2019 Top 25 Agent CX Success Stories
AGENT AWARD WINNING CX STORY
Determined to Make a Difference
“I Can, I Will, and I Did resolve her call.”
I received a call from a member who was on vacation at a Vineyard located on an island. When she outreached to Blue Cross and Blue Shield of Vermont for help, I was determined to make a difference in her day. I listened, showed empathy, and reassured her that I was going to help her. Those few steps I took to resolve her call left an impressionable WOW moment.
While the member shared her story with me, I kept thinking about what I would do in her shoes. How can I resolve this for her? She was stranded at the Vineyard for two more weeks with an injured arm. The only way off the island was by pre-registration for ferry transport. She wasn’t scheduled to leave for another two weeks. The emergency room took x-rays and confirmed she had fractured her arm in two places. The physician referred her for immediate follow-up care with an orthopedic surgeon who was on the island. They refused to see or treat her without a primary care referral. She contacted her primary care provider in Vermont, and they refused to send a referral on her behalf without seeing her first. Obviously, this wasn’t possible, and clearly not an option for her. She was feeling desperate like no one wanted to help her, so she called me for assistance. I felt the panic and discomfort in her every word. She was in pain and the last place she needed to be was in between a provider turf war.
After researching her benefits and options I ran into some snags. Although her policy didn't require referrals, the orthopedic surgeon required one. So, I outreached several times to her PCP office and left messages, but no one returned my call. When I finally got through, they indicated they had tried calling but our call volume was too high, and they weren’t going to wait to get through. Although I pleaded on her behalf, they still refused to send a referral to the orthopedic surgeon or submit an out of network authorization request. Financially, she needed an out of network prior authorization to reduce her out of pocket expense. I worked with my team leads and supervisors to brainstorm and find an alternate way to assist my member. My options were limited, as rules restricted me from making outbound calls out of state for pre-service issues without permission. So, I contacted the necessary outreach and obtained the permission needed to outreach to the out of state provider.
The orthopedic surgeon needed reassurance that the member’s plan didn’t require referrals and that I was going to complete an out of network prior authorization on the member's behalf so she could get her best level of benefits.
At last, I got through to the surgeon’s office, gathered all of the relevant information, and completed the out of network prior approval form on the member’s behalf, and sent it to our Integrated Health Team for review. Finally, I received approval for the out of network surgeon. I called the surgeon back, provided the approval information and they agreed to see the member. When I called the member back, I could hear her sigh with relief. She didn’t have to fight anymore, she wasn’t stuck in the middle anymore, she was relieved that someone had listened.
I put my member's needs first. When roadblocks appeared, I calibrated with leadership to come up with non-traditional options and sought the best route to resolve the call. These simple steps made an impact on the member's experience. Three months later, the member sent me a personalized thank-you letter.
She shared how patient and helpful I was. How I followed through and went the extra mile to help her when no one else would. How appreciative she was that I called her a few days after her orthopedic visit to ensure everything went well. The most impressionable comment she shared with me was, “If you ever feel like not getting up to go to work – think again! What you do and what you did for me made a huge difference.” Her heartfelt appreciation made every step I took worthwhile. With empathy and compassion, I showed her that, “I Can, I Will, and I Did resolve her call.”
Terry Lyn Bicknell – Blue Cross and Blue Shield of Vermont
Acknowledging the Customer’s Emotions
“I was able to understand her feelings through empathetic interaction.”
At the beginning of 2019, Winsome and I sat down to set a goal for the year. Winsome was committed to becoming World Class Certified and achieving better results than the prior year. Winsome accepted feedback and wanted to learn how she could improve upon her skills. On average, Winsome takes anywhere between 40-50 calls every day, and the topics and how one delivers the resolution may change depending on the caller and call type. Winsome takes it upon herself to resolve customer issues to the best of her ability, even if that includes setting follow-ups to complete something later during the month, or calling the customer back when she finds the resolution that best fits the needs of the customer.
Winsome came to me after she received a call from a customer whose brother had passed away in a plane crash. She wanted to see what we could do for the customer and make the process as easy as possible. The customer had received a bill under his brother’s name, so Winsome wanted to see if we could waive the bill for the customer. At that point, it was a no brainer, and we waived the bill and sent the customer a return label to send the transponder back as well. But Winsome wanted to go above and beyond for this customer, so we decided to send flowers to the family on behalf of 407 ETR to show our condolences. In 2019, Winsome received a call from a customer whose mother had just passed away and this was very personal for Winsome given that she too had just lost her mother not too long ago. This is what Winsome had to say about this particular call:
“One experience that I handled a few months ago allowed me to demonstrate my customer service skills to a customer who was sounding down, frustrated, and hopeless. After answering the phone, the woman said, “this is my mom’s account, and I can’t afford to pay this bill because she is gone”. Not sure what she meant by “she is gone”, I asked her to elaborate but she continued to say, “she can’t pay this bill.” I told her I can help her with that. I placed her on hold to review conversations on file and found she returned her mom’s transponder because she was sick and not able to drive any longer. Upon resuming the call, she was able to confirm the information above and later explained that her mom had passed away. I immediately sent my condolences to her and her family. I also informed her that my mom passed away recently, and I understood her grief and frustration. Due to the circumstances of her situation I adjusted the bill as an adaptable solution. In this instance, I was able to understand her feelings through empathetic interaction while also helping her to resolve her concern. My customer stated, “she was happy and thankful that she got through to someone helpful and understanding.”
This one situation shows how Winsome tried to put herself in the customer’s shoes to assist them in the best way possible. Acknowledging the customer’s emotions and having gone through such a tough situation herself, Winsome was able to provide her customer the best resolution without troubling the customer or getting the customer to do anything from her end. She tried to make it as easy as possible for the customer so the customer could spend the time with her family and not have to worry about a 407 ETR bill.
Winsome set her goal to be World Class Certified and customers acknowledge her ability to put herself into their shoes and provide the best possible solution as evident in customer survey feedback:
- “She was very personable and took the time to understand exactly what I was asking to have done to my account.”
- “She was extremely polite. She understood exactly what I was talking about and everything was done in a timely manner.”
- “She was very understanding. She checked all the information right away and sounded very concerned and on top of it. She took a lot of pain to make sure it was done.”
In addition to her CSR role, Winsome is one of my go-to CSR’s when we have a new hire who joins the team. She helps me train and teach them the ropes with a positive attitude. I am proud to say Winsome achieved her goal of being recognized as World Class Certified and has set the bar even higher for herself in 2020!
Winsome Gray – 407 ETR
Ensuring a Loved One is Comfortable
“One of my greatest passions in life is helping others”
I started with Blue Cross Blue Shield of Massachusetts in 2018. Prior to starting with the company, I worked in retail for 13 years where I was looking for new challenges and more learning opportunities. I had never worked in health insurance before, and I knew that BlueCross had an excellent reputation with opportunities to grow.
It was my first time working in a call center environment. At first, it was all brand new to me, but I was ready for the challenge. Some members' calls were tougher than others. I constantly reminded myself to be patient, take a deep breath, and treat each interaction as a learning experience. From a very young age, I’ve always enjoyed learning new things. One aspect that I love about working in Member Service is that I am constantly learning something new every day.
One of my most recent calls was with a spouse who called on behalf of his wife who was receiving care in a skilled nursing facility. She was scheduled to be discharged at the end of the week. His wife was initially supposed to receive hospice care directly after being discharged from the facility. He even ordered a hospital bed to be delivered to their home. Prior to the discharge date, the wife unexpectedly took a turn for the worse. Her husband stated he had to cancel the order for the hospital bed as she was not going to be discharged.
She was approved to stay at the facility, but they were informed that the member’s stay would cost over $400 each day. Her husband was devastated. He didn’t know how much time his wife had left, and this was such a burden they were not expecting. I empathized with him because I experienced a death in my family several years ago and understood how important it was to ensure that a loved one is comfortable, and most importantly, has the best access to care.
I called the skilled nursing facility and learned that the charges were for private care residence, and not covered by insurance. I reached out to the hospice company with whom the wife was initially supposed to receive care from at home. I made an outbound call to the hospice company and spoke to a kind and patient intake coordinator. I confirmed with the coordinator that the wife had full benefits for hospice care without any out of pocket costs. She was able to assist both the spouse and me with coordinating the skilled nursing facility to have hospice care arranged in the wife’s home instead. The intake coordinator advised that a nurse would be visiting the wife at the skilled nursing facility that same day to perform a screening. She was able to arrange for an in-home evaluation to be performed first before ordering equipment including a new hospital bed to be delivered to the wife’s home.
The husband was so appreciative of all that had been arranged, working with both the skilled nursing facility and hospice care company to coordinate his wife’s care at home. He asked to speak to my supervisor to tell them how grateful he was for my help and that we were able to resolve this matter for him and his wife. He could now have peace of mind.
I followed up on the wife’s account and discovered she had passed away 2 weeks later. I knew that it was not an easy time for either the spouse or their family. I sent a card expressing my condolences. It’s scenarios like this that remind me how valuable our roles are working in Member Service, and how rewarding my job is. I understand now that one of my greatest passions in life is helping others, and I am so appreciative to be able to work for a company that has built its foundations around that.
