SQM Group

2020 Top Twenty-Five CSR CX Success Stories


Put Herself in the Customers Shoes

“Tiana is empathetic and puts herself in her customer’s shoes to help them with their needs.”

Tiana is well known for her calls. When you talk to her you feel at ease and comforted that she is in your corner to help resolve the issue. She goes the extra mile to ensure that our customers are satisfied even through very difficult situations.

Tiana had a call with an upset father calling because his son’s pediatrician had recently found a health concern. The pediatrician had referred the young boy to a specialist in a nearby city, however, because this provider was the only specialist in the area, appointments were booking several months out.

Extremely frustrated and wanting care for his son, the father understandably did not want to wait months for his son to be seen for something that could possibly be serious. This is where Tiana went to work. She did some research online to see if there were ANY other specialists in the area and to her surprise, there were not. Being a parent herself and feeling the desperation from the father calling, this was not an acceptable answer to give him.

She went back to the father and gathered a little more information including how far they were willing to travel for care. Tiana placed the father on hold and called several providers. She spoke with a scheduling rep and explained the situation and the urgency for an appointment for that same week. One provider’s office was able to work with Tiana and the father and an appointment was made. The father was extremely happy and thankful that we were able to help find a provider to see his son much sooner.

This is just one of many examples that show how great she is. She is empathetic and puts herself in her customer’s shoes to help them with their needs. She is able to use her resources and handle very complex issues while maintaining posture and positivity.

Tiana Pierce – AmeriHealth Caritas

 


One Step Further

“Go the extra mile it’s never crowded.”

For associate Victoria Stanford going the extra mile is never hard for her to do. Victoria is the core example of what the name Caritas means; Care is the heart of our work. Victoria is able to display that she is dedicated to the mission of helping people get care and stay well.  

Victoria has demonstrated these values several times. But one time in particular Victoria received a call from a member who was in desperate need of getting a Primary Care Provider (PCP). The member was new to the plan and had not seen a PCP in years. By the time Victoria talked to the member it was his 5th call to the plan. The member was given several PCP’s but each PCP that was given to the member was not accepting the member insurance. This of course left the member upset. The member expressed all he wanted to do was see a Provider who would be able to assist him with his health needs and concerns. Victoria was able to empathize with the member, she knew how important it was to make sure the member was provided with accurate information.

Victoria took it upon herself and went one step further. Victoria went through the provider directory with the member, the member chose 5 providers that met his criteria, and once the member chose the providers Victoria then placed a call to each of the provider offices. The first two providers she called advised they do not accept the members insurance. The next two providers she called advised they do not have any new member appointments available; their calendar was booked out. Victoria called the last of the 5 providers and she was advised they were accepting new patients as well as the member insurance. Victoria conferenced the member in on the line so the member would not have to repeat any demographic information, the only thing the member had to do was advise what date and time worked best for him. Victoria stayed on the line with the member until his appointment was successfully booked with the provider. The member ended up getting an appointment the very next week and was able to address all of his health concerns with his new provider.

Victoria was elated to be able to give the member the outcome he had been hoping for. Because of Victoria’s determination, need to help, and ensuring member satisfaction this member hung up knowing that our associates are always willing to go that extra mile. The member expressed a great deal of gratitude to Victoria stating he was very pleased with her services and truly appreciated her taking the time to truly assist him.   

Victoria states this year in particular has been a very challenging year and she comes to work every day knowing that we are all facing hard times. If taking an extra step, spending a little more time on the phone with a member to talk through their issue/concern or clarify something will ease the stressful situations they may be facing then that’s what she’s going to do. Just knowing that she is helping is what makes this job so rewarding for her.

Victoria Stanford – AmeriHealth Caritas

 


Learning a Different Communication Style for Email Contacts

“Not only was I able to earn a coveted World Class survey out of this interaction, but those around me, such as my leadership, could see the extra work I put forth to be a one stop shop for this member and allow her to finally have the peace of mind she deserved.”

Achieving world class status during 2020 is truly an accomplishment. During times such as these, many people are experiencing fear and concern. Knowing that I have been able to ease our members’ worries throughout the pandemic means a great deal to me. When I was growing up, my “dream” job was to help people, and I have finally found the perfect place to do that.

Last year, I achieved the highest world class score for my call center. While I was on the phone, I felt like I was really making a difference in our members’ lives. On a phone call, it was much easier to connect with them and ensure they understood what was going on with their insurance. This year, it has been a bit different. I moved to a new department where I work with members via email.

I assumed the change would be painless and I would continue to be a world class representative. When I began written work, I started to receive fewer positive surveys. Even though I was giving the member correct information, they were not satisfied with the way I conveyed the message. I started to feel it would be impossible to achieve World Class status in the written department because the members could not hear my compassion or determination through email.

Instead of admitting defeat, I decided I needed to work on being more personable and less robotic with my emails. I reviewed and applied direction from my supervision and our Quality department. I took the initiative to self-educate by using training manuals, and I reviewed email responses from my colleagues to learn from their successes. The harder I worked on relating to the member and writing to them as I would speak to them on the phone, the more World Class surveys I received. My emails naturally became more empathetic and helpful. Members began to leave surveys mentioning that I was pleasant to work with and their question was answered with ease. I could see the effort I was putting in was being noticed by the member. This pushed me to work even harder to advocate for our members.

Back in August, one of our members had an accident and needed dental work, but she had no dental policy. She emailed in asking for coverage information. Thankfully, the representative she worked with was able to determine these services could be covered by her medical contract. She was thrilled to find out she would have some coverage and began working with her dental provider.

Fast forward to a few weeks later- her dentist sent in medical records for us to review and ensure the services would be covered. Once a determination was made, we responded directly to the provider. I received an email from the same member questioning what the determination was and why she was not receiving email responses from Customer Service.

