through my years of experience in the financial industry, I have come across many clients who wanted to experience the joy of taking control of their own finances but needed a bit of guidance to set them in the right direction to financial independence. Furthermore, I could relate to them as I also was in their place several years ago, overwhelmed by the prospect of managing my own investments and making sure I had the tools and knowledge available to make sound investment decisions. I made a connection with the client by sharing my personal experience with them. I told them that I would like to see their original intentions come to fruition and that if they spent a few moments of their time with me, that I would help improve their confidence. At Scotia iTRADE we believe that knowledge is key to becoming a confident investor which is why we have the Scotia iTRADE® U program. It is the educational section of our website where our clients have access to a vast range of free educational tools and resources. I walked the client through the various articles, modules, and webinars to help them build their own investment strategy. The client was pleasantly surprised at the amount of easy-to-use tools and guides. By the end of the conversation, the client's morale had made a 180 degree turn and decided that they had originally made the right decision in coming to us. They were quite pleased that I took the time to help them change their mind on closing their accounts and in bringing them peace of mind and boosting their confidence.
The importance of providing great client experience cannot be emphasized enough. Great customer experience is a revenue driver while poor customer experience is a cost driver. Clients who are pleased with the service they're receiving will recommend our brokerage to their friends and family. For myself, I have experienced that firsthand. Furthermore, the high level of service and call resolutions will incentivize them to maintain and grow their business with us. This is one of the main reasons as to how I have been able to earn my clients' business and achieve 215% of my annual sales target.
Jafar Abbas – Scotia iTRADE
Shooting for The Stars
“Providing value and care to the customer.”
Jasmin ended the 2018 World Class CSR Certification period with a 100% score. She began the first quarter of 2018 with a Service Organization wide recognition for achieving the highest Customer Satisfaction (CSAT) score within the FEP department. This was only the beginning of an outstanding member performance experience that Jasmine delivered throughout the remainder of the year. Jasmine was again recognized by Senior Leadership as a World Class Performer in the second and third quarters. During the fourth quarter of the year Jasmine worked with the training unit sharing her insight and knowledge with the new FEP customer service representatives.
Continuous recognition was received from members who sang the praises of Jasmine’s commitment to assisting with each member’s inquiry and her hunger to be the best when performing her job duties. One such praise came from a Provider representative at a retreat facility who wanted to let Jasmine’s manager know that she had spoken with Jasmine Austin who she referred to as the “Subject Matter Expert.” She said that Jasmine was absolutely wonderful, and that “every time I speak with her, I get good information.” She wanted everyone to know how well Jasmine performs each and every time she speaks with her. Jasmine is confident in her knowledge and abilities, and this comes across during the conversation with the members.
A complimentary call was received from a member whose comments demonstrated this. He said that Jasmine was an outstanding employee. He said that she was knowledgeable; she did not hesitate for a moment or question the information she provided to him, and for that he was very thankful. Jasmine Austin is a role model for service excellence. This is exhibited in the high-quality attention that she provides to our members each and every day. Jasmine was also the recipient of the Florida Blue Cosmic Award that is given to team members who demonstrate excellence within the organization.
Jasmine Austin – Florida Blue
In Desperate Need
“I understood that he needed me to listen.”
One afternoon, I received a call from a member who didn’t know where to begin. This member had suffered a traumatic brain injury (TBI) and was confused, frustrated, and just needed help. After assuring the member that I could assist him, I started to ask some questions to gain understanding on what he needed help with. Due to his injury, the member struggled to form his thoughts, complete his sentences, and was overly apologetic. I could tell he needed reassurance. I gladly reassured him that I was here for him, that he could take all the time he needs, and there was no need to apologize. After a long silence from the member, he explained how due to issues with his memory, he normally has everything written out, but he had lost his notes, so we were starting from scratch. I again reassured him that this is what I am here for, I am happy to help, and we’d figure it out together.
After a few minutes, the member explained that he had received a large bill from a local hospital for a large sum. This bill was causing stress and issues at home because he thought he had paid it already and his family was in desperate need of winter tires before the snow started falling. He was feeling confused and frustrated because while he had thought he had already paid this bill, he simply could no longer rely on his memory and was looking for help to validate what had transpired and understand next steps.
Throughout the call the member kept apologizing, which I found a bit heartbreaking as he had absolutely nothing to apologize for. I continued to provide constant reassurance to the member and allowed him the time he needed to form his thoughts and words at his own pace. He explained to me that calling different companies about bills or with simple questions was always a tough task as he easily got confused and frustrated. He had lost touch with friends and family members as they would get frustrated with him because he was not able to express himself or get out his thoughts like he once had. He explained that when he picked up the phone to call us he knew it wasn’t going to be easy for him, and that he might get turned away because he didn’t have all the information like he had in the past from other companies. One thing that customer service teaches you is patience, compassion, and understanding. I understood that he needed me to listen and not rush him and that’s exactly what I did.
We walked through each of his claims together until we found the one in question. I researched the claim processing and determined that the claim had processed and we, BCBSVT, had actually paid the claim in full to the hospital. He was not responsible for making any payment on this claim. The hospital had billed him in error. This was such a relief because I now knew exactly what I could do to take this member out of the middle and resolve his issue. At this point, we still didn’t know whether he had made a payment to the hospital. I reassured the member that BCBSVT had paid this claim and there was no member liability that he is responsible for. I let him know that my next step in resolving this issue for him was for me to call the hospital on his behalf. He was very appreciative of not having to make this call, especially given his lack of confidence.