Eric Phouthavong – Blue Cross Blue Shield of Massachusetts
Confidence By Believing In Ourselves
“I could confidently help and assist our members with whatever challenge they were facing.”
Before I began as a Medicare Markets Representative, I had been in retail management for the entirety of my career. I wanted to make a difference and feel as though I was helping someone at my job and that wasn’t happening. A change needed to be made. I wanted a career that challenged me and allowed me to use the customer service skills I had cultivated.
A friend referred me to the call center at Blue Cross Blue Shield of Massachusetts. I was excited to start something new, but nervous. No longer would I be able to rely on body language or facial expressions to help communicate my empathy or willingness to engage. As I gained more experience, I still did not have the confidence in myself to resolve matters on the first call. In Medicare Markets Member Service, we have a team of confidence coaches. These coaches are our peers who mentor and guide others by sharing best practices, spending one on one time with us, and they help us to build our confidence by believing in ourselves and what we have learned. I volunteered for a confidence coach. As I worked with my coach, my confidence was increased, and I was resolving member’s inquiries on the first call. It provided me with the reassurance that I needed so that I could confidently help and assist our members with whatever challenge they were facing.
The calls that really touch me are the ones that I have been able to alleviate common fear and dispel the confusion that prompted the call. Diffuse the emotions that make our members anxious. I feel gratified and fulfilled when I ensure that the member, who only has a couple of days left of the medication she needs to sustain her life, can get her refill before she runs out, or the crying spouse who has a policy to cancel because their loved one has passed away. Or the family member to whom I’ve just had to explain the difference between home health and hospice. Calls that may require one to take a few moments following the call to regroup because they’ve taken every ounce of tenderness and compassion one possesses.
A recent call that stands out to me was when a member called who was angry. Why was she angry and most of all, what makes most people get angry? Fear. Confusion. Hopelessness. Embarrassing emotions. Asking for help is hard. If I can, those are the emotions I want to address, not the result of those emotions. If I react defensively, it escalates the situation. The important thing here is to listen because when you listen, people will tell you everything you need to know without having to ask. In this case, the member received a bill from a provider, and the amount requested was more than a person on a fixed income can possibly afford without depriving oneself of life necessities. The member wants to know why they are getting a large bill when they’re paying so much for insurance that is supposed to be the best.
Now I know what to do. Empathize, address her feelings, gain confidence, resolve this issue, build value in the product. I use the timbre of my voice to convey I’m invested in getting to the bottom of this bill. I explained how I understood, “that this was a lot of money, and how scary it would be to get that bill. I’d love to take a look at that claim for you and see what’s going on.” As she gave me the pertinent information on her bill, I could hear her calming down, allowing herself to be relieved that someone is taking ownership and trying to help. I gave her an ally. When I saw the claim, it was clear to me what happened. The claim had not been processed by Medicare. Unfortunately, this happens much of the time. I went back to the member and explained what the situation was and educated her on how I was going to get this resolved for her.
I asked the member to allow me to contact the provider’s billing department to ensure they have all the information they needed to process the claim correctly. Now she felt silly and didn’t want to be a burden as she could call them herself, and she was certain that I had more important things to do. Here was another emotion I could negate. I told her that I am her advocate and that I’d be honored if she’d allow me to straighten everything out for her. I told her that she’s important, absolutely worth my time and that her feelings were valid. I contacted the provider and gave them all the necessary insurance information. When I came back to her, I let her know that she needn’t do anything and may disregard the bill. I heard her let out a breath, and with it, went her fear.
She apologized to me for being so cross when she called. She thanked me for taking the time to explain everything to her and “averting a heart attack.” She told me she was glad it was me who answered the phone and admit she was afraid to even make the call. She let me know how grateful she was to have chosen Blue Cross Blue Shield of Massachusetts. I thanked her for being a member and told her never to be afraid to call us. I told her she’s why I got out of bed this morning. She laughs, assuming I’m joking. I’m not. What’s a day without purpose?
I thank every member who calls. I thank my trainers, leaders, confidence coaches, and peers. I thank them for alleviating my own fears and confusion, for taking the time to explain things and educate me without making one feel silly for asking, but most of all for proving a job can be more than a paycheck and that a company can be more than the sum of its parts.
Jill Adams – Blue Cross Blue Shield of Massachusetts
Ready to Make a Difference
“It’s the feeling I have when I've talked to someone and I know I've made a difference in their life.”
Being a World Class Customer Experience Representative (CXR) is more to me than positive comments and customer feedback compiled into a story. To me, being a World Class CXR is a feeling. It’s the feeling I have when I've talked to someone and I know I've made a difference in their life. It’s the warmness I get in my heart and an instant smile on my face when a member's tone of voice is uplifted or when tears of sadness turn to tears of joy. When I experience these interactions, I know that I am a World Class CXR. Seeing my worth as "World Class" has not always been that easy. I look back to where I started and where I am today, and I am ecstatic to be recognized as part of this World Class CXR group! I know I am appreciated, and my efforts are not overlooked. I am very proud of this achievement!
I want to share a story and how the comments from our members have empowered me to become a World Class CXR.
This month marks my 5 years at Blue Cross and Blue Shield of Kansas (BCBSKS) which is a huge accomplishment I never thought I would make it to. You see, I started in Provider Benefits, like most people, and then moved to my next line of business. I started Traditional training in the Fall of 2015 and was very eager to learn something new and excited to start talking to our members. I went through training and was ready for production. I could not wait to start using my new skills. This is also when I was first introduced to SQM. I was ready to start hearing feedback from actual members on how I helped resolve their issues.
It did not start out as great as I had imagined. It was actually very eye-opening to hear from our members that I was not helping them. I struggled. I mean, I struggled hard. I could not fathom how these comments were being said about me when I felt like I was doing great. I wanted to quit and was convinced I was going to get fired. I cried and had nervous breakdowns. I just wanted to be the best. I had so much enthusiasm and I was ready to make a difference. To hear that I was not making an impact, devastated me. I had a lump in my throat and a pit in my stomach. I was to the point of not feeling good enough for this job and I was failing as a person and I was failing our members. My spirits were down, which caused my Blue Trust scores and adherence, to lack in performance. I felt so worthless and I continued to beat myself up. I was at a point I was scared to take the next call for fear of letting someone else down. At this point, I knew I had to try something different and open up to some real changes.
I used the SQM portal every day and I kept track of everything both "good" and "bad". This is when I learned to buckle down on making EVERY call a World Class experience for our members and not just World Class in my eyes. I learned how to put myself in their shoes and think like a customer. I was patient and really listened to their words, heard their questions, and concerns. Then, I started seeing positive feedback and my resolution scores began to rise. I was able to achieve World Class recognition in 2018 and then again in 2019. I have not mastered it, but I am still learning and growing. I am on my way and I know I am a World Class CXR. I feel it in my heart and soul, and I am happy.
It took me two years to certify in the Traditional line of business, which felt like forever. After that certification, I learned Plan 65, State of Kansas, and ITS. I was able to regain my confidence and turn my career around. I used SQM to learn and build myself back up. I had several supervisor meetings and coaching sessions that really opened my eyes to ways to better myself. I started taking Blue University classes to work on my confidence, as well. I took classes like Adapting to Change, Building Trust under Pressure, Matching Energy Styles, Workload Management, and many others. I was able to complete my PEPPER courses in 2019 which helped me with work success, and also my personal life. I am thankful for the opportunity to take these classes as they have helped me be a better person and a better CXR.
In addition to the classes, I owe a huge part of my success to my supervisors who never gave up on me. When I would come to them upset about failing someone, they would turn it into a positive, something for me to learn and build from. If she has not already nominated herself, I would like to nominate Jody Broughton for Supervisor of the Year. Without her constant support and drive to help me improve, I am not sure I would have made it through those tough few years. She really is an outstanding supervisor who keeps it honest and open and will put a fire under your rear when it's needed. She has been my supervisor for the past 5 years and I am grateful for her. I also could not have made it through those rough patches without my Unit Assistant, Kellie Walker, who should be Unit Assistant of the year. They have both put up with my rollercoaster of emotions in times of success and failures. They never gave up on me and always backed me up and supported me. They have always helped me see my worth, even when I could not see it myself.
So, you see, with the support of great supervisors, encouraging Blue University classes, and the help of the SQM system, I have turned into a great success and I owe it to all of you. Even if I am not selected as CXR of the year, I know my worth and I love my job. Making an impact and helping the members of this community and state, make this the absolute best place to work. It may not always be easy, but it is definitely worth it! I am grateful and proud to be part of the Blue Cross and Blue Shield of Kansas family.
Morgan Milbradt – Blue Cross and Blue Shield of Kansas
Going the Extra Mile for Customer Satisfaction
“She is compassionate with every call and will let nothing get in her way when it comes to customer satisfaction.”
I want to give a HUGE shout out to Renee Rinehart who worked to resolve a very crucial situation with a member of ours by taking control of the call and eliminating any homework for the member. Renee is always going the extra mile for customer satisfaction.
One night while working the late shift, Renee Rinehart received a phone call from one of our members who was a nurse. The member was very distraught and in tears when Renee answered the line. She could barely talk and was trying to explain what happened to her. While at work she was treating a patient with HIV and was stuck by a contaminated needle. She went to a pharmacy to get the medication, but the pharmacy stated it needed a prior authorization to be filled out. The price of the medication was also too high to pay for out of pocket.