With my desire to provide the best experience possible and eliminate any hardship or confusion for our member, I began to research and found that she had been sending her questions in separate emails, causing us to reply to each question in a different email. All of the back and forth caused a lot of confusion for the member as each time we would only answer the question asked in the individual email and not take into account the larger picture. She expressed the pain she was experiencing from her accident and how helpless she felt with all of this. Not only was she in physical pain, but she also had to figure out what was going on with her insurance and we were missing the mark in providing what she needed. I imagined how I would feel in her situation, and I became determined to resolve this for her.

Stepping outside of our normal processes, I began by letting her know that I would research all her questions and reply in one email to make it easier for her to follow. I worked with several other departments to fix the issues preventing her from being able to pursue her upcoming services. Once I received confirmation that her services would be approved for payment, I sent my final email to the member.

From her other emails, I could see she was not comprehending the way we were answering her questions. In my email, I made sure to provide her with real-life examples of how her benefits worked. I worked diligently to eliminate jargon and possibly confusing information. I also took the next steps towards resolution and broke down the exact dollar amount she would owe for the upcoming procedure. Although the member was frustrated when our interactions began, by the final email she began to gain her trust back with BCBSKS and was pleased with the outcome. Not only was I able to earn a coveted World Class survey out of this interaction, but those around me, such as my leadership, could see the extra work I put forth to be a one stop shop for this member and allow her to finally have the peace of mind she deserved.

The change to email correspondence has been challenging and not without learning experiences. Throughout it all, I have held tightly to what motivates me: empathy and service for those in need. I anticipate the need to continue to grow and evolve as I learn more about what our customers want, and I have both the passion for and confidence that I will continue to be part of building our SQM legacy in this arena.

At the end of the day, we must be aware of and acknowledge that many people become frustrated and confused by their insurance policy. For people who work in our industry, it is easy to understand the way insurance works. For our members, it is a much more difficult task. When a member contacts us, they are often facing a difficult time in their lives. They deserve a CXR who will go above and beyond in helping them understand their insurance while treating them with compassion. I am proudly committed to fulfilling this role each day. In 2021, I will continue to treat every member as a member of my family and have confidence I will remain a World Class CXR.

Alassa Gevanni – Blue Cross and Blue Shield of Kansas

 


Providing Concierge Level of Service

"Consistently exceeding all expectations on her accountabilities, Brittany was one of the very first representatives who was asked to join our newly created Blue Connect team.”

I would like to nominate Brittany Badua for Customer Service Representative of the year. I can’t say enough great things about the service Brittany provides our members – as well as her peers. She is always willing to help our team any way she can. The team looks up to her for support and guidance when they need help on calls. Her ability to handle difficult callers amazes me.  

As one example, we had a member who was very upset and very vocal about her situation. When she called, most representatives dreaded getting her calls. Not Brittany! Without hesitation, she took a call when this member was in tears and was able to calm her down.

The member’s husband worked out of state and only returned every three weeks. The member had to make sure her procedures and surgeries were all scheduled for when he would be able to take her. If anything got rescheduled for when her husband was out of town, she would have to pay someone to stay with her and make sure she made it home safely.

Brittany made several phone calls internally and reached out to both the surgeon and facility to make sure the correct orders were in place for the member's upcoming surgery to remain on schedule. She really listened to what the member was upset about and thought outside the box on what she could do to assist her. This member was so grateful for all Brittany had done for her and to this day she reaches out directly to Brittany.

Because of the numerous compliments and consistently exceeding all expectations on her accountabilities, Brittany was one of the very first representatives who was asked to join our newly created Blue Connect team, which provides concierge level of service. She was asked to assist one of our high-profile groups by going onsite every other week to assist their Human Resources department by meeting with their employees when they have questions about their insurance claims or benefits.  

Many times, I have received very nice accolades about Brittany’s service. These are just a few of the compliments in the words of our members:

  • “I want to tell you how impressed and thankful I am about the service I received from one of your staff named Brittany. I was trying to determine if a specialist I was referred to was in my network and couldn’t find their name on the website. She was amazing. She really did her best and went the extra mile to find the answer to my question. Because I am in Colorado, she reached out to the provider office and confirmed they are in network. What I was really impressed about was how she went the extra mile. Give my sincere appreciation for the service she gave.”
     
  • “I just want to tell you how much I have enjoyed working with Brittany Badua. She is my contact that my company provided for me. I have had so many questions and having her has been such a relief because health insurance is so difficult, but she is so accessible and so kind and patient. It’s just really been a great asset and advantage to have someone like her that I can call and quickly get answers. She definitely goes the extra mile to help me find solutions to my questions. I just want to say thank you for all that you do there and thank you for having people like Brittany. In all these unprecedented times, it’s nice to know that I can rely on people like Brittany, and I can just call her up and have honest conversation with her. She’s been really great!”
     
  • “I just spoke with Brittany and I want to compliment her. She went above and beyond to help me work through switching over to COBRA Care to make sure that I could attend an appointment tomorrow and to make sure that I have coverage so that I wouldn’t be turned away at the door. Things are tough right now for everyone. I am sure that you guys are being left with some unpleasant callers with some unpleasant words. I was just so thankful to be taken care of the way that I was, with such respect and such kindness. She went out of her way to make sure that everything was taken care of and called so many people. She made sure that I could see who I needed to see so that I could be taken care of the way that I needed to be taken care of. I just wanted to make sure someone knew just how amazing she was. Brittany is STELLAR – she is INCREDIBLE!”

Brittany Badua – Blue Cross and Blue Shield of Kansas City

 


Following a Situation Through to the End

“Our members recognize Gretchen for her kind and caring nature time and time again.”

I would like to nominate Gretchen Gladden for SQM World Class Customer Service Representative of the year. Our members recognize Gretchen for her kind and caring nature time and time again. For Gretchen, resolving an issue involves more than giving a simple answer, and she makes sure to follow a situation through to the end to make sure the member is satisfied with the outcome.