When I outreached to the hospital, I reviewed the claim and explained that we had paid the balance in full, yet the member had received a bill. I also requested that they review his current account balance to confirm whether the member had already sent them payment. The hospital confirmed that the member had already paid the balance in full and that the second bill should be disregarded. They also advised that they didn’t have a copy of the Remittance Advice showing that BCBSVT had made payment and that would be required in order to reimburse the member. In order to expedite the reimbursement to our member, I worked directly with our research team. We then called the hospital back to confirm receipt of the fax and to verify how long it would take them to reimburse the member.
The absolutely best part of my day was getting to call the member back. For this member, remembering people’s names was something he could no longer do, but he remembered my name because his daughter’s favorite song had been “Jenny from the block” and he had heard it all the time prior to his accident. This was a great satisfaction for him that brought us both to tears. The member then apologized again for my having to outreach on his behalf. I told him this is exactly what I am here for. I come to work every day to be able to assist members and was happy to help him to resolve this bill. I let the member know that his recollection of paying the bill was in fact correct. He did in fact pay the large bill to the hospital and was due a refund. With the member on the line I then connected to the hospital and spoke with the same representative as before. She was wonderful and explained to the member that she had already sent a request to have the funds be returned to his credit card and that he would receive his money back within 2-3 business days. This was such a huge relief, removing the additional financial stress.
This gentleman, our member, started the call off feeling frustrated, confused, and upset due to issues with his memory, difficulty forming thoughts and sentences, or speak like he once had in his life. He struggled and was apologetic because in his own words, “he had been treated like his brain injury made him less of a person.” After being patient and listening, I was able to resolve this member’s issue, which was very fulfilling, but more importantly I was able to connect with this member as a human being and show him that we are not just his “insurance company” but instead, we care and serve as an advocate for our members. I reassured him that if he ever has any issues in the future, he should never be nervous to call us. He was much more comfortable, and we were able to joke and laugh together. His words to me before ending the call were, “there should be more people like you and companies like BCBSVT in this world.” That was a truly heartfelt message that I will cherish.
Jennie Shangraw – BlueCross BlueShield of Vermont
One Person Can Make a Difference
“He exemplifies what it means to have a heart for service.”
I was not at all surprised to see John on our list of World Class CSR recipients this year as he exemplifies what it means to have a “heart for service”. John works with our Senior members on our Medicare line of business. When they say one person can make a difference, I believe that to be true; John makes a difference. I have no doubt that John’s actions, and interactions, are part of the reason our entire plan is receiving an FCR Improvement Award this year, as he has been an inspiration to our other Medicare CSR’s.
Early in the year we realized that we were struggling with resolution on our Medicare Line of Business. Operating on a new system, CSR’s were having trouble navigating their resources and it was negatively impacting call resolution. John was selected to be a part of a CSR lead workgroup aimed at improving Medicare FCR. He was selected because of his passion for service. John and another CSR created a new resource package for Medicare representatives to better organize and locate their needed information, and then he trained it to all our Medicare reps. We saw our Medicare FCR scores begin to climb almost immediately afterwards and then continue to remain high throughout the year. We ended the year at 76% FCR on our Medicare line of business which was an improvement of almost 10% over the previous year. This increase helped to boost our entire plan’s FCR score for the year.
In addition, knowing that our senior members were going to experience major plan changes this year, John volunteered to attend townhall meetings with our sales team to answer the members’ questions about the upcoming changes face to face. This meant leaving his family for 2 whole weeks to travel by bus across the state. John could not say enough about how that experience solidified the importance of the CSR role, and it has made him even more determined to approach every call with care and compassion.
John has a heart for helping others and he is a positive role model for our entire staff. When asked for a story it was hard to select just one. I believe the story below exemplifies how John approaches every interaction and shows how he follows them through to full resolution, no matter how long it takes, to ensure the member’s situations are resolved and all their questions are answered. This was recently sent by his supervisor.
I received a call yesterday from a member praising John. “I am just thrilled that John, one of your exemplary customer service advocates, resolved a claim for me that will also affect many other customers. He needs an applause. He stood through this situation week after week and he called me frequently with information. I am a former school teacher, so I am quite critical. I know that when praise is due, it is really due. Keep that guy on your team. I appreciate all that he has done.”
John Kolath – Blue Cross and Blue Shield of Minnesota
We Are the Team They Call First
“I reassured her that things would turn around.”
I’ve been with Marchon Eyewear nearly two years. I spent my first year working in Customer Service, helping our accounts order frames or work through issues. I’ve learned countless valuable skills in my time here, one of the most important being empathy. I took this skill with me when I was promoted to working in Sales Rep Services. It’s similar to working in Customer Service, however, our callers are our very own sales reps. Sales reps have a challenging job. They physically bring a wide variety of product to our accounts every single day and do their best to make sales. They often drive quite a distance and work long hours. They rely on Sales Rep Services to help them get their jobs done quickly and efficiently. When they run into any kind of problem, we are the team they call first.