Renee called the pharmacy to see if there was anything that she could do to get them to fill it, but since Renee wasn’t trained in the pharmacy department, she didn’t have access to override the medication for the member. She contacted me as I was the late-night lead and stated, “I don’t know if there is anything more we can do for this member, but I just have to try.” Renee herself was in tears because she felt so bad for this member, who in her job, always helped others.
The sooner the medication is administered the more successful the results. The medication is a specialty medication and could be overridden through the regular pharmacy benefits; however, it was 7:30 at night and our pharmacy department was closed. I went through the steps of trying to locate information to assist in resolving this while Renee stayed on the line and continued to comfort the member, but everything I found, Renee had already tried. We decided to contact the supervisor of the pharmacy department at home to see if she could assist with an override on this medication, as I knew we could override medication for HIV. I explained the situation and asked the supervisor if there was anything she could do to help this member out.
The supervisor contacted a pharmacy representative to put in an override for the medication for us. Renee was updating the member on what was happening when I contacted the pharmacy to have them run the claim to ensure it would go through. The pharmacist at the pharmacy said they didn’t have the medication on-hand and it would be a few days before they could get it in (this was at 8:35 p.m., already 35 minutes past closing time for Blue Cross and Blue Shield of Kansas City and 25 minutes until closing time for the pharmacy).
I told the pharmacy supervisor the situation and told her since the overrides were in the system that I could go in and edit the NPI to match another related pharmacy. While I contacted the other related pharmacy to see if they had it in stock, Renee explained to the member the situation and asked her to hold while she contacted the initial pharmacy to have the prescription transferred to the other store. Once this was confirmed, Renee told the member to head to the other pharmacy and stayed on the line with her while she drove there.
I called the pharmacy that had the medication in stock and asked them to run the claims to make sure they would process it for this member. This was at 8:50 p.m. (now 50 minutes past closing time for Blue Cross and Blue Shield of Kansas City and 10 minutes until closing time for the pharmacy). The member walked in and did get her medication for the HIV prevention.
The moral of the story is: When you put a scared member and a determined Customer Advocate (Renee) together, you create harmony within a team to succeed for a single mission. The thing about Renee is that she is compassionate with every call that comes into her and will let nothing get in her way when it comes to customer satisfaction. Here are a couple of other compliments Renee has received from members:
- “I am a new member and I called today because I am pretty sick, and I need to go to urgent care or ER, and I got Renee. Our information had not been loaded into your system. She straightened out everything for our insurance. Renee made calls, typed a letter, contacted urgent care that I will be going to, and let them all know that I am covered. She gave me her direct contact info if I have any problems when I get there. Incredibly efficient, wonderful caring service. Very kind and polite. I just can’t say enough about her! Thank you so, so much.”
- “Renee was so helpful. Between all the confusion of who owes what in this situation, she helped me through the process. She called me back as promised. She definitely went above and beyond, and I can’t thank her enough.”
Renee Rinehart – Blue Cross and Blue Shield of Kansas City
“My work is rewarding in so many ways.”
When I first started at Blue Cross Blue Shield of Massachusetts 20 years ago, I didn’t know what to expect while working at an inbound customer service center. Talking to people over the phone as opposed to face-to-face was new to me. With all the jobs I had from social work to a special education teacher, to a sales position, I was face-to-face helping people and seeing their emotions to help better understand their situations. I soon learned that you can still feel the members' emotions over the phone. I try with every call to make sure that the member has been thoroughly assisted. I strive for positive resolutions throughout every interaction.
One call that stands out to me was from just a few years ago. I remember it was the end of the week and I was leaving work for the night when I heard about a person that was in an accident. The following week, my first call was with a woman asking questions regarding coverage for an inpatient hospital stay. She said her husband was in an accident and while she was talking, I quickly realized that her husband was the person in the accident I heard about. I advised her that the hospital would call us to let us know their situation and make sure all the proper approvals and reviews were in place. I also proactively educated her that she may receive an ambulance bill and how that will work. After realizing that she would potentially stay at the hospital with her husband while he recovers, I gave her my direct email address and told her that she can send me any questions or concerns that she may have. I even offered for her to send me bills that she was questioning so that I could make sure that they were processed correctly and could give the insurance information on their behalf if needed.
Her husband was hurt early in the year and was not released to go home until later that same year, so it was a very apparent, long road for them. There were weeks where I received multiple emails and other weeks where I would only get a few, but I stayed busy working to resolve every inquiry I could for this member. I still remember how rewarding it was when I got the last email in late fall stating that her husband was at home and doing great.
My work is rewarding in so many ways. To be able to stick with someone, see them through a difficult situation, and to feel their gratitude is something that makes my job worth getting up for each morning.
Karla St. Marie – Blue Cross Blue Shield of Massachusetts
Giving the Member the Gift of Precious Time
“I have the ability to change people's lives for the better.”
“I am frustrated and the last thing I want to be doing right now is talking to my insurance company,” this is the first thing the member said to me as I answered the phone. I could hear her voice shaking and tone escalating. She rushed through the caller identification and verification process seeming more aggravated with every question I asked. Before I could finish asking her what was wrong and how I could help, she interjected and said, “there is a big problem that needs to be fixed right away and I need to tell you about my situation”.
I let her know I am here to help and encouraged her to share what was happening. She explained how after years of being on the same insurance plan, her employer had made a drastic change to their insurance plan and she no longer understood how any of this worked. Previously she was on a plan that covered the majority of her services at no cost to her and BCBSVT would simply make any necessary payments to her providers requiring minimal effort on her part. She now has a high deductible health plan that works with a health reimbursement account (HRA) that is partially funded by her employer. It was her understanding that she would only have to pay $1,000.00 out of her own pocket in a year but somehow ended up having to pay $1,600.00. She went on to explain that financially she could not afford to pay more than her responsibility and she needed to be reimbursed by BCBSVT as soon as possible.
These call types can be challenging as I have less control in resolving the issue for a couple of reasons. The first is that all employer groups choose how they want to fund their employee’s HRA accounts and we don’t have visibility into what that arrangement looks like. The second reason is that HRA accounts are managed by separate financial institutions, some more willing to work with us than others. I knew this wasn’t going to be easy, but I was ready to roll up my sleeves and get to work. I immediately reassured the member that she had come to the right place, I was here and ready to resolve this issue. I then acknowledged that the plan she is currently on is more complex than her previous plan and assured her we’d figure this out together. Once she knew I was on her side, I noticed she began to relax. First, I walked her through her benefits with BCBSVT, explaining how her deductible and out of pocket maximum works. Then I explained that she has an HRA that is partially funded by her employer and each employer is different in the way they choose to fund the account. I explained how when a claim processes, we communicate that information to her HRA so that they can determine what if anything they need to pay to the provider on her behalf. To verify how her HRA was funded, we called over to the HRA Company together and verified her arrangement. They confirmed that she is responsible for the first $1,000.00, her employer funds the rest of the account up to her out of pocket maximum, and they make the payments directly to her providers.
I now had all of the information I needed to begin researching her claims to identify where the $600.00 overpayment came from. When the HRA Company disconnected from the call, I was taken aback by a moment of silence. As I go to ask her if she has any questions about the process, she breaks down. Her voice is soft and mellow as she explains that she has a devastating medical diagnosis and how she was originally diagnosed ten years ago and had surgery to diminish any chance of getting it again but found out a couple of months ago that it had come back and was given a life expectancy of approximately one year to live. She shared how she spent many hours, which have turned into days, trying to look at her insurance claims and compare them with payments made by the HRA and what she has spent out of her pocket to no avail. She found the process overwhelming and said she wants to enjoy the time she has left in this world, not deal with insurance, and have to track down the money. Wow, this was hard to hear, my heart went out to her. I could not imagine overcoming a disease, only to find out ten years later that it had returned, and the prognosis was so bleak. She had so much going on in her life, there was nothing I wanted more than to take this worry off her plate. I was going to do everything I could to help her. She should not be spending time dealing with insurance or feel alone in this process. I gave her my word that I was going to see her through this situation and make sure she gets her refund. I explained my next steps so she knew what to expect and promised that I would keep her informed throughout the process and would not stop working with her until her problem was resolved.
After researching all of her 2019 claims, I found the claim that had been processed incorrectly with a greater member liability than it should have. The HRA had paid the correct portion to the provider, causing the member to be billed by the provider for the $600.00 overage. Not knowing what to do, the member simply paid the bill instead of calling for help. I worked with our team to escalate the reprocessing of the claim. When I called the provider to advise of our error, and the need to reimburse the member, they were unsure if they should reimburse the HRA or the member given the integration. To ensure this was handled correctly the first time, I outreached again to the HRA Company to discuss our reprocessing and confirm who the provider should reimburse. I then called the provider back and reassured them that they did need to reimburse the member for her overpayment of $600.00. I received confirmation that they were taking care of this. Due to the complexity of the HRA and that the provider uses two separate billing companies that I needed to call and work with on the member’s behalf, it took me three weeks to reconcile the member’s account with the provider to ensure she was reimbursed appropriately. During this time, I kept my promise and continued to check in with the member to let her know I was still working on her issue and was not giving up on it. In the end, the provider sent the member a refund and her account was corrected.