As one example, Gretchen received a call from a member who was a breast cancer survivor and was inquiring about purchasing a prosthesis bra. The member was disappointed about the service she received at a boutique and wanted to know if she could go somewhere else, such as Nordstrom, to purchase the prosthesis. Gretchen found out Nordstrom was an option for the member, but her provider was trying to discourage her from going there by saying Nordstrom would not know how to handle the billing. That’s when Gretchen took over and researched how many prosthesis bras per year the member would need, how much it would cost per bra, whether the member needed a prior authorization, and more. Gretchen called the prosthesis hotline at Nordstrom several times to help the member. After researching the information, Gretchen educated the member about the billing and payment process to ensure she knew how it would be handled. As a result of Gretchen’s efforts, the member was able to purchase her bras successfully. Gretchen’s top priority through all of it was to ease the member’s mind and help her through a difficult time.

Many members have shown their appreciation for Gretchen’s kindness and concern by taking time to leave her compliments after speaking with her:

  • “I have been working on a pharmacy problem for about a month now. Finally, Gretchen spent about 20 minutes on the phone with me and the pharmacy and finally got my problem resolved. I just want to commend her and, if there’s any award or benefit you can do for her, she is an excellent employee and I am fully thankful for her. I truly appreciate her. Thank you!”
     
  • “Gretchen, I was on the phone with a member for at least 10 minutes listening to him talk about how much he appreciated YOU! The member stated that he was frustrated when he first called in because he had made a decision to change plans but didn't realize that his doctor was not in network with this plan. Some of the kind words he said were, ‘Gretchen did a great job handling my situation. I felt like she cared. She was so kind, patient and didn't make me feel rushed as we walked through my options. This is the best service I have experienced in years!’”
     
  • “I had a couple of questions on a claim and a few other things with our insurance and spoke with Gretchen. She was really personable and very helpful. I thanked her but wanted to leave you a message so that you could thank her as well. It’s probably good for you to know that you have such good people working for you. I appreciate the help she gave us. You don’t hear thank you enough.”
     
  • “I just need to share that I had an AWESOME experience with Gretchen! She was very patient and great at getting the job done and I want to share and thank her!”
     
  • “I had the opportunity to have Gretchen ascertain some information concerning our insurance and she was able to do a fantastic job! I just wanted to tell someone that she is fantastic. She’s that good type of customer service person that is really caring about the individual and not just doing her job. She’s doing an excellent job – she treats you like you are family! I wanted to leave a recommendation for her.”

Gretchen Gladden – Blue Cross and Blue Shield of Kansas City

 


Building Lasting Relationships

“Building relationships with our members is truly Tracy’s number one priority.”

I would like to nominate Tracy Shifflett for SQM World Class Customer Service Representative of the year. Tracy has been World Class Certified all three years she has been eligible. As a new Customer Service Advocate, she ended 2018 with 89% of her attributed calls meeting World Class criteria. She stayed focused and produced even better results in 2019, ending her year at 90%. For 2020, her overall World Class and Csat percentage ended at 95% for all members surveyed and 100% of the members surveyed said she resolved the reason for their call.

In addition to these exceptional statistics, the following story and compliments from members demonstrate the value of Tracy’s dedication and excellence at building lasting relationships with our members.

Tracy received a call regarding a member who was having an issue with the shipments of her wearable sensors for monitoring glucose levels and managing diabetes. While the member was not receiving her sensors, she went into a diabetic coma and was in the hospital. Tracy worked diligently with a Blue KC provider representative, the pharmacy, and the sensor company to get the days extended to allow for two weeks of overlap for shipping. After several calls back and forth, the sensor company even ended up writing off balances for the member. Later the member’s mother found out about a new drug that could help her daughter and lessen her dependence on insulin. Tracy was able to help get this medication approved for the member, which helped balance her insulin levels.

At one point, there were storms in the member’s area that caused her refrigerator to malfunction, causing damage to the medication that had to maintain a certain temperature. Normally this is something we would not be able to cover, but Tracy was able to work with the pharmacy to make a one-time exception to cover the replacement of the medication.

The member’s mother has continued to call Tracy directly over time due to the trusted relationship they have built. When Tracy took the first call, she was motivated her to do as much as she could to guide them through the situation and to get resolution. Even after moving to our Blue Connect concierge team, Tracy has continued to stay in touch with them.

Building relationships with our members is truly Tracy’s number one priority. She connects with members each and every day – a phone call is never just a phone call. These are just a few examples of members who spoke with Tracy and offered their words of praise:

  • “She has been absolutely amazing! She helped us tremendously and I just wanted to let you know how grateful we are that we got to work with her and how much of a good job she is doing. Give her some kudos!”
     
  • “I was just helped by Tracy. I had a bunch of questions about my claims trying to get ready to prepare for my taxes and she did such a great job! She answered all of my questions and helped me to get online and waited to make sure that I was able to get logged in. I appreciated her going the extra mile to make sure I had everything I needed.”
     
  • “I wanted to leave a message with some kinds regards for Tracy. She has been helping me with a claim for my daughter and she has been so nice and so good to follow through. I know that this is still being looked into and, regardless of the outcome, I really have appreciated the assistance she has given me. I wanted you to know how helpful she has been. She is wonderful!”

Tracy Shifflett – Blue Cross and Blue Shield of Kansas City

 


Staying Involved in the Process

“Hannah, if anyone can do this for our member, you can!”

It was the beginning of December when I first interacted with a member in need of diabetic supplies. She was reaching out for assistance in obtaining a new pump from a different diabetic supplier. I have family members with diabetes, so this member hit close to home. Knowing the importance and urgency of such a crucial medical intervention, I knew that advocating for this member and seeing her through was my highest priority.