A memorable call from this past year was with a sales rep who was simply having a streak of bad luck. She called in very flustered, audibly upset and explained her situation to me. The week prior, her car had been broken into and all her belongings, including her product and her iPad (with all her orders and information on her accounts) was stolen. I imagine that this is devastating for a sales rep. They make their living by showing products. Their sales are made seamless by the iPads they utilize with account information, stats on frames that sell well in their region, and all the specific notes they keep for each account. Of course, Marchon snapped into action to help her immediately. We sent her all new products and a new iPad so that she could continue to do her job. Of course, new gadgets always need to be set up and everyone can relate to how tricky that can be sometimes. This rep was dealing with that frustration. She was already in a process with IT to have her issues fixed, but she still had a problem that was urgent. Around the time that her car was broken into, one of her accounts was in dire need of a replacement frame for a patient who had broken theirs. She had written the information down in her iPad and was going to call in to put through an order, but then her car was broken into. She was calling out of desperation; she didn’t have the frame information and didn’t want to call the account to ask for it again. She wasn’t sure if there was anything we could do. Luckily, I had a few tricks up my sleeve. She knew they needed a Nike frame, had originally ordered it not too long ago, and while she couldn’t remember the patient name exactly, we thought maybe if I read off a few patient names, she might recognize it. I went through a few of their recent orders and sure enough, there was one placed not too long ago, and the rep recognized the patient name instantly. You could hear the relief in her voice when I read off the information. I took it one step further by offering to overnight the frame and waive the shipping charge. I explained that given the circumstances, it would be no trouble at all to give them this extra bonus of a quick delivery. She would be able to maintain the good rapport she had with this account. After having such bad luck, having everything stolen, needing to start over again, feeling out of sorts, she was so grateful to finally just have something go right.
I feel this call’s resolution was driven by my empathy for the sales rep’s situation. Several years ago, I also had my car broken into, and things that were precious to me were stolen. I was heartbroken. The next few days, it felt like everything was going wrong and I was becoming more and more upset, until one day, I got a knock on my front door. There was a construction worker standing outside holding my bag with the things I thought I’d never see again.
He told me he found my bag near one of his worksites and thought I might be missing it. I was so overjoyed that I cried. Finally, things were good again. I couldn’t help but think of this experience when that sales rep called me. I wanted to pay it forward. I wanted to be the one who changed the tough times into good times, so I did everything I could think of to make that happen. After I placed the rep’s order, I told her about my experience. I reassured her that things would turn around and that I hoped it started with this call. In the end, the rep left the call feeling uplifted, as did I.
Juliana Klingel– Marchon/Altair
Truly a Testament
“He was at his wit’s end.”
Karla has been here five years and assists our members with questions and concerns about their benefit plans. She is patient, able to actively listen to our members, as well as consistently achieve satisfaction and resolution targets. Her genuine compassion and professionalism are traits to emulate and share with others. I appreciate Karla can navigate delivering even the most difficult news in a caring, compassionate way. She definitely casts the shadow of a leader and exemplifies her skills which reflect the Cambia Core Values that guide our culture.
This year, one particular inquiry stands out in her memory and it was truly a testament that Karla shares many of the values we so highly regard: Empathy, Courage, Trust, Commitment, Collaboration, and Accountability.
In the fall of 2018, a member called about some claims and explanations of the benefits he received. He indicated he was very confused. He had been disputing the processing for some time, as well he shared he was beyond frustrated with the processing of a procedure he had done and that it was being denied as not a covered service. He was at his wit’s end trying to deal with it.
Karla immediately took accountability and voiced empathy with him acknowledging his frustration. She assured him she would go through his account and go over the claims with him so he could understand the processing and reprocessing that occurred and then committed to getting resolution for him. He stated over and over it is unbelievable how many times he has contacted Regence and his provider. His provider advised they had sent in the corrections and Karla did confirm that it was rebilled from the provider thus removing one of the charges. The member said he saw the letter the doctor stated they sent in. He felt like he was in the middle of the mess having to talk to both Regence and the providers and the claims were not being reprocessed. Karla patiently asked him further questions hoping to clarify when the provider stated they sent in the “letter” that he thought was possibly an appeal. She engaged him in the conversation trying to get more details as she did not see anything received on her end. As she patiently listened to him waiting to read the letter she suggested that the letter sounded like an appeal. She clearly explained the appeal process is 180 days from the processing date and was concerned it may have passed. She offered that with the new claim processing date she thought they could possibly pursue the appeal on that claim. The member voiced a profound dissatisfaction and frustration at that point and Karla maintained her composure and assured him she would assist in this process since he really felt he had done this already multiple times. Karla attempted several times to contact the provider to get a copy of the letter he was referencing keeping him informed daily of her attempts. Finally, Karla asked if he could send his copy of the letter in. Karla partnered with the member to send his appeal forward. Karla was able to call the member to advise his appeal was overturned the decision on the original denial and his claims were being reprocessed. Karla’s patience, ability to listen, and commitment to following through as promised with this member, helped him trust her intent and get the results he believed he was entitled to from his benefit plan.
Karla has been World Class certified every year and I appreciate everything she does for our members. She is simply outstanding and truly enjoys her job as is confirmed by our member feedback.
Karla Bare – Regence Blue Cross Blue Shield Plans
It’s About More Than Just the Numbers
“Earning our Customer’s Business 24/7.”
With less than three years of experience in her Customer Service role at Consumers Energy, Katrina has proven that she truly understands how to compassionately relate to her customers under any circumstances with which they are dealing.