I was so excited to call the member and give her the good news that her problem had been resolved! She was so grateful for all of my help and thanked me. She said, “I was able to spend the past weeks with my grandchildren enjoying my time and building memories with them for when I am gone. Without you, I would have been on the phone wasting the precious time I have left.” As the member said this to me, I got goosebumps, and this has truly changed the way I look at my job. She was so happy that I had advocated on her behalf that she wanted to speak to my manager.
Manager feedback: “I took the loveliest compliment from this member. This was not your traditional compliment call that we receive, this member boasted about Kasia’s exceptional service for over 10 minutes! I was so touched by how Kasia’s assistance had positively impacted this member.” The follow is a snippet of what the member shared: “I am so delighted and wanted to reach out and give a big thumbs up on your employee Kasia who has really done an exceptional job here. When Kasia got involved, everything clicked into place. She has an exceptional bedside manner. By the time I got to her, I was losing patience, but she was awesome. She set the expectations appropriately as to when she would reach out to me, she never missed a date, and each time the ball had been moved further to resolution and now it was resolved, and wow, what an awesome experience. In the last decade, she was the best customer experience I have ever had.”
I am proud to call myself a customer service representative. I am not just a call taker. I am our member’s confidant, problem solver, shoulder to cry on, person to vent to, and whatever else they may need. I am the person who answers the phone ready and willing to help them with everything they need. I am proud to be a member of such an outstanding customer service team at BCBSVT where we can say we will see our members through any situation and help them be well. This member helped remind me that by taking my members out of the middle and providing concierge service, I have the ability to change people's lives for the better and give them the most precious gift of all…time.
Kasia Starzec – Blue Cross and Blue Shield of Vermont
Problem Solvers, Not Problem Starters
“I would not stop until this issue had been resolved.”
Working with Blue Cross and Blue Shield of Vermont, I have had hundreds of conversations that I will always carry with me. Sometimes it’s a funny joke the member says, maybe it’s the way they pronounce my name... (I will forever hear, are you named after your dad? As I repeat for the third time, “it’s like Jeff but with an N”) maybe it’s because, after the five frustrated members I spoke to, one, in particular, said good morning back. I catch myself every so often saying, “I really do love my job” after I hang up the phone. This one member, in particular, reminded me why.
I remember it being a cold Vermont day, so naturally, Vermonters aren’t their normally bubbly self. There is snow everywhere and the sound of ice being scraped off of windshields is playing through the air. This was one of my first calls of the day. As I pick up the phone and recite my greeting “Good morning, thank you for calling BCBSVT, this is Nef, how may I resolve your call today” before I even finish my sentence, the member with zero hope in his voice replies “I hope you can because I’m starting to think no one can”. This is always jarring to hear as it sends a clear picture that this isn’t the first time they have tried to get an issue resolved. By the sound of his frustrated tone, the member hadn’t had much luck with this issue before. I start to ask some probing questions to gain insights into what was happening. The member seemed bleaker as he answered each of my questions and advised that he hasn’t had much luck with insurance before and he felt that this call would end up like his others. Part of me was at a loss, the other part of me thought “challenge accepted”.
This member explained how he had been trying to get a prescription he is supposed to take daily for two weeks now and each time he went to pick it up, the pharmacy would advise that the drug was denied for a lack of prior approval. Looking through his account, I confirmed that the drug did need prior approval, but there was not an approval on file. I knew this was now in the hands of the provider. When I got back on the line with the member to explain that he didn’t have an authorization on file, he was understandably more frustrated than before. “Why is no one trying to help me?!” Hearing this broke my heart, and I could tell he had been down this path before with no success. At this point, he was feeling lost and not confident that I was going to help, and I was starting to really feel for this member. Everyone can relate to needing help and feeling like you keep hitting walls. I wanted to open the door for this member. I reassured him that I did want to help him, and I would not stop until this issue had been resolved. The first step was to talk to the doctor. I let him know that I would do the leg work to make sure this request was submitted and that I would call his doctor’s office on his behalf. While I hadn’t won him over yet, I could feel some of his tension dissipate.
Calling a doctor’s office can be hit or miss. You either get someone who is kind, generous, and willing to walk the long trail with you, or you wait on hold to get someone who tells you they can’t help. Sadly, my situation was the latter. I called the provider’s office. At this point, it was 4:00. After waiting on hold for 15 minutes and knowing they probably close at 4:30, I started to lose hope. How am I supposed to talk to someone about getting an authorization for this member, and have it approved before they go home? Not only was this a priority for the member but it had become a priority for me as well. I make a point of trying not to set unrealistic expectations for our members, but I do set them for myself and I was determined to be the one to resolve this. After waiting for what felt like light-years for someone to pick up the phone, I finally heard a soft tone pick up the other line. I was quick to explain the situation and to my surprise, they stated they had submitted an authorization two weeks prior. I didn’t think the pharmacy vendor authorization process took that long to review and that likely their request had not been received, but I advised I would follow up with the pharmacy vendor, thanked the provider, and hung up. Next step: call the pharmacy vendor.
At that point, I was very hopeful for the member. I was thinking that could call the pharmacy vendor, and they would say everything is approved and the member is all set. However, when I did call and was connected to a representative, that was not the case. After searching for this authorization, they confirmed my fear that they did not have any record of receiving the request. I was feeling as though I not only let the member down but also myself. It had been about an hour and a half by that point, and I was in the same position as when I started. I was not willing to give up just yet. I asked the pharmacy vendor representative if there was anything that could be done at this point to get an approved authorization on file that day. With a helpful tone in her voice, she said, “I can’t guarantee that it will be approved but I will call the provider’s office now and initiate the authorization over the phone”. I’m such an optimistic person, at times almost too optimistic I think, but when the representative said that I instantly had hope again. She let me know I could wait on hold while she tried to connect to the office. After 4 minutes, she came back and let me know she went to voicemail but would try again. On hold again (at this point I have their hold music soundtrack embedded in my brain) I waited for what felt like forever and finally, I heard her voice again saying, “Nef, I just wanted to let you know we completed the review” and then what felt like the most dramatic hold between sentences I have ever heard, she says the words I had been waiting to hear all day, “He is approved to get the prescription”. I wish I could insert a picture of myself from that moment because I stood up with such excitement and fist-pumped the air...Literally. It was almost embarrassing, but I was so excited. I thanked the representative and prepared myself for the final step.
I didn’t want to call the member back just yet. When I called him back, I wanted everything to be done. To ensure I truly saw this through, I went ahead and called the pharmacy. It took me moments to get connected to the pharmacist. As I gave the member’s name for verification, they instantly knew who I was talking about “I’ve been working with this member for a couple of weeks now, is this for his prescription?” I let the pharmacist know we had resolved the issue and obtained the authorization, and I asked if they could try to run the prescription claim through again. Adding the cherry on top to this rocky road sundae, the prescription went through and was ready for the member to pick up! I could barely contain my excitement by this point. Calling the member back had been on my mind all day. I heard him pick up on the other line and told him who I was. I continued to fill him in that I was able to connect with his doctor’s office, have his pharmacy vendor initiate the authorization, and obtain approval. I let him know I then called the pharmacy to have it run through, and all that was left was for him to do was to go and pick up his prescription. What the member said next is why I do what I do. As he thanked me for my hard work and making his issue my priority he said, “Nef, you have gone places where others have gone and failed, and YOU made it happen. This is why I work with you guys. You are problem solvers, not problem starters”. The member went on about how happy he was and even requested to speak with a supervisor to compliment my customer service. My job is hard. Some days it’s hard to leave with a smile on my face. With everything you hear about insurance, you start to think, “maybe I am the bad guy”, but its members like this that change that perspective. I’m not just a big corporation. I’m one person taking each call one by one trying to be that member’s voice, an ear if they need listening to, and a friend to vent to. This member was right. We are problem solvers. We can make a positive difference and that is what makes it all worth it.
Nefedaya Smith – Blue Cross and Blue Shield of Vermont
Commitment To Excellence
“Treating members the way she would want to be treated.”
Candace McMurran truly embodies the BlueCross and BlueShield of North Carolina (Blue Cross NC) value that every customer matters. Candace joined Blue Cross NC in November 2014. She supports our Student Blue Concierge Service Team, where our focus is to provide World Class service to over 50,000 students and their families in North Carolina.
Candace has a reputation for following the “Golden Rule” and treating members the way she would want to be treated. She constantly puts herself in the shoes of members with whom she interacts. This doesn’t stop with our members. Candace also applies this mentality to her peers as well. Her growth mindset allowed Candace to make great strides in 2019, being highly ranked in World Class Recognition as well as improving her WCC score by 15% from 2018 to 2019. In addition, throughout 2019, Candace consistently exceeded all her call quality metrics.
Candace is a walking omni-channel for the Student Blue team. She is a key player in supporting inbound calls and emails, and she also serves as a subject matter expert on several customer experience projects. Her indirect leadership with her peers has positively impacted our team FCR. Candace’s commitment to excellence doesn’t go unnoticed by our members. One member recently shared that, “She was really professional and able to answer all my questions very efficiently. Then when I was done, she made sure that I didn't have anything that was left, any need left unmet.”