The member shared with me that she had started this process in August with one supplier after having a terrifying near-death experience related to her diabetes. After that episode, it took her four months to get the necessary insulin pump delivered to find out it was not the pump she expected. She knew she needed to get someone to advocate and assist her, which resulted in her call to our Blue Cross Blue Shield of Vermont Customer Service Team. After reviewing the members contact history, she’s called us often over the years, so knew the level of service and advocacy we would provide. Her goal was to return the incorrect pump and receive an Omni Pod in its place, one that would be more practical and efficient for her lifestyle. Because it was December, not only was she in need of the product due to medical concerns, she needed this completed before the end of the year as she had already satisfied her deductible and out of pocket. Finances are a driving force for a lot of our members, and the added stress of COVID made 2020 even more challenging for many individuals and families.

The member had her appointment with the Endocrinologist the following day and was going to discuss options with her, but I didn’t want to delay. I discussed benefits with the member before ending our call with a promise of research and timely follow up. Immediately I got on the phone with one of my Team Leads to discuss next steps, which is when she said “Hannah, if anyone can do this for our member, you can!” The positivity and encouragement were the boost of energy I needed, so I followed that call with another into our Integrated Health Department who handles Case Management and Prior Approvals. I wanted to work collaboratively with all impacted departments to ensure that I was going to come to the cleanest and most efficient solution for our member. Because our Integrated Health Department works closely with many suppliers and members in diabetic case management, I thought they would be a great place to start for advice. I was immediately given a direction of obtaining the pods at the pharmacy, and then assisting the member with getting a script for the pods to the pharmacy. Once she had the pods the new supplier would send her the personal monitor.

It’s important that we follow through on our promises, as it gives our member a sense of confidence and lets them know we are there for them. Therefore, with a direction and next steps in mind, I called the member that next afternoon. Unfortunately, she was not available, so I tried again the next day. It’s vital to us that we attempt a member multiple times as we know that sometimes schedules don’t match up with people’s busy lifestyles, and the information was important. I was excited to hear the member answer that next morning when she told me the appointment with her Endocrinologist went well, and that she was ready to proceed. Not only did I provide the next steps, but I assured the member I was still going to be by her side through the process until she had her product in hand!

I followed that discussion up with a phone call to both the provider and the pharmacy to confirm that a prescription was going to be sent to the pharmacy so the member could get her pods and personal monitor. Once again, using our resources and our network of partners, I called our pharmacy vendor to discuss how the product worked and which supplies were needed to make sure all avenues were being explored to come to the best possible outcome for the member. We always want to anticipate our members needs so that we can provide an accurate and complete solution! I was able to then explain to the member exactly where she would be able to get her pods going forward. I also closed the loop by following up with her provider to keep her informed throughout the process.

Now that we had direction, we needed to get the member her products, so we started making phone calls to check stock, and to see if we could get products shipped out. The monitor supplier told us that once the member had the pods from the pharmacy, they would then be able to send her the monitor. The member had a script at her local pharmacy, but they did not have the product. Continuing to take the member out of the middle, I called another local pharmacy, and was told that while the supplies were out of stock, they could get them to her overnighted. We were elated and had the script transferred to the new pharmacy right away. Typical of our Vermont weather, we were faced with a snowstorm that night and the necessary supplies were delayed in Boston, MA. We were so close, but not quite there!

Taking our members out of the middle and making phone calls for them is very important, but so is keeping them informed as to where we are in the process. This continues to instill confidence in our members. Thankfully, I checked in with the member and she had been informed by the Boston pharmacy that her supplies were on the way. She also had just received a second call from the supplier that her monitor was on its way too. Finally, the pieces started to come together.

I maintained involvement in the process to ensure that our member not only was able to get her pods and personal monitor, but also that the return of the incorrect pump was a seamless process for her. As I was keeping the member informed in the process, the excitement in the members voice was so rewarding, she thanked me for my continued support through the whole progression. Knowing that I was an advocate for our members and that I truly made an impact on them is such a gratifying feeling. It was an absolute pleasure that the final day of working on the case was the members birthday, so I closed out the case with a phone call to the member wishing her a happy birthday. Making a human connection is what drives my passion every day. We are Vermonters serving Vermonters and it’s important that we treat ever member with advocacy and support, and we always see them through.

Hannah Tomeny – Blue Cross and Blue Shield of Vermont

 


Helping a Girl Out

“I am not ‘just’ a customer service representative.”

Some days I think, “what am I doing with my life?” I am “just” a customer service representative. However, it is times like these when I remember that this is not true. I am the person who is strong when they are weak; I am their voice when they cannot speak. They may be tired and wanting to throw the towel in, but I am there to give them hope and let them know they are not fighting this crazy world of healthcare and insurance alone.

It is another day and I answer the phone, ready to resolve the member’s call. I can hear a newborn baby’s cries in the background. As the new mama on the line is quietly shushing him in hopes he will calm down; I wait. He quiets down for a moment and I can hear her exhale. She sounds tired and is scrambling to find her words. She takes advantage of the quiet moment and frantically starts telling me her situation.

The member contacted BlueCross BlueShield Vermont prior to her son’s birth. She lives out of state and wanted to make sure she had all of her ducks in a row prior to the arrival of her baby and the inpatient hospital stay. She wanted to be prepared financially and not be surprised by any bills. I explained her benefits and advised her that she has the PPO network. We confirmed her doctor and the hospital were in-network and made sure we had all authorizations on file for her stay. She took the initiative to ask questions so she fully understood her benefits and made sure she was prepared.
 