Katrina is quick to recognize when a customer needs empathy and compassion, leading to numerous expressions of gratitude being shared with me by her customers. I’ve even had customers call back after having completed their call with Katrina simply to express to me how thankful they were with how she handled their call. Here’s an example of one such call from Katrina’s recollection:
We often receive calls from customers regarding the accounts of their loved ones who have passed away. These callers are often in a delicate, emotional state, and it is imperative that we handle their calls with a great deal of respect. One day, I received a call from a woman who had lost her mother unexpectedly. The call was additionally emotional for the caller as she had lived with her mother. She shared with me several concerns about the process of transferring her service as she had poor experiences with other providers before calling Consumers Energy. Having recently suffered the loss of a parent, I was able to provide her additional information, as well, regarding working with the courts and allocating death certificates to all the necessary entities. The caller stated she had never spoken to a representative who genuinely cared about what was happening in her life and wasn’t in a hurry to get her off the phone. Through our conversation, I shared with her the loss of my father, and I could tell the customer just needed someone to care about what she was experiencing. I was able to make the transition of service effortless for the customer. She was a manager for over 30 years in the medical field, and at the end of the call, she shared with my supervisor that I was an asset to the company, and Consumers Energy needed to know it!
Katrina consistently arrives to work with a smile on her face and a twinkle in her eye, which comes across in her calls. Customers are quick to recognize that they have someone on the line who really cares about serving them. An example of Katrina’s customer care is shared through this contact:
I received a call from a customer who was very distraught due to not being able to make a payment through our automated phone system. The customer was blind, and not able to enter the necessary information to initiate his payment. When he reached my line, he had been stuck in the automated phone system for approximately thirty minutes and had already spoken to a number of other representatives. By the time I answered his call he felt defeated and asked with tears in his voice, “What is someone like me supposed to do to make a phone payment at Consumers Energy?” He asked why we didn’t care about people like him. I apologized empathetically to him about his experience and explained to him that Consumers Energy does care about all our customers and that we are making strides to improve the customer's experience whenever they reach out to us. I made him aware that we would soon be adding voice options to our IVR for our customers. The customer began to understand that I was willing to make sure he got what he needed and that I was more than willing to help him. I was able to contact a payment agent to process his payment over the phone without having to use the automated system. The time it took to help this gentleman was well worth it. It not only preserved his diminished confidence and loyalty in Consumers Energy, it proved to him that people care at Consumers Energy. Our company is more than a name, but we are made of thousands of men and women who not only talk about taking care of our customers but do it. The customer told me that he could tell I was a very caring person who loves what I do sincerely.
Katrina Lloyd – Consumers Energy
Making Someone Else’s Day is More Fun
“I never lose the yearning to make a difference in every setting I am placed.”
Acts of service and words of affirmation have always been my meaningful languages, to give and receive. At age 11 in our family home business, my mom gave me a script to start answering the phone. The one thing that always stuck for me was her guidance, “Let them hear your smile.” Still today I smile when I talk on the phone and in person. A second impact in my life was my grandpa and hanging out with him at the farmers market in his small town. As he gave more and received less than anyone else selling at the market, he had a huge smile on his face while talking to each customer or new friend. I will always remember asking him, “Why do you always give everyone extra and charge less than anyone here?” He replied, “I’m not making money, I’m making friends. And if they weren’t having a good day yet, they are now. Making someone else’s day is more fun.” I have never forgotten those words, so very true.
To this day I love to make others smile and make others happy or “make their day.” In my job of 22 ½ years, I answer the phones in customer service. Some may think that would be a tough job. I love my job. I get to bring those wonderful life lessons with me. In serving others, I don’t want to give them what they asked for I want to give them everything they could need, along with making their day better. I don’t want to take numbers or orders at someone’s beck and call, therefore I don’t. I am building relationships and making friends all day long. My grandpa was right, it is way more fun!
Answering phones for customer service is not always a bed of roses; it can be heartbreaking and trying in some conversations. The difference for me is caring about the person calling and sensing what they are going through. How would I feel in if I were in their shoes? What if my family member was going through what they are going through? I am not the company on the other side of the caller’s issue, which is how almost every caller feels when they call in; I am the extended hand they get to grab on to for help. It is rare for someone to bite a helping hand. I have only had 2 in almost 23 years. I have received a lot of blessings over the phone, especially from my favorite, the over-65 crowd, but I am blessed to be able to work for a company that recognizes good service. I have five World Class call nominations and other awards that show I work for a company that appreciates me.
Recently I received a call from a mom in distress trying to figure out what to do for her now-to-be adult age daughter. Due to her daughter’s medical condition the doctors were encouraging the daughter to have a hysterectomy. As a mom of four kids, I knew the trembling voice on the phone asking about the prior authorization status wasn’t trembling out of frustration. She was a mom trying to hold it together as the little girl she raised and hoped to have children of her own was being told she needed a procedure that would change the course of her lifetime. I assured the mom I was going to see it through, I would get the answers needed and make all the calls for her. All I wanted her to do was just focus on her and her daughter. As a mom I could only imagine what she was going through. She cried and so did I. We cried even more together the next day when I called her back with the authorization which I was able to urgently get reviewed. Even though the procedure was not wanted it was needed. I didn’t just take a call that day, I changed someone’s day.