Candace deserves to be in the running for the CSR of the Year award for her dedication to our members and her team!
Candace McMurran – BlueCross BlueShield of North Carolina
“Allow the member to build trust within us.”
Carmen is a multiple-time World Class award winner and last year was a finalist for CSA of the year. Throughout her tenure, Carmen knows what it means and takes to be World Class. She understands that one call does not earn you World Class, but it is all about building trust with your customers every day. Although she has earned World Class the past 4 years and been a finalist, she is determined on each call to exceed the customer’s needs. The following story is an example of her building trust.
Late one afternoon, Carmen received a call from a member stating her provider called to cancel his radiation treatment taking place the next day. The provider stated that the treatment was canceled because the pre-certification had not been approved. This member went on to tell Carmen that he was a cancer patient, and this was his regularly scheduled radiation treatment. He was upset about the last-minute cancellation and how it was being handled. Since this was a needed treatment in his recovery, he wanted to know what the next steps would be for his recovery and how he would be able to reschedule in such a short time frame. He went on to state that this treatment was over an hour away from his house and he was worried how it would impact him if not approved.
Carmen, in her reassuring voice, first told the member she was sorry for all he was going through. She was immediately able to tell this was something that could be taken care of. First, she showed her empathy for what he was going through. Knowing he was going through cancer treatment was hard enough and having to deal with this situation had to be an added stress. She worked on building his trust and assisted him through his journey. First, she let him know to not cancel his treatment and that she would be his advocate and take care of it. She would then call him back with a resolution. Knowing he had to drive a long way to the appointment and leave early in the morning, Carmen promised a call back with a resolution the next morning.
Carmen took ownership and resolved the issue by clearing up the mistake. Not only did she resolve the issue with the member but she also contacted the provider to make sure they did not have any issues on their side. When she contacted the member the next morning the member was appreciative that he had a trusted advocate on his side and a company he could always count on.
When we asked Carmen what her tips are for being a great Customer Service Advocate, she stated, “If you listen, be patient and compassionate to the member, regardless if they are frustrated, it will build confidence in the call and allow the member to build trust within us (you) so that we can resolve their issues.
Carmen Storey – BlueCross BlueShield of South Carolina
A Service Star
“I think of my members as though they are a family member.”
Starlight Ervin is a true Customer Service ‘Star’. She has the shining ‘Star’ attitude that members love when talking to her, and she puts the members first in everything she does. Starlight is consistently looking for ways to resolve members’ issues as soon as they get on the phone. Members have always stated, “Starlight is a ‘Star’ in the service industry.” Recently, management received a call from a member who wanted to show their appreciation for Starlight.
A member whose child had a heart defect was having trouble getting a life-saving medication. When she called into the call center, she indicated that her local pharmacy stated that they were out of stock of the medication and she only had one dose of it. The mother did not know what to do because if the child missed a dose of this medication it could be fatal. The member was in tears because the pharmacy and pharmacist were not being helpful and stated it was out of stock and they did not know when it would be in. Starlight, hearing the worry and despair in the member's voice immediately jumped in. Starlight immediately began researching this mediation and began calling pharmacies in the member’s surrounding area.
Starlight called over 20 pharmacies to find the one that had it in stock. She finally was able to find a pharmacy that had the medication in stock. She then contacted the original pharmacy and had the prescription transferred. Not only did Starlight go above and beyond for this member and find the one pharmacy that had the medication (it was the one pharmacy in 50 miles that had it in stock), but she got approval for this member to get the medication filled at this specific pharmacy. Starlight was then proactive to make sure the member did not go without the medication going forward by working with the mail-order company that works directly with the manufacturer so there would not be a retail shortage and the medication is sent directly to the member's home.
Upon receiving the news, the member was overjoyed and began crying. She began telling Starlight that all the health problems her son had, and he was about to have his sixth surgery. She stated, “Starlight was her shining star, and no one has ever gone above and beyond for their family.”
When we asked Starlight what it means to be World Class, she stated, “Nothing gives me more joy than being able to feel the sincere gratitude from my members over the phone when they call it, ‘going above and beyond’, as I call it doing my job by making sure they are completely taken care of. I think of my members as though they are a family member who doesn’t understand an insurance letter or has a bill when they thought they should not owe. By doing that, I am able to assist my members in a natural business manner.”
Starlight Ervin – BlueCross BlueShield of South Carolina
Dedication to Our Customers
“Never afraid to take full ownership.”
Paul joined Cogeco Connexion as a Technical Contact Representative. Over the past 13 years, Paul has consistently provided customers with a friendly, understanding, and focused approach. We, at Cogeco Connexion, are recommending him for this award as we feel he should be recognized for his consistent efforts not only in this calendar year but for his dedication to our customers over the past decade.
In knowing him and reviewing his SQM Surveys, Paul is very well received by his customers and ensures they are at the heart of his approach. He is quickly able to build rapport with a customer by utilizing active listening skills, a positive voice tone, and truly being their advocate with Cogeco Connexion. He will also often make small chat while waiting for equipment to reset and generally likes talking to customers and assisting them in resolving their issue on the first call. Good evidence of this is right from the voice of the customer in a survey where a customer stated, “He was very good, the best I've ever dealt with.”
In his position, he often has to rely on the customer to complete troubleshooting steps on the call and he effectively gets them to follow his instructions by being patient and focused. He will ask a customer and not tell them what to do, and ensures he adjusts his pace and terminology to his customer’s abilities. Good examples of this approach are shown in SQM surveys where customers commented:
- “He was very good in his explanation to what he was going to do and that was it. I hung up very satisfied.”
- “He helped me through my connection problems and explained what the problem was, which meant a lot to me. Thank you.”
He also often follows up with customers to ensure that the troubleshooting steps provided resolved the issue and is never afraid to take full ownership of an issue to ensure a second call is not needed. A good example of this is in a survey where a customer stated, “He was very helpful, and he called back on a few occasions.”
Not only is Paul well received by our customers but also by his peers and supervisor. He has a collaborative approach and although he is working from home, he will often join in the group conversation in chats and email. When customer-impacting issues are driving significant call volume, the feedback he provides is trusted and valuable to the management team. His feedback, as well as his peers’, is utilized during the investigation and handling of technical issues to ensure a full understanding of the customer experience.
When reviewing the Voice of the Customer feedback, Paul is open to feedback in order to improve his performance. He is always looking to learn and develop his skills and ensure he provides the best customer experience he can. In closing, by utilizing the Voice of the Customer, his experience, and being proactive in finding solutions, Paul has made great gains in his SQM Survey results this year. He continues to think outside the box to find solutions for customers on their first call while also making efforts to build rapport. By truly being an ambassador for our customers and implementing feedback, we feel he should be recognized for his efforts with this award.
Paul Adamo – Cogeco Connexion
Sigh of Relief
“Everything will be okay.”
Bridgette Yoder has been a Customer Service Representative with Consumers Energy for 14 years and has heard her fair share of life experience stories from customers across the entire state. It can almost be automatic to already have, ‘the answer’ in your mind of what to say to a customer. Bridgette has always prided herself on being a customer advocate, doing what is right by customers, and relieving any anxiety and/or frustrations they may have prior to calling us for help. After all, it is not always easy to ask for help when you already feel vulnerable and nervous about the potential outcome.
This call started as a ‘routine’ billing inquiry with the customer asking, “How much do I owe?” Bridgette first advised the caller that she’d be more than happy to help with her account and proceeded to obtain her account information. Before Bridgette could confirm the account information, the customer nervously said, “I can’t pay the whole thing, I need my service….” The customer then became quiet, and as soon as she did, Bridgette said, “I want to assure you that your service will not be interrupted at this time.” Bridgette proceeded to discuss with her that her account was marked as senior because of her age and said, “you are protected, and everything will be okay.” Those words touched the customer so much she let out a sigh of relief, and it was silent again for a moment. The customer was adamant about paying something on her bill and Bridgette took the time to accept her arrangement, advised her of what would be owed after the payment, and encouraged her to seek assistance because those programs are there to help people. The customer ended the call by saying, “Thank you so much for being there, I was so worried.”
So often, we minimize how we impact customers’ daily lives. Bridgette’s words conveyed a feeling of support, caring, and a genuine feeling of hometown service.
Bridgette Yoder – Consumers Energy
Partnership Can Lead To Success
“Turn a bad day into a good day for our customers.”
I am Toni Fox, and I have had the joy and opportunity to serve our customers as a customer service representative with Consumers Energy for the last seven years. I want to share a bit of a journey I had with one of our customers this past year and show how our partnership can lead to success for our customers. Also, I want to show how putting in a little extra work can go so far, helping them believe in us and change the way customers view Consumers Energy.
I had the joy of speaking with one of our senior customers a few months ago. From the start of our very first call, you could hear the frustration and the angst in his voice. For his privacy, we will call this customer, ‘Mr. Smith’. Mr. Smith had spent countless hours on the phone, calling over and over in hopes of getting assistance with his bill. This person, Mr. Smith, was in jeopardy of losing his electric service due to a past due balance.