The member had her son and both child and mom are happy and healthy. She was enjoying her maternity leave and bonding with her baby when she received a bill for $10,000. The bill states during her son’s inpatient hospital stay, he was seen by an out-of-network pediatrician. The mother is upset because during her stay, after the delivery of her baby, she advised the nursing staff at the hospital she has BCBSVT insurance and her baby needs to be seen by in-network doctors (which is the last thing a mother should be worrying about after giving birth). The member reached out to the hospital where her son was born to discuss this with the provider who saw her child, to ask why they did not have an in-network doctor provide care to her son. The hospital thought the baby was going to be added to the state’s Medicaid program so they had him see a state eligible doctor. The member was furious because she advocated for herself while at the hospital, telling them her insurance and trying to make sure she did everything right so this situation would not happen. The hospital apologized for the misunderstanding but informed her that there was nothing they could do because the care had already been provided. The member then called the pediatrician’s billing office where they also informed her they are out-of-network, will not bill insurance, and that there is nothing they could do for her.

I acknowledged her anger because this is a very frustrating situation and the last thing a new mom should be having to deal with. I assured her, in a calm voice, that I was here to help and will not stop until we have the bill resolved for her. I reviewed the member’s situation with a supervisor and advocated for the member, explaining she had done everything right on her end to make sure the services would be eligible; the hospital had made the mistake. I got approval for the claim to be submitted and we would allow the services to process the member’s in-network benefits with us.

I worked with the BlueCross BlueShield in the state the member lives, requesting they ask the provider to submit the claim. They informed me that the provider is out-of-network, so they will not request a claim from them; they gave me permission to contact them and work with them on our member's behalf.

This is when my work really began. It took multiple calls to get in contact with the pediatrician’s office. I would either get voicemail and not get a return call or be told the person I needed to speak with was not available. On my fifth call, I was able to speak to a representative, where I explained that though they are out-of-network, we were going to allow the claim to process and request they submit a claim on the member’s behalf. The representative gave me the run around and a long list of excuses as to why they would not submit the claim. I brainstormed and worked with my team to find another solution for this member. I decided the member could submit a member claim form along with an itemized bill from the provider. I reached out to the pediatrician’s office asking for the itemized bill to be sent to the member. They refused unless the request came from the member. I conferenced the member in, and they confirmed that they would send the itemized receipt to her. After this, I made a plan with the member to submit the information directly to me. I informed her that I would follow up and have the claim processed for her. I thought it was going to be smooth sailing from here, but unfortunately I was wrong.
 
I received the documents from the member, but the diagnosis code on the bill was missing. In order to be able to process a claim, and in addition to the procedure code that tells us the service performed, we need a diagnosis code telling us the reason for the service. I set up a time with the member to conference with the provider again to get the diagnosis code. The member was frustrated that this provider was being so difficult and not working with us-her insurance company. At this point the member was ready to give up and just take on the debt. She was exhausted from giving birth and being a new mom, her family was affected by COVID-19, and she saw no light at the end of the tunnel. At this moment, I knew fate led her to me. I was not going to give up on her. I told her I was going to fight through all of this with her. She began to cry, which made me tear up. She continued to thank me for my help and for sticking it out with her. I let her know I was happy to help and on her side all the way. We worked with the provider to get the diagnosis code. I helped the member submit her claim and have it processed towards her benefits.
 
I continued to monitor the claim for the member and once it processed, I followed up with the member weekly to give her updates. We processed the claim and sent payment to the member because the provider is out-of-network. I followed up with the member to make sure she received the check and advised her on the next steps. The member needed to work with the provider and see if they would be willing to accept our allowed amount as payment in full. When a claim is billed to insurance it processes towards a contract which is an agreed upon rate between BCBSVT and a participating in-network provider. If a provider is out-of-network, it processes towards an allowed amount, which is a rate determined by the usual and customary pricing of services based on industry standards. It is known as balance billing when a provider bills the difference between what they charge, and we allow.

In most cases, as with this one, the allowed amount is less than what the provider charged for the services. The member sent the provider the payment and a copy of her health plan payment breakdown, showing the allowed amount the claim processed with and why she paid what she did. I called the member two weeks later to see if she had been billed for the difference. She confirmed they cashed her check and did not hear back from them on the difference between the allowed amount and total charge. She believed they were accepting the allowed amount.
 
A month went by and I got a call back request from the member. My stomach dropped. I called the member and before she could tell me what was happening, I could hear her voice trembling in disappointment. The provider did come back and balance bill her and not only did they bill her, but they sent her to collections. She did not receive any bills and did not hear from them about the balance billing. We conferenced to the provider again to get to the bottom of the situation. I explained the situation to the representative at the pediatrician’s office. She did confirm they sent the member to collections and did not send a bill or notice because they assumed she was aware of the balance because she had made a partial payment. I went into detail advocating for the member, explaining why she paid what she did and asked that she be removed from collections and to have her balance reviewed. The representative was also a mom and agreed this is not a common situation and would work with us. After much review and many phone calls with the member to the provider’s office to check on the status of her account, we prevailed! They removed her from collections and agreed to accept the allowed amount as payment in full.

After everything this member had been through, I followed up another two weeks later with the provider and her to make sure everything was completed and settled. The member was so grateful for my help-which makes everything worth it for me. She said not many people would “help a girl out” when it comes to insurance. She has been with companies who just throw their hands up and say it’s not their problem. She said she was forever grateful that she called that day and spoke to me.
 
Little does she know I am just as grateful for her, reminding me my job matters and I am important. I am not “just” a customer service representative. My name is Kasia, I work at BlueCross BlueShield of Vermont and will always be there for those who need my help.

Kasia Starzec – Blue Cross and Blue Shield of Vermont

 


Member Service is Rewarding

“To be able to make a member a believer in my ability to assist is rewarding”

When I initially started within my member service position at BCBSMA 4 years ago, I knew nothing about working within an inbound customer service center. I spent much of my career in retail, where I handled customer inquiries face to face. Not only was it new for me to be assisting customers over the phone, but health insurance itself was an avenue I had never explored. I had no idea what to expect but thinking about the different battles in common day life in relation to people’s health; I could assume it wouldn’t be easy. I was up for the challenge, I made it my duty to always be personable with our members, showing them that they indeed have an advocate who is genuine and, on their side, to assist in easing the difficulties surrounding their health care.