That is just one example of many examples of how every call should be an extending hand. I don’t help others once in a while, I always help them. Whether on the phone, or with a co-worker, stranger, friend, family, you name it; I wish everyone was continuously ready to extend a helping hand. This winter a young mom was coming out of the store in the rain. I was parked next to her and asked her if I could help unload her cart so she could get her baby get out of the rain. I put the groceries in the back of the SUV while we talked and shared laughs. As she headed home with her once a week load of groceries, I headed to work thankful that I got up early to get coffee creamer that morning. Each moment can be making someone else’s day better. It’s what I do!
I don’t want to keep what I do to myself. I try to share what I have learned with others around me, with my coworkers, leaders and with my own kids. I have helped coach alongside teammates, been an ambassador for our customer service department, and covered supervisor positions for my department, but in all things, I never lose the yearning to make a difference in every setting I am placed.
Kelly Carpenter – Regence Blue Cross Blue Shield Plans
“These are the types of calls that make me love what I do.”
Lapriel Williams is a long tenured employee of BlueCross BlueShield of South Carolina. She is a proud World Class Advocate and walks the walk when it comes to assisting our members each and every day. She not only takes pride in her work but also takes pride in helping others and sharing her knowledge. Although she works from home, her goals are to assist others to become World Class.
In early 2018 Lapriel received a routine call. When the member began describing his overall experience though, this “routine call” now sounded off, so Lapriel began to ask the member probing questions. Lapriel has a way of getting members to divulge information about them that may or may not have to do about their current call, or their insurance in general. During the conversation Lapriel learned that the member had piles of health care expenses each month and did not understand what all of the expenses were. When discussing with the member, Lapriel learned that the member was going to an out-of-network provider and paying out of pocket for these services. The member explained he was on a fixed income and needed help. Lapriel asked if he could send her a copy of what he had in front of him so she could review.
Fast forward several weeks. Lapriel received the copies of the receipts and just as she confirmed, the receipts were for out-of-network expenses that were eligible for reimbursement. Lapriel relayed this information to the member and asked if he had any questions or concerns other than the receipts, to which he responded no. She then asked if she could work on his behalf, to which he agreed. From there, she started working with the provider to get copies of the claims and itemized statements. One by one she waited for the claims and itemized statements to come through. As she waited for each one and the arrived, she had them processed for payment directly to the member.
At the end of the day, Lapriel assisted the member in getting reimbursement of close to $1,000 for something he had no idea that was even due for payment. It was only because Lapriel stopped and asked questions and listened to the member was she able to help him. When asked about this experience, Lapriel stated, “These are the types of calls that make me love what I do. I get so much pleasure out of helping someone who feels lost and has nowhere to go for help. This member did not ask for help but was just venting. By listening to him, I knew I needed to jump in and help him to the best of my ability.”
Lapriel Williams – BlueCross BlueShield of South Carolina
Made My Day
“He was so extremely helpful, courteous and knowledgeable.”
Nic’s professional approach with his callers sets the tone for positive customer experiences. He is known for his ability to problem-solve his callers’ needs and conscientiously works hard to make sure his customers feel secure, respected, and cared for. One recent customer stated: “I’ve been with you for many, many years. I just had the very distinct pleasure of speaking with Nic. He was so extremely helpful, courteous, and knowledgeable. I have 32 years of management with Delta so I know you like to hear when someone gives exceptionally good service. I wanted to pay Nic a compliment.”
Another customer recently gave great praise to Nic for saving the day by working through a challenging and urgent situation. The customer received notification from the State of New York that her driver’s license had been suspended, and she owed a significant fine for not having automobile insurance in place. The customer was distraught over what had happened and needed calm and expert help to resolve the issue. Nic quickly identified the issue as an error in electronic reporting of insurance information and proactively offered to speak with the DMV with the customer on the call to detail what had happened and what he could do to resolve the problem. Not only did Nic rectify the reporting issue by offering to send the appropriate documents, he offered to stay with the customer and the DMV representative on the line until everything had been received and processed. Nic was able to take ownership of the issue, which allowed the DMV representative to waive the fine that the customer owed to them. Nic was with the customer the entire way until the problem had been completely resolved. Our grateful customer said that Nic not only made her day, but made her week!
In addition, we have entrusted Nic to represent our company to prospective new hires. Nic’s passion for customer service makes him a valuable and sought after mentor for new employees who have expressed admiration for his knowledge, commitment, and dedication to doing the right thing for our clients. He demonstrates to them the “ins and outs” of the job responsibilities and inspires them to see the satisfaction and career development that can come from the role of Customer Experience Representative. For Nic, going the extra mile is standard. In his spare time, he thoughtfully makes suggestions for process improvements, which have been gainfully implemented to the benefit of our employees and customers. Nic is a true asset to our company, corporate culture, and to our customers, as demonstrated by his perfect SQM satisfaction ratings in 2018.
Nic Carter – Name Withheld
Taking Control and Ownership
“I could tell that he was choking back tears.”