After reassuring Mr. Smith I would do everything I could to help, I reviewed his account only to find day after day and note after note almost the same history was given by my fellow CSRs. The notes described how Mr. Smith was calling because he needed to find a way to pay his bill living on his fixed income, that he was aware of a monthly plan we offered but it was too much for his budget and he was trying to seek assistance, however, he could not read or write making the application process impossible for him. He explained to me that he would do his best each call to try to take notes, draw pictures, something that would help him refer to the conversation he had each time. However, this process was not working for him. Mr. Smith felt that there was no one here who was willing to listen or help him.
We made promises to each other on that first call. We promised that we were going to figure out how to make this work for him, and that we were a team. Mr. Smith and I started off trying to reach out to assistance agencies to help with the application process. I left him that day after conferencing him to an agency and assured him he would hear from me on that following Friday.
I had high hopes as the phone rang to start our second call just a few days later. He started the call saying, “close but no cigar.” He was denied assistance because his income was slightly higher than what was allowed. Mr. Smith felt defeated, helpless, and once again, frustrated. He was sure that was the end of our history together. I reminded him that I was here to stay, and my job was to make sure all our customers are helped, and I let him in on a secret, he was one of my favorites.
At this point, Mr. Smith considered me a friend. Opening up a bit more on his situation, he thanked me for caring and believing in him. He explained that his family had been trying for some time, to put him in a nursing home. He explained that they didn’t want to ‘deal with him’, so asking family for help was out of the question. I remember him telling me on the first call, full of tears, “I was his angel sent to him allowing him to keep his independence a bit longer.”
Fast forward a bit in our conversation, I had to deliver some hard news as I was eight months pregnant and would soon be off for leave. You see, Mr. Smith trusted me, he trusted our relationship we built together. He believed I was the only one in our company that was willing to help an “old man with little talent", as he described it. I again promised him that I may not be the one calling, but I assured him he would not be alone in this journey. Before this call, I had already reached out to a coworker to ask him to help me with Mr. Smith in my absence.
I left for maternity leave not long after this call. As promised, my fantastic coworker, followed up with Mr. Smith. We had found a plan that worked but he was not confident in the process as he could not read his bills sent each month. While I was away, my coworker called him the first month to review and confirm his monthly amount due on the plan he was enrolled in.
I have talked to Mr. Smith twice since returning from maternity leave and I am happy to report, he is doing wonderfully on his arrangement. After a few months of his consistent payment amounts, he knows what to expect and feels confident with his arrangements. He has my name, and his account has notes that can be found everywhere to refer him to me if he should call in the future.
After our first call, I counted 17 different calls in one month from Mr. Smith. He had spent so much time with us and still felt that he meant nothing to us. It took one call to show him we cared, and four calls from us to show him we meant it, and that he could not only trust me, but he could also trust Consumers Energy. He may be one person, but he is one very important, independent, and a trusted person we are so lucky to have as our customer.
As CSRs, we have the opportunity to help each, and every person that comes on the line. With this opportunity comes unique situations that we must be flexible to. In doing so, it allows us to turn a bad day into a good day for our customers, give them the chance to feel independent, and to help them feel cared about. If we focus on the person, the individual on our line, and really listen to them, without effort, we will change how they view Consumers Energy. That’s what I did with Mr. Smith. He now believes that Consumers Energy is a fellow ‘Michigander’, that we are his friends, and that we are, and will always be, there to assist him as he needs.
Toni Fox – Consumers Energy
Taking Time to Listen
“Sometimes our job is one where we just need to listen and let the member know we care.”
A call that I remember well was one that I did not receive a kudos. A member called and told me about a recent inpatient hospital admission. He is a veteran and when he went to the hospital, he was feeling very confused. He was admitted to the hospital against his will (a term called ‘Baker Act’), to treat a mental condition.
He explained that the hospital did not assist him with the reason he went to the hospital in the first place. They gave him pills he did not want to take and felt he did not need them. This experience had him very anxious about going back to that hospital. He was once again feeling ill but needed to go somewhere else as he was afraid that he would be ‘Baker Acted’ again. He had numerous health issues, had no family members near him, his daughter was not talking to him, and he lived alone. As he talked, I was very concerned about his overall wellbeing and realized I might be the only one to be able to help him.
The member finally agreed to allow the police to check on him and take him to the hospital if needed. He asked me to reach out to his brother and his attorney to let them know of the situation. He insisted that I take this action for him, and I agreed. To complete this request, the nurse agreed to take over the call and make sure the member was okay while I called his brother and his attorney. I was able to reach his attorney to inform him of the situation.
Taking the time to listen to him and getting the nurse on the line made this member feel that we cared about him and that I was doing everything I could for him. I know I did not have to reach out to his brother or attorney, but I felt it was the right thing to do especially since I told him I would.
Even though the member was unable to provide a compliment to my supervisor, I know that in listening and being patient, I helped a member out. Sometimes our job is one where we just need to listen and let the member know we care.
Brenda Olympia – Florida Blue (Federal Employee Program)
“Helping our members and setting the service expectation.”
I have had the privilege of being Steven’s Team Leader at Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) since he completed his training. Since that time, Steven has shown an uncanny ability to connect with his members and provide World Class Customer Service on a consistent basis. How consistent you may ask? Well, Steven has yet to have an SQM-IVR survey where a member stated that he did not resolve their issue. Moreover, Steven has received 100% Call Resolution on every SQM survey completed and as a result, he has exceeded his goals every single month. This is the type of consistency most can only hope for and the type of consistency that separates the good from the great.
Reminding The Member That Their Insurance Company Can Care:
On any given day, Steven 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. But sometimes, a member calls in who needs our help, and it’s what we do during those moments that define who we are.
The call that exemplifies what service should look like, is a call from a member who had just had an accident. This member had called our Case Management team and, not from a lack of trying, they were unable to assist with some of the questions the member and their immediate family had. They sent me an urgent request to have one of my agents reach out to this member ASAP, as they wanted their questions answered before any emergency procedures were done. By this point, Steven had proven himself to be a go-to person for inquiries like this from our Case Management team.
What made this call different was how quickly and urgently Steven responded to the call for action. Steven understood what the member needed, and made sure to help them sort out every area of concern, including going over surgery benefits, out of pocket expenses, etc.
Steven’s tenure so far is abundant with stories similar to this one. Some stories as simple as getting someone an ID Card they had been requesting for weeks, or as complicated as the story I just shared previously, but they all have the same World Class Customer Service in common.
In summary, I feel Steven is an example for Horizon BCBSNJ agents and for the international SQM stage to share his experiences helping our members and setting the service expectation.
Steven Clancy – Horizon Blue Cross Blue Shield of New Jersey
“I have the ability to change people's lives for the better.”
In January 2020, Christina was starting her day, like most families; getting dressed and ready for work, preparing and serving breakfast for the little ones in the house, and simply carrying on her morning like it was just another morning. However, this morning wasn’t going to continue like every other morning. In the midst of getting two kids and herself ready, her 6-year-old exclaimed that something smelled like it was burning. And soon thereafter, the realization of her day became clear as the fire alarms in the house started blaring. She gathered her two children, and two huskies, and proceeded to run outside with no jackets, and no shoes. And then, she and her kids simply waited and stared in disbelief as their house burned.
But it's what happens next that was just as surprising and upsetting as watching her house burn. While her house was still smoldering, people started to gather around. At first, she thought these were people simply stopping to gaze at the fire. Then, one of the bystanders said, “Hi!”, handed her a card, and proceeded to explain how she would need a contractor, and that they could give her a good deal on fixing her home. This continued, with dozens of contractors repeating the pitch, all while she’s still outside with her kids, and still in shock at the fact her house was on fire. Each person she met lacked the one thing that was most needed at that point. Rather than just empathizing with her, and trying to understand the shock of the situation, they all looked at her as a transaction, in hopes of securing an almost guaranteed insurance payment to repair the home.
Christina didn’t need to learn how to empathize with people, she already does it today as a Member Help Team (MHT) agent at Independence. However, her experience was a stark reminder of how it feels to be the other person, the person in the middle of a difficult situation, the person who needs help; she was that person. Although she is still working through the difficulties of rebuilding after losing so much, she continues to support our members on the phones with a perspective that is renewed, and joy in helping others.
What I found most admirable of Christina was that even though she still must deal with the aftermath of the fire, she’s still managing her day, and coming to work, helping our Medicare members as though nothing has changed.
Just recently she was able to help someone out of a difficult financial situation as a result of multiple bills the member had been receiving. This member was distraught from the overwhelming thought of the money she would have to spend. The member had been trying to stay on top of the Dr. visits and bills, but she didn’t understand everything she was receiving and felt lost. During the call, Christina started working through the bills, one by one. After realizing how many there were and how much work and time it would take, Christina, offered to go through them personally if the member could simply send them in.
After receiving all the bills from the member, Christina proceeded to work on our member's behalf, comparing, and making sense of all the bills. After her review, she was able to determine that not only did the member not owe anymore, but she also found that because her deductible had already been met, she was due a refund from some of the larger payments she had already made. Rather than stopping at finding the issue, Christina then called the various offices to reconcile their billing with how the claims were processed.
When Christina called the member back, the member was grateful that someone would advocate on her behalf the way Christina had. The member Christina had helped, was alone, with no one to help her, no kids, no family, no one that she could turn to for help sorting out her medical bills. Christina was able to be that person, not only advocating for her, but also providing the empathy and care that we should all hope to receive if we’re ever ‘down and out’, and simply need some help.