When I think about the many calls, I have had in these past 4 years, one call in particular stands out. I received a call from a member who was struggling with headaches for some time. She expressed how much it really took a toll on her daily living, and even within our conversation, she informed me that she was in excruciating pain. As I empathized with the member, she went on to explain that her doctor had now ordered an MRI and that she hoped there was coverage on her policy for such. The member had already set up an appointment for the following week, and really wanted assistance in confirming coverage. Upon reviewing her benefits, I advised the member a preauthorization would be needed, and that there was not yet one on file. Sounding frustrated, the member began to question how she would go about assuring that an authorization was on file for her MRI, to avoid any unnecessary costs. I took this as an opportunity to jump in and follow the member through this situation.

I briefly took a moment to explain the process to the member, advising her that the ordering doctor along with the servicing facility, were responsible for reaching out to the appropriate parties to initiate the preauthorization request. Once the request was received, it would then be reviewed, and a determination would be made whether the MRI service could be approved or if it was denied. I recognized a moment to take the member out the loop. I mean thinking about the headaches she was already having, even in that moment, I could only imagine how the member would feel having to connect back with her doctor, the facility etc.

I gathered some information from the member and contacted the facility in which she had her appointment. I spoke with a representative, giving them the information needed to submit for a preauthorization, as well as requesting that they issue it as a priority. I continued with advising the member that I would monitor her account personally and would contact her within the coming days for a status update. When we received the request, I was able to email the member letting her know we were reviewing it, and once it was approved, I was able to advise of such as well. The member was so appreciative that I not only made the outreach to assist in getting what was needed, but that I had also followed up with her, just as I said I would. She said that she was skeptical at first, not believing that I would follow up with her, but that I had now made her a believer in our stance to helping manage her care.

To be able to make a member a believer in my ability to assist is rewarding. To show them that their conversation with me is not just another member call but that I am dedicated to resolving their personal inquiry, is rewarding. To feel the warm gratitude from a member who is already dealing with an ongoing medical related issue, is rewarding. To take the member out the loop, in what I would say, as being one less headache, is rewarding.

Keisha Wright – Blue Cross Blue Shield of Massachusetts

 


Leaving a Lasting Impression

“Zamir cares about his performance, his members, and doing the right thing by our members.”

I want to nominate Zamir Matos for CSR of the year. Zamir is driven, courteous, and a master at de-escalating irate members.

Zamir goes above and beyond to solve problems.  There was one member he was working with who was having an ongoing issue for a long time. While the issue appeared to be resolved, Zamir noticed some subtle details that showed that this wasn't the case. He brought this to leadership's attention and has stuck with this member through resolution. 

Zamir cares about his performance, his members, and doing the right thing by our members. Zamir goes above and beyond to follow up on his cases between incoming calls to ensure resolution in the time frame promised to our members. Zamir has left a lasting impression on many members. Here are some kind things they have spoken with me about that I have shared with our team:

  • "I spoke with him today, and he was amazing. He took the time and really explained everything with me. He deserves the world!"
     
  • "I just want you to know how great Zamir was.  He went above the call of duty to help me. He's really nice and knows what he is talking about. Give him a pat on the back for me!"
     
  • "I want to thank Zamir for helping me with an ongoing issue with Quest Diagnosis.  He is amazing!  He has been on top of this and continues to follow up. I really appreciate all he is doing to resolve this issue for me."

I would like to see Zamir win this award because he has come such a long way and worked hard to get where he is now. He has a lot of potential, and I see great things happening for him down the line. 

Zamir Matos – Blue Cross Blue Shield of Rhode Island

 


Making a Difference in a Short Time

“Even though Christine is one of the youngest in our group when it comes to tenure, she has really managed to keep up with her peers that have been here much longer.”

From our Concierge Service Team, we are nominating Christine Castro for CSR of the Year Award.

Christine works very hard to ensure that each member she speaks with receives the utmost respect, empathy and the best service she can provide. Christine is empathetic and cares about each member she speaks with. Because of her simply infectious jovial demeanor, Christine is highly skilled at de-escalating frustrated members. Christine has been with the company a little under 2 years and quickly earned a spot on our Signature Service team as a Customer Solutions Expert after only one year!

Members consistently say things such as “she is so cheerful and polite”, “I didn’t have any issues at all, she just took the ball and ran with it, she did great” and “she went above and beyond!”. Christine is often observed assisting her peers (and her leader in certain cases) any time that she is needed, while making sure that she is staying on top of her core responsibilities. Even though Christine is one of the youngest in our group when it comes to tenure, she has really managed to keep up with her peers that have been here much longer. Christine is very dedicated to her team and our members and takes every call with a smile in her voice. For 2020 Christine ended the year with a 78% First Call Resolution score, 92% Issue Resolution and a 92% Customer Satisfaction score. Her World Class Call rate is an astounding 88.9%, over 20% higher than our contact center average.

In sharing some of the comments left by our members below, you can clearly see that Christine is a valued asset amongst our team. Members advise:

  • “I was a bit frustrated. She was very patient, very understanding, and informative. She was not dismissive or anything like that at any point. She took it right on and kind of helped get me where I needed to be information wise. I had to respect that.”
     
  • “She's just very nice. She cared about my needs, why I was calling in, and she answered all my questions. Just a very nice person.”
  • “I'm dumb founded with their performance. I've never dealt with an insurance company who was that awesome.”

Christine logs in every day with a smile and the absolute best attitude no matter what. She follows through with each member she assists and never gives the impression that she is being bothered. Based on the feedback left by our members, she really makes a difference. I can’t think of anyone better to receive this award, she deserves this and much more.

Christine Castro – BlueCross BlueShield of North Carolina

 


I Won’t Give Up for My Member!

“As a customer service advocate, I knew I had to do all I could to assist and advocate for my member!”