I took a call from a member one day that was questioning a bill he had received. The bill was for over a thousand dollars and he couldn’t understand why he was getting this bill when his maximum out-of-pocket limit had been met for the year, so his services should be covered in full. He went on to explain to me that he had been undergoing treatment for two types of cancer and so far everything had been covered without issue. Hearing about his cancer diagnosis felt like a punch to the gut and immediately took my breath away, I couldn’t imagine what he was going through. During such a challenging time in his life, I certainly did not want him worrying about a bill. I empathized with him, let him know I was sorry to hear about his health situation and that I could certainly take a look into his account to see why he was getting a bill. I placed the member on hold and looked into the dates of service he gave me from the bill he had received. I did not locate any claims that showed member responsibility. We had indeed been paying everything in full as his maximum out-of-pocket limit had been met. I was a bit puzzled, but I knew what I had to do next.
I got back on the line with the member and advised him of my findings. I explained that based on the claims we have processed, there is no reason he should be receiving that bill from the provider. I told him that I would be more than happy to give the provider’s office a call for him so that I could review the processing and determine why they were sending him a bill, since it didn’t look like they should be. He happily accepted my offer. I could hear in his voice how tired he was so I gave him the option of either staying on the line while I outreached, or if he preferred I could give him a call back. He chose the latter. The moment I hung up and proceeded to outreach to the provider’s office is when I realized that the provider I needed to call was located in NY and per BCBS guidelines, I was not able to call them directly. For a brief moment I felt a bit defeated. How was I supposed to take care of this for the member and resolve the issue if I couldn’t call the provider? Thankfully, even though I was not allowed to call the provider directly, I am allowed work with the provider’s BCBS. I called BCBS of NY, explained the situation and asked if they could review the claims in question and outreach to their provider. The BCBS NY representative I spoke to was more than helpful, and after looking into the claims in question, it was determined that the provider was trying to bill my member for some late charges. The NY Plan explained that because the provider hadn’t submitted them in a timely manner, they were not allowed to be billed to the member per their contract with BCBS NY and the charges needed to be written off. The BCBS NY representative then called the provider for me to discuss the claims with them and after a brief hold came back on the line to tell me that I could tell my member to disregard the bill. What a sigh of relief that was!
I called the member back as soon as possible and shared the great news that he could go ahead and throw away that bill. I explained that he did not owe it and the provider was writing off the charges. He seemed almost shocked at first, he couldn’t really believe it. He asked me in a couple different ways, “So you don’t want me to pay this bill?”, and “I don’t need to pay this bill?” “That’s correct!” I reassured him that the bill was sent to him in error and that the NY Plan had already discussed it with the provider and they are writing off the charges. This is when I heard a shakiness in his voice, and I could tell that he was choking back tears. What he said next made the hairs on my arms stand straight up because it felt so amazing to hear. He said, “I'm just so grateful, God bless you! I can't tell you how wonderful your service has been and how grateful I am, boy, if I do ever need anything else, I will remember your name girlfriend!”
Taking the member out of the middle, taking control and ownership of the situation, and working with another Blues Plan to resolve his call, had a positive impact on his life. Being a light in his day had a huge impact on my life as well. At the end of the day it was just one phone call that made these impacts, but it can truly be the little things in life that make all the difference.
Rebecca Lee – BlueCross BlueShield of Vermont
“It was going to do more than just help her. It was going to save her life.”
In June of 2018 I took a phone call as a customer service representative that truly made me realize how important my skills and my heart are in this field of work. The customer had called the Consumers Energy Customer Service line in a panic as to how she was going to pay her bill. These are the types of calls I take day in and day out, always searching for the very best payment plan, assistance agency, or alternate option for each individual customer and circumstance. As I always do with my customers, I was trying to talk with her to get a little more insight on her life and see what the best option for her would be for her unique situation. The more we got to talking the more she began to tell me about her life. She was taking care of a toddler for her granddaughter that also lived in the home and was supposed to be working and helping her pay her bills. However, the granddaughter was not going to work when she left the house, she was taking her grandmother’s money that was meant for gas and spending it on other things. The customer was in a bad position in her life, financially and mentally. She felt like she was drowning, and it showed in our conversation; I knew I had to be her life raft.
My heart sank when this sweet, frantic woman told me she wanted to harm herself. There is nothing in this world more important than a person’s life. At that moment in time I realized that I could be the last person this stranger talked to if I didn’t reach out. I immediately pulled out my arsenal of tools given to us to help our customers in any way they need. Luckily, when I offered her the Gatekeeper referral, a program we offer to our senior citizens in need, she was grateful. I have used this tool multiple times in my career in the hopes that as much as possible, that it helps the person I’m referring. This time though, things were different though; it was going to do more than just help her. It was going to save her life.
A week later, I reached out to her to check on her situation and to ensure that the Gatekeeper Program had contacted her because I couldn’t get the situation off my mind; sadly, I had no response. Luckily, a month or so later I received a letter from The Department of Health and Human Services Office on Aging & Adult Service. They were writing to thank me for referring this customer to the Gatekeeper Program. She was currently getting help with her isolation issues and was also able to get assistance with her bill and other basic needs. I’m sure we all know that being a customer service representative is taxing most days and can be exhausting others, but it’s rewarding every single day. This is more than a job for me. This is a way to reach people that need it the most; those who are hurting to pay their bills, need a helping hand, and a kind voice. I pride myself in never judging a book by its cover and always giving everything I can to every caller because you never know what they might be going through.
On this day that I had the pleasure of speaking to this customer, I was more than just a customer service representative. I was a friend; a voice for my customer when she felt like she didn’t have one. I was her life raft when she needed it the most. She wasn’t the first customer that I lent a listening ear and went the extra mile for to find the best resources and help, and surely will not be the last. That’s what being a customer service representative is about to me, something bigger.