I believe Christina has what it takes to be a CSR of the year. She exemplifies the qualities of a CSR and has a renewed appreciation of what her work means, and the impact of how her interactions can have on people.
Christina Wallace – Independence Blue Cross
The Power of Yes
“This opportunity reminded me how impactful every call can be.”
Matt Sandman works on our Consumer Team. While most of our business is conducted directly with our doctors, we do receive calls from consumers who are in need of assistance with everything from finding a doctor in a new town to needing nose pads, to having a broken frame with no option to have it repaired or replaced. Every consumer call is unique and the guidelines to resolve these calls are fluid depending on the situation but always keeping in mind our mission, ‘We Help People See’. In his role, Matt was given the unique opportunity to help someone that deserved it most, a soldier deployed overseas.
Here is his story:
One morning I took a consumer call from a customer. He started off by telling me that he loved his current brand and that his current frame was by far his favorite pair of glasses ever! However, the glasses were broken, and he was out of town and needed help to get them repaired. I asked him some more questions about his being out of town and he disclosed that he was overseas and that he had purchased the glasses in the United States. He shared that this particular brand of the frame had worked well for him because of its durability.
He was calling me using an online web application, but the connection was poor. I assured him that I would take ownership of his issue but needed an alternate contact method ASAP in case the call dropped. I asked him if he had an email address that I could use in case we were disconnected. Having his email address enabled me to focus on the resolution instead of whether I was going to lose the overseas call. As the conversation continued, I learned that this customer had only a broken temple on his glasses and was just looking to replace the part. He mentioned that buying a new frame was outside of his current budget, not to mention being nowhere near an office to purchase a new frame.
I knew I wanted to use my empowerment or, ‘The Power of Yes’, to help this customer the best way possible which meant sending him a brand-new, full frame. Thankfully, there was an optical office on a base that could swap out the lenses for him, but I had no idea how to get the frame to his location overseas as we do not ship overseas. The customer provided me with a United States address that receives and inspects mail for deployed soldiers before sending it overseas. I needed to verify that we could send it to that address and reluctantly asked if I could contact him back through email. He said that was fine and he looked forward to hearing from me. I didn’t want to make any promises to him before I was sure that my plan would work.
I confirmed that the address would validate through our ordering system and that we had his frame in stock. I then was able to email the customer back and tell him the good news. I was sending him a brand-new frame at no cost! Even though we were now communicating through email, I could sense how grateful he was. When he responded with, “It’s times like these, and people like you, who make me smile and proud to serve our country.” I must admit, I choked up a little. I thanked him for his service and told him that it was an honor to have been able to help him.
I still think of this customer to this day and wonder how and where he is. This opportunity reminded me how impactful every call can be. Not only was I able to build brand loyalty, but I was also able to carry out our company mission of Helping People See!
Matthew Sandman – Marchon/Altair
A Simple Plan That Results In First Call Resolution
“It only took me a moment, but it meant so much to the customer.”
Aleida consistently provides excellent customer service by connecting with her callers and providing them with all the necessary tools to resolve their issues. Aleida has the skillset to de-escalate calls by listening to the issue, acknowledging the concerns, and providing the caller with a simple plan that results in first call resolution.
Customer feedback: “She was amazing. She did everything and she gave me the information that I need so that next time this doesn't happen again. I called upset, she was the best person. I think she deserves a raise. I wish I knew her name. But everything was handled very quickly. Never had a problem like that with AmeriHealth and I didn't think I would. This was definitely way better than my experience at another provider. You guys are amazing, she was amazing.”
Aleida recently received a call from a highly upset customer. He was unable to get his medication from the pharmacy and did not have money to pay cash for the medication. The member was upset because he has been on this medication for over ten years and now it is not covered. Aleida empathized with the member and understood how this could be frustrating. She explained that this medication had an authorization on file, but it had expired. Since it was a continuation of therapy, she was able to place a one-time override to hold the member over until the doctor could submit another authorization. It was important for the member to get his medication that day, so he did not miss a dose. Aleida made an outreach to the pharmacy to ensure the medication could be dispensed that day. She also explained the process of how to obtain the authorization for future fills. She made sure that the member understood all the information that was provided.
Customer feedback: “They were extremely courteous, professional, and polite. Any time I call, everyone has been just incredible. Very nice people. They resolve any issue that I've had. I think I've only had to call two times in the past two years. While I have the opportunity here, whoever is listening to this, I would like to say thank you very much. I wake up every morning grateful I'm here for having this insurance. I wouldn't know what to do if I didn't have it. So, I thank you. I thank everybody who may hear this call. Thank you very much from the bottom of my heart. You guys practically, probably, saved my life. Thank you again. God bless you all.”
Another customer called in, panicking because he was concerned about not having his pain medication. He did not understand what was going on or how to obtain his medication. Aleida empathized and understood his concerns. She advised the member on the authorization process, the turn-around time for the review process, and provided every piece of information needed for the member to obtain his medication. The member was grateful for the interaction with Aleida because she informed him about what needed to be done.
Aleida has many interactions where callers are initially upset but end up thanking her by the end of the call. She is able to walk her callers through the proper steps to better understand their plan. Aleida is a customer advocate and does everything in her power to provide excellent customer service.
Aleida Wallace’s feedback: “I am always trying to assist our customers in any way that I can. I provide them with the information they may not know. It is necessary so they may be well informed in the processes of how they can obtain/continue their medications. I also have gone the extra mile for our members in need. For example, one of our members called in with a reference to specialty medication. He was frantic because it had not been reviewed and he had an upcoming appointment. I let him know that I understood that it was very important that the authorization was reviewed in case there was any additional information needed for the authorization his doctor could send it right away. As it turns out, we had received the authorization, but due to the many authorization submissions, it was not yet reviewed. Due to the importance of the request, I contacted the pharmacist and asked that it be reviewed as soon as possible so as not to delay the member’s appointment. I let the member know that he could check back the following day for the status. I also advised him that if I had a free moment later in the evening I would check and give him an updated status. I was able to provide him with the approval info that evening. This only took me a moment, but it meant so much to the customer.”
Aleida Wallace – PerformRx
Doing Whatever It Takes To Help
“Glad I decided to make the commitment to dig in my heels and help.”
We all know that some calls are just more difficult than others. My first call with one of our members was one of the most difficult calls that I've ever taken. He was yelling and screaming and barely letting me respond when he would ask a question. I just wanted the call to be over. I was not able to resolve his needs in that call, but I did take his number in order to follow-up with him.
That night at home, I couldn't help thinking about how the next conversation with this member was going to be. Honestly, I dreaded it. But then something weird happened. I just had this overwhelming feeling that I needed to help him. So, I promised myself that instead of shying away from him, I was going to really lean-in and do whatever it took to help.
In our next conversation, he was still highly frustrated and yelling. But this call was different because I patiently listened to his concerns without letting his temperament affect me. Slowly, his behavior changed. I think that he began to trust that I really was going to help him.
I ended up working with this member for almost a year. During that time, I found out that he had been in a really bad accident. He had to have a total hip replacement and he lost the tips of his fingers on one hand. Also, his dog had recently passed away. Talk about a series of unfortunate events! He had been traumatized and I imagine that he felt like the world was against him. Looking back, I realized that this member wasn't angry in that first call, but rather, he was scared. I am so glad that I decided to make the commitment to dig in my heels and help him because he really needed someone on his side.
At the beginning of the following year, this member had decided to go with another insurance company, for financial reasons. He called to tell me that he already regretted his decision. He told me, "There is no YOU there." This remains one of my favorite compliments I have ever received from a member.
Alison VanSmith – Regence Blue Cross and Blue Shield Plans
“We are here to be the experts for them on their unique healthcare journey.”
Albert has been in the customer service department for 9 years. He has a unique way of approaching every member interaction, pulling from his personal experiences to be empathetic and put himself in members’ shoes. He recently told me, “We don’t need to make this complex for the member, I get to the core of what they are after and resolve it for them.” He promotes the idea that our members come from all walks of life and often do not have time to learn the ins-and-outs of the insurance industry. We are here to be the experts for them on their unique healthcare journey. This clearly resonates with our members and ties in closely with the Voice of the Customer feedback we have received:
- “It was just easy, quick and it solved my problem with no issues.”
- “That was the easiest call I've made to a call center ever. They were amazing.”
- “He was very friendly, knowledgeable, and wanted to make sure that I understood the resolution to the issue that I had. He did a great job.”
- “I'm very satisfied because Albert went out of his way to help me. It took a little bit of time. He didn't try to rush what was happening. So Albert was absolutely fantastic. And it was about an incident report. He actually filled it out for me over the phone.”
Albert is a leader among his peers and is always sharing ways to improve and provide better member experiences in meetings, team chats, and casual conversation.
This approach has given Albert the opportunity to work directly with one of our groups to ensure we are providing the highest level of service. Early in 2019, a large client of ours expressed concerns about the level of service they were receiving. Albert had the opportunity to meet directly with the HR leadership of this employer group and understand their expectations. We devised a unique offering through which he responds to employees of this group directly through their own company portal. He also played a key part in supporting our other CSP’s who serve this group to make sure we are meeting their needs. Since establishing this unique offering, the client is overwhelmingly satisfied with their experience with us.