Our member called our call center to question several chiropractic visits he had to pay for out of pocket. The member was under the impression he had met his deductible and maximum out of pocket, and he was very frustrated!

I assured the member that I could help him and quickly reviewed his account and claims. I found the specific dates of service on file he was concerned about and compared them to the days he seen his chiropractor. During this review, I noticed some of his visits were not in our system or applying to his benefits. He told me he had already been struggling financially due to the pandemic. Paying out of pocket when he should have no patient liability was weighing heavily on his shoulders. I could hear that in his voice. I could have told him to call his doctor, but instead, as a customer service advocate, I knew I had to do all I could to assist and advocate for my member!

I offered to call his provider to find out how I could get the missing claims on file, and he agreed. Even though I did not get an answer from the provider, I called him back by the end of the day to provide him with a status update and let him know I would continue to reach out to the provider’s office and keep him updated. He was thankful for the returned call and so appreciative that I was not giving up on resolving his issue.

I followed up with the doctor’s office several times the next day with no luck. What seemed like a simple solution turned out to be a daunting task. After several calls to the provider and continuing to follow up with the member daily, I was able to speak to a staff member at the provider’s office. She informed me she would research the issue and call me back.

The provider’s office failed to keep its promise, and I called back several more times but had to leave multiple messages. I continued to keep the member abreast of my efforts, and he was so thankful for my diligence. Even though it seemed as if I was getting nowhere, I knew my member was counting on me, so I continued to call. After 12 calls and 25 days, the provider filed the claims to the member’s insurance. Since the member had already paid for these services, he was refunded $1,100 by his provider! This was such a considerable amount of money at a time when he was really struggling financially. He was so overwhelmed with the service I had provided and couldn’t thank me enough! The process was lengthy and frustrating at times, but I would do it all over again knowing how much I was able to help this member.

Jantiest Damon – BlueCross BlueShield of South Carolina

 


Help! I need surgery!

“Hearing how upset she was, I tried to put her mind at ease and let her know that I was here to help!”

Our member was beside herself when she reached me. She was scheduled for eye surgery the same day, but the provider told her she did not have medical coverage. She was in total panic mode, as she was diabetic and needed eye surgery desperately. Hearing how upset she was, I tried to put her mind at ease and let her know that I was here to help!

I quickly reviewed this member’s account and assured her that she did have medical coverage and an approved authorization for her eye procedure. I told her that I would reach out to her provider to confirm her benefits so she could continue with her surgery. I gave her the option to hold while I contacted the provider or to let me call her back once I resolved the benefits issue. She preferred I call her back, so I let her know that I would call her back the same day as soon I was able to reach her provider.

I then called the provider’s office and spoke to several people until I finally reached the administrative nurse who handled eligibility. I walked the nurse through the steps to view the member’s eligibility online so we could confirm the member’s benefits while I was on the line. This time she was able to see the members medical coverage! The nurse said she couldn’t view these benefits before, indicating a “human error.”

The nurse said she would speak with the ordering doctor and the Scheduling department to reschedule the member’s surgery as soon as possible, and then she would update the prior authorization. I followed up an hour later with the member and explained that I had personally walked the nurse through the verification process on our website. I let her know that the nurse would update all authorizations and be in touch regarding the rescheduled surgery, which would be done within the next few days.

Our member was so relieved and happy that she could still have her surgery, even with the small delay! She was also thankful that I went above and beyond to contact her physician’s office for her. The surgery was performed three days later. I monitored the member’s account every day until I saw the claims for her surgery process appropriately. I knew the last thing she needed after surgery was any unnecessary stress.

Stacy Small – BlueCross BlueShield of South Carolina

 


A Service Star Shines Bright

“Nothing gives me more joy than being able to feel the sincere gratitude from my members.”

Starlight Ervin is a true Customer Service “Star”. She has the shining “Star” attitude that members love talking to 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. As 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 who was recovering from COVID-19 for the second time and lost her husband in March from COVID-19 called in due to the overwhelming bills she started to receive. The member immediately started crying, still in a state of disbelief and grief over the loss of her husband. The member was having issues with billing because they were not able to assist her with explaining her husband’s patient liability and would only tell her, ‘you need to call his insurance’. The member’s grief touched Starlight’s heart and she immediately reassured the member that she would be her advocate and assist her in resolving all her questions and concerns regarding all the bills she has. Starlight started walking the member through each bill she had and explain the liability on each claim. Then Starlight offered to call each provider and ask to put the accounts on hold to give the member time to recover from COVID-19 and make payment arrangements with the providers.

Upon receiving the news, the member was overjoyed and began crying. She stated Starlight was her “Shining Star”, and no one has ever gone above and beyond for their family. When asking 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 for, as they call it, ‘going above and beyond’ but I call it doing my job by making sure they are completely taken care of. I think of my members as 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

 


Helping Change a Customer’s Life

“This is when Amy Jo took initiative and gave the customer what he needed, and which Consumers Energy couldn’t offer.”

Amy Jo has a caring heart which goes far beyond her work at Consumers Energy.  Her care for her customers is what allows her to consistently deliver a world class performance with a hometown touch.  The following example not only helped change a customer’s life, but it also demonstrates how Amy Jo strives to make a difference for her customer’s every day.

Amy Jo’s call that afternoon started out like many natural gas turn-on calls she’s taken before.  There had been a dispute between the customer and their former fiancée resulting in the service being turned off.  After listening a few minutes to the customer’s story Amy Jo could tell something else was going on.  He had left the trailer over a month ago and was now returning home to settle things with the mobile home park through eviction court.  When he arrived, he found the heat off and everything gone, including his emotional support dog from Veteran Affairs.  Amy Jo could hear shivering in the man’s voice as he tried to figure out what he needed to do in order to stay warm.  