Rebecca Newman – Consumers Energy
Reminding the Member That the Company Cares
“I applaud you and the company for having the foresight in hiring Robert.”
Sometimes the difference in a customer’s interaction with their insurer, boils down to getting an agent like Rob. I personally have had the chance to sit with Rob to shadow him so I could get to know Horizon and its processes. During each time, Rob has demonstrated what it means to help our members and take them out of the middle of the ‘insurance process’. As a result of Rob’s conversational approach on calls and his effectiveness helping our members, he’s since become a part of our Concierge team. This is a team that helps key members with a ‘white glove’ approach.
In any given day, Rob and most agents will field between 25 and 35 phone calls. The topics can vary, and the help provided isn’t always a compelling story. Sometimes, however, a member calls in that really does need our help, and it’s what we do during those moments that define who we are. The call that really exemplified what service should look like, is a call from a member who was looking for help sorting out multiple bills he had been receiving. Normally, this would be a routine call, but in this case, it took on a whole new life, as Rob assisted the member navigating his services and reaching out to various providers to sort out the bills he had been receiving.
What made this call different, was the member had recently undergone throat surgery and was in the recovery phase. He couldn’t speak at his normal volume, but needed help working through the claims he had been trying to keep track of and help understanding his benefits as it related to everything he was going through. The task was difficult for our member as he struggled to speak but needed help. Rob understood what the member needed and made sure to help him sort out every part of the member’s concerns. As part of sorting everything out, Rob began calling the providers, and making sure the providers were accurately assessing liability for the services they had provided.
The call lasted approximately 2.5 hours, during which time, many agents that Rob conferenced in to help our member were less patient, and often not as empathetic towards our member’s inability to speak as loud as they wanted. Rob intervened multiple times to alleviate any need for the member to explain anything and focus the calls with the helping agents to fully resolve the questions on the bills and claims.
When the call was complete, Rob had helped the member work out the 4 months of stress that followed their procedure, as well as understand all that might have been billed. He was able to connect with multiple providers, give clarity to the member and providers, and lastly, helped sort out a delayed prescription that was waiting on an authorization.
The real measure of how successful the call went, came in the form of a testimonial, sent directly to the CEO of Horizon BCBS. Below is that testimonial, which I feel better summarizes why Rob, in my mind, is a World Class Agent and real advocate for our members:
I would be remiss if I didn’t apprise you of an experience I had with one of Horizon-BCBSNJ customer service representatives. His name is Robert Mills. I’m a senior (I prefer seenager) customer and had some issues with my account. Additionally, I had recent vocal cord surgery and it sometimes has made it difficult to be understood on the telephone. Robert was very knowledgeable with what I had to discuss, quite personable, most engaging, and very, very polite. But what was most important to me was that he treated me most kindly and patiently due to my difficult ability to speak with this new voice I had inherited. There is no doubt in my mind that Robert was raised well by his family and trained well by your company. Robert makes an excellent ambassador for Horizon-BCBSNJ. I applaud you and the company for having the foresight in hiring Robert and the good fortune in being able to retain him. May I ask one favor from you? Please distribute a copy of this letter to Robert so that he may know just how favorably I appreciated how he performed his duties.
Robert Mills – Horizon BCBSNJ
She Goes the Extra Mile
“This was not an acceptable answer to give him.”
Shandra is well known for her calls. When you talk to her you feel at ease and comforted that she is in your corner to help resolve the issue. She goes the extra mile to ensure that our customers are satisfied even through very difficult situations.
Shandra had a call with an upset father calling because his son’s pediatrician had recently found a spot on his child’s bladder. The pediatrician had referred the young boy to a specialist in a nearby city, however, because this provider was the only specialist in the area, appointments were booking several months out.
Extremely frustrated and wanting care for his son, the father understandably did not want to wait months for his son to be seen for something that could possibly be cancer. This is where Shandra went to work. She did some research online to see if there was ANY other specialists in the area and to her surprise, there was not. Being a parent herself and feeling the desperation from the father calling, this was not an acceptable answer to give him.
Her first thought was a nearby hospital. Shandra had personally taken both of her children to that hospital and knew they are amazing at working urgent matters into their schedules. She went back to the father and gathered a little more information including how far they were willing to travel for care.
Shandra placed the father on hold and called the hospitals urology department. She spoke with a scheduling rep and explained the situation and the urgency for an appointment for that same week. The hospital was able to work with Shandra and the father and an appointment was made. The father was extremely happy and thankful that we were able to help find a provider to see his son much sooner.
Shandra felt very happy that she was able to help this customer in a very difficult time. This is just one of many examples that show how great she is. She is empathetic and puts herself in her customer’s shoes to help them with their needs. She is able to use her resources and handle very complex issues while maintaining posture and positivity.
Shandra Roberts – Premera Blue Cross
I Was There to Help
“We were mothers, friends, and we were a team.”