Putting his approach and considerable skills to work, Albert recently had an opportunity to help a member who was struggling to understand how his benefits were organized and how to find contracted providers on his plan. Albert naturally listened, empathized, and acknowledged the member’s concerns. He took the time to not only help the member but to go through his options and clearly walk him through the tools he had access to. The member's frustration began to dissipate, and his confidence grew over the course of the call and by the end, he began feeling comfortable with his plan and the online tools he has available to him.
This is just one of many examples where Albert used his calming demeanor to make a challenging situation understandable and less intimidating for a member who needed an understanding voice and someone to advocate for them.
Albert Brosa – Regence Blue Cross and Blue Shield Plans
Hallmarks of Memorable Customer Experiences
“The defining attribute of a customer service agent is first and foremost, to empathize.”
The ability to empathize with someone and truly imagine yourself experiencing their problem is an underrated skill. Everyone has difficult days. Behind the face of someone you walk past on the street, is someone under pressure. It could be a family obligation, work obligation, or personal problem. The defining attribute of a customer service agent is first and foremost, to empathize. The best customer service is given to clients who have had difficult experiences, by representatives who refuse to let difficult experiences change how they interact with future clients.
The best example that comes to mind is one in which a client needed to unlock their locked-in account (LIRA). The client who called needed money for living expenses. I could tell from the distress in their voice that they were in a difficult situation. They didn’t understand the process for unlocking their account, so I had to explain to them what the options were in each case: 1) Financial hardship which was based on different situations including Low income, Eviction, and Medical Costs, 2) 50% unlocking which allowed them to unlock their LIRA to a LIF and RSP/RRIF account, and 3) Small balance unlocking, the requirements of which they did not meet. I guided them through the government website and explained what each term meant for unlocking. Without giving direct advice, the client finally settled on a financial hardship unlocking. They needed to send the unlocking form, a letter of direction, along with other documentation.
Without wanting to pry too much I inquired why they needed the money and they explained that they had recently been laid off. They went on to talk about the events that led to their current situation for about 20 minutes. The client felt comfortable enough to share their personal circumstances with me based on the fact that I had earned their trust and I was happy to help. I listened, cared, and I had obligations to meet as a CSR. I took the time to explain that they needed to open a RIFF/RSP account to facilitate the final transfer. I realized that they never opened an account on their own before and noticed that the wait time to open new accounts with an agent was considerably long, so I walked through the entire account application with them and showed them how to sign it off.
What struck me about this interaction was the fact that I made someone’s day simply by taking the time to listen considering the client was in a bad position. The ability to listen to them and allow them to express what they were going through and be an open ear not only impacted their financial situation but helped them go through whatever it was that they were experiencing in their personal life. In the end, the client was ecstatic and thanked me for taking the time and showed appreciation for both walking them through the government website and opening the account for them to facilitate the process of accessing their locked-in funds. Providing the concierge service by going that extra mile and empathizing with clients are in my opinion, hallmarks of what makes for a memorable client experience.
Denzel Ryan-Stephens – Scotia iTRADE
Brightening the Life of Someone
“I try to share my light every day.”
Working for Security Health Plan, I’ve had the pleasure of assisting people every day to better understand the maze of information that is health insurance. I’ve had days of pleasant conversations and chances to grow by facing uncommon situations. Customer service offers me daily chances to better myself by assisting others and many of these interactions have stuck with me.
The first of two stories I would like to share is about me developing my empathy to a degree I never thought I would have to face. Starting at Security Health Plan meant I mostly worked on the senior Medicare plans – though, I now assist on all lines. It isn’t all that uncommon to receive distressing calls of failing health or updates of a member’s passing. It’s the calls after the passing that can sometimes leave us a bit dulled to the world, but I still try to shine as brightly as I can for them.
An older gentleman called in a few weeks after the passing of his wife. He was confused about some bills. This level of stress, I can’t pretend to understand. What I can do is listen and empathize with the tones, his words, or even the way he paused between answers. He didn’t want to relive it again and again, but more papers showed up every day to drag him back.
I just talked through the information with him at first to ensure he understood what his responsibility was and what was being handled by Security Health Plan. I would pause to ask questions and make sure he was alright. As the call went on, he began to just talk to me. I can’t know how many people he talks to per day or if he has someone to just sit down with, so I do what I can over the line. If a faceless man, some unknown miles away can be an ear to a weary heart, then I’ll let the sands fall through the hourglass.
I know efficiency is important while on the clock, but I cannot leave a soul in shambles when just a portion of my day could be spent brightening the life of someone searching for a light. We talked about his life between billings, about how he missed her between his questions, and even simply the weather to fill in the gaps. It wasn’t until some time had passed in our discussion when he became quiet for a moment.
Silence turned into hastened breathing which quickly manifested into sobbing. I have never found empathy or action difficult in such situations when in person. Over the phone it somehow felt just as natural, I struck a chord in the gentleman. Through tears almost audible in the call, he took a moment to thank me. That was all it took. Not a desire to succeed or make my numbers appear better for the team, just a few minutes of discussion and empathy. He thanked me several times before asking if my mother was still alive. I thought of no reason to lie or deny him an answer, I said, “Yes.” I can still remember his quiet voice in a broken accent tell me, “When you go home tonight, I want you to tell her that she raised a good son. Will you promise me?”
I try to share my light every day. I try to make our members happy. Making them laugh is a bonus I strive for if the conversation allows it. I could only fight back tears of my own. I’d empathized with the man, and now he seemed to reach out into me. I’d never been asked to do such a thing and I’d never heard a request sound so finalized. It was like, as odd as it sounds, hearing someone’s last request. Sincerity in every syllable, I could only accept.
I’ve always been a natural at empathizing, yet somehow customer service offered me a soul I found something new in. I try to emulate that deep emotion with every call like it. I don’t talk through the issues with a member just to leave them alone with their answers and thoughts. I want them to know that someone heard them and someone cares. Hearing this elderly man make such a request will always stick with me. It may very well stick with my mother too.
My other story is one I find difficult to tell. Thank you for giving me this avenue. Every call is a chance to assist with information or to help someone through difficult times. I don’t see myself changing the world, but I can offer that light to one person at a time.
This story is one where I’d done the best I could. A young woman called in to ask about coverage for a very specific procedure. It would seem fate dealt her a dismal hand as health issues compounded over insurance limitations. She’d found a list of only twelve providers named in a national database that would perform a more advanced procedure, but unlucky in that none existed near her.
We had denied her request to travel into the southern states to see her chosen doctor for this specific procedure because we had other providers within her network that could do it. A decision at the time I had no idea she would come back to. When reading through her case, I’d found that someone could perform a similar service within her network. It wasn’t long into her explanation and then my first answer that emotions began to manifest. I remained calm though she began to raise her voice. I tried to offer her assistance as she denied me the opportunity. For a moment I believed it was just someone being difficult. That sort of mindset isn’t conducive to proper customer service or my personal values. So I attempted to dig deeper.
It would seem that the specific procedure she’d requested was less invasive, offered a higher rate of recovery, and retained the prospect of children in the future. She’d done all of this with the hope that someday she could start her own family. It wasn’t someone being difficult. I found myself now bearing this newly increased weight of the discussion. It would also come out after this explanation that she’d been diagnosed with cancer. The outlook for treatment was good but cancer is cancer, no matter how small. Another voice some unknown distance over the line looking for a bit of light in the impending darkness. I explained that I would help her—though she said it would do her no good. That isn’t an answer I’m willing to accept. After telling her I would call her back with updates, I proceeded to call clinics to see if anyone could perform the procedure she’d been hoping for. Explaining the situation, a team from one particular clinic was similarly empathetic to the situation. We worked together to get details from a certain doctor to do the exact surgery she’d requested.
I called the member back but could only leave a message. When she called back the next morning the flustered and panic-stricken woman I’d heard previously had disappeared into a calm, collected person. I was excited to go over our resolution so that her future could be realized. She declined. I remember being at a loss for words. Fumbling for what to say next, she continued in a sense of peace I’m not accustomed to in our daily calls. “Do you believe in God?” An odd question to hear at work. I could only say, “Yes.”
She continued, if a bit paraphrased, “I’d told myself that if I couldn’t get the surgery with the doctor I wanted, that it meant simply that it was time to stop fighting.” She went on to say she appreciated my assistance and how kind I was to her. She said I had done so much for her. She asked to speak to a manager so she could express her sincere appreciation for the service she had received from me. I attempted to resist as I couldn’t accept that sort of outcome, not until she explained. It was a sort of bet within a prayer. A single line that seemed most likely to occur based on her information. She’d asked for guidance and if the answer was “no” it meant that she was to find peace in the coming end. Whether you believe it or not isn’t important. She did. I could hear that in her voice. I felt it in my chest. I disconnected and walked away for a few minutes so no one could see me.
I’ll always shine a light on those that need it. Listen when they need it. Explain what needs explaining. I’ll try to connect with someone to understand that it isn’t just a voice on the line. Great customer service isn’t just a phone call with a high-scoring survey. It’s being a bright light for anyone who comes to you. If I can help even one person through the dark, then I’ve surpassed what it means to be world class.
Anthony Haessly – Security Health Plan