My name is Toni, and I have had the honor of working with our customers for the last six years as a customer service representative at Consumers Energy. I wanted to share a recent interaction that I had with a customer that not only changed her view of our operations but allowed me to realize how much of an impact we can all have on the individuals we speak to every day. This call started with a frustrated woman who had called three previous times begging for help only to be told her options were to seek assistance. She apologized at the start of our call for the tone in her voice, as she was not upset with me, but rather upset with the situation, and the lack of help from the company. She was a single mother of four who works two jobs and runs an entire house on her own. Despite her best efforts of doing what she could for her finances, she continued to fall behind. As I listened to this woman’s story, I could only admire her for her strength.
As she continued to share a small part of her life, I could hear the tears beginning. I reassured her I was there to help, and together we would find something that would work for her and her family. I understood that while assistance agencies seemed to be the ideal answer, they were not the best option for her as a mother of four school-aged children, who worked two jobs to make ends meet. This woman was the meal-maker, the laundry-doer, and the house cleaner that had no time left in her day to get to an agency to seek assistance. Soon after our conversation began, she quickly realized that I meant what I said. I was there to help, and one way or another, we were going to find a way for her to succeed. Eventually, we found a plan that would not only resolve her shut-off status, but going forward, would relieve the stress of future disconnect notices and the precious time spent calling Consumers Energy regarding them. For the seven minutes we were on the phone together, we were mothers, friends, and we were a team.
Once again, I could hear the tears in her eyes, but this time she was not alone, I had joined her. She went on to tell me she kneeled down and prayed before she called for someone to just hear her and to help her. She said I was her answered prayer. I was so taken aback by that. I woke up that morning and came to work to do my job, which is all I had done, and this woman said I was the answer to her prayer. She thanked me for being there and listening to everything she had told me that day. I thanked her for the kind words she had shared with me, and agreed we were two working mothers who were destined to cross paths.
I have thought about this conversation often since that day. I have thought about how we were both brought to tears, how all this woman needed was another person to realize she was an individual, and that though we may hear this similar story in many of our calls, it does not mean that this person deserves to be treated as any less. Though we think giving the generic answer is the cure-all, it is not. It is our job and our privilege to slow down and really hear what our customers are saying to us, to be their hand to hold when they need it.
I soon realized that if I were to change the life of just one customer a week I would impact the lives of 52 customers a year. Having said that, in my six years of service, I would have made an impact on 312 of my neighbors here in Michigan, providing what our company strives for, hometown service. I come to work every day striving to make a difference like this on all of my calls.
Being a CSR can absolutely have its challenges. It also allows so many opportunities to make a difference in someone’s life. It is so much more than doing a job. It means being a helping hand to my neighbor, bringing a smile to a widow, sharing joy even when it seems impossible, and at times, strengthening someone’s faith.
Toni Fox – Consumers Energy
The Member Needed Someone to Take Ownership
“I felt like I made a friend that day.”
At the beginning of 2018, Trish made a commitment. After nearly missing the measure in 2017, it was now her year to become World Class Certified. Her team had recently gone through training pushing them to put themselves in the member’s shoes. Trish admitted in the past, she hadn’t been thinking about our members in that way. She decided for every call she would try to find a way to empathize and connect with the member. Trish found an opportunity to do just that when a member called, concerned about medication for her son.
Immediately Trish noticed the member’s son was the same age as one of her own daughters. This bonded the pair and helped Trish feel like she could understand the parent’s frustrations. Everything had been approved for the member’s medication, but at the last minute the provider on the authorization cited contract limitations and claimed they could not agree to administer it. Together, Trish and the member’s parent called the provider to get on the same page about where things were getting off track. After being put on hold multiple times and being on the call almost an hour, it was clear more research and calls would be needed. Trish knew the member needed someone to take ownership; it’s what she would want done for her. Trish explained, “[I wanted to] remove her from the middle of everything, make these calls for her… she had enough on her plate.” They ended the call with the provider, and Trish reassured the member she was going to find resolution, stating, “If there’s any calls that need to be made out to the providers to get this resolved, I’m going to do that for you.”
Privately, Trish wasn’t sure how to tackle the issue. However, the confidence she had when telling the member she would find resolution was real, as she knew she had the support of her entire team behind her. She started asking questions, reaching out to other departments, and then following up with the provider to make sure everyone had the same plan of action and knew which piece they were responsible for. With each new development, she made sure to keep the member’s parent informed of the progress being made. Ultimately, Trish helped the referring provider through the process of changing their authorization to another entity who could administer the medication. On the last call to the provider, Trish made sure to thank the nurse for her help. The nurse told Trish, “Oh I don’t think I could have done it without you!”
After resolution was finally achieved, the member’s mother wanted to make sure Trish’s help was noticed. She wrote a letter to Trish’s manager, stating Trish “stepped in and took care of everything.” The letter detailed a moment in the call when, after being placed on hold yet again, the member’s mother assumed Trish must hate her job. However, Trish clarified she actually loves what she does. The caller wrote, “She told me she gets tremendous satisfaction from being able to help people. I really appreciated hearing that. I felt like I made a friend that day.”
The member’s parent went on to let us know the provider told her she had never seen a representative go through so much trouble to advocate for a patient. When asked about the efforts she made to help this member and his mother, Trish stated, “Personally, I just feel like I did my job.” It’s clear from her World Class Certification, she has truly raised the bar for herself. Trish made a goal to connect with this caller and asked herself what she could do to exceed the need, then did just that. We’re eager to see what Trish will set her mind to next; the results are sure to be phenomenal!
Trish Smith – Blue Cross Blue Shield of Kansas City