About halfway through the call Amy Jo could hear he was starting to break down.  Remembering that he was a military veteran she began talking calmly to him about the town and what he enjoyed doing.  He mentioned that he was looking to move somewhere that would keep him away from drugs and help get him back on his feet.  Before returning home, he’d been bouncing between living on the streets and a veteran’s assistance home.  At one point the caller even said, with distress in his voice, “I don’t want to die.”  This is when Amy Jo took initiative and gave the customer what he needed, and which Consumers Energy couldn’t offer.  She provided him with the name and contact information for a veteran’s recovery home she was familiar with in the area called Fiddler’s Green.  They could provide him with a room, meals, counseling, help with finding employment, etc.  By this time, the gentleman was sobbing and thanking her for saving his life.  When it was time to end the call Amy Jo again urged him to call Fiddler’s Green and wished him luck.

Normally the story would end there.  Amy Jo would be left to wonder what happened.  But as it turned out, our gas field leader was out at the residence later that day addressing the gas issues.  While on site a worker from Fiddler’s Green arrived to take the customer to their facility.  While they loaded the truck with his remaining possessions, they both expressed gratitude to the field leader for Amy Jo’s actions, again stressing the fact that she had saved his live.  Amy Jo was able to confirm later that week that he had checked in and doing well in his new home. 

Amy Jo Schultz-Porter – Consumers Energy

 


I am here to help!

"I am here to help. We will always make an arrangement for you if needed.”

Jennifer King has been a customer service representative for over seven years. During this time, she has truly exemplified our cultural norm of caring. Jennifer understands the customers concerns and needs sometimes before they even do. She is deliberate in her goal to assist as many customers as she can. If Jennifer can’t assist them with the tools she has, then she is sure to advise them how to seek assistance from other agencies. She strives to set her customers up for success.

Jennifer received a call from a young, single mother who is a gas customer of ours. It was the start of the heating season and she had fallen behind with her gas bill. She had been affected by the COVID-19 epidemic and also had delays with receiving her unemployment benefits. She started the conversation apologizing for defaulting on a previous arrangement she had for her account. She was very scared because she had a shut off notice for just over $200 and didn’t know if she would be able to make another arrangement because of that default. She had already tried seeking assistance with the Department of Health and Human Services but was denied because her income was just slightly over the income requirements for utility assistance.

Jennifer started by telling her, “I am here to help. We will always make an arrangement for you if needed.” Jennifer acknowledged that she was a good customer, making payments each month even if they were smaller than the balance due. Jennifer asked her if she would be able to make a payment today for another arrangement. The customer stated that she could not. She stated she had literally paid us her last $50 just a few days prior. She went on to explain that she was thinking of winterizing her home and temporarily moving in with her mother, so that she didn’t have to worry about not having heat for the winter for herself and her small children. She thought if she did that then she could just catch up on the bill once winter was over.  

Jennifer’s heart broke hearing her frustration and the struggle in her voice. She told her “I will take care of you!” She explained to the customer that she was going to credit her account for the past due balance and bring her account current with company funds that were available. She advised the customer that all she would have due would be her current bill, and that wasn’t due until the end of the month.

When Jennifer told her what she was doing, you could literally hear the customer gasp she was so surprised. She was so appreciative, and you could hear the difference in her voice when she realized she didn’t have to worry about this balance anymore. She could stay in her home, with her children and not have to worry about having the heat turned off when she desperately needed it. By the end of the call she was in tears, just having this burden lifted was an emotional experience not just for her but for Jennifer as well. Jennifer was in tears too.

Jennifer still checks on this customer’s account. She has not had a turn off notice since that difficult time. She just needed a helping hand to get her through a rough spot and Jennifer is thankful that she was able to do that for her.

Jennifer King – Consumers Energy

 


Make it Simple for the Customer, Show the Customer Value

“Personally, nothing is more enjoyable than a sense of accomplishment after a day resolving problems and being of service to those who need help.”

As a CSR, I always try to empathize with the situations our members are going through, whether it’s a request for an EOB or a complicated issue with a denied claim. Personally, I have always believed in doing the best job possible the first time. No issue is too large or small.

This applied philosophy led to being recognized by a valued member recently. Here is what our member explained to the Senior Advisor.

Make it simple for the Customer:

  • “I had the pleasure of speaking with a member and she said she could not get off the phone without telling someone how wonderful John is. This member said she has just started with Medicare and it was all so confusing to her until she spoke with John. She stated he was helpful, kind, patient, and professional. She stated he even reached out to a couple of her regular providers on her behalf to make sure everyone was on the same page. She says she now has the tools and information she needs as she enters this new chapter in her life. WOW JOHN!!!!! SPECTACULAR JOB!!!”

Upon speaking to our member she advised that she had recently retired but was having trouble understanding how her new Medicare coverage works with FEP. I listened to her, asked questions when necessary, and realized she needed to be educated completely on how FEP coordinates with Medicare. I simplified the Medicare processes in an easy-to-follow format with clear answers to her questions. Medicare is a whole new world for a lot of our retired members. I feel it is imperative as an FEP CSR to make sure our members understand without a doubt how the benefits coordination will work for the member going into future.

Since the member had established providers, I advised her on how her claims would be submitted now that Medicare was primary and offered to reach out to any of her providers to advise. Now equipped with a complete understanding of how to navigate her new coverage, The member was extremely grateful for the level of assistance and clarification to help her understand her benefits better since retiring.

Ultimately, it was important to me as an FEP CSR that our member was able to retain that information and understand how to navigate this new information going into the future. It’s always a pleasure educating our newly retired senior members.  

Show the Customer Value:

  • “I received a call today where the member wanted to leave a kudos for John. The member has done business with Florida Blue for many years and stated that John is best rep he has ever spoken with at Florida Blue or at any company. John had technical skills and people skills. He resolved the issue that could have ended ugly. Thanks to John’s great customer service, he was able to resolve the issue and help the member. The member states to, ‘keep John happy and keep him around’, and looks forward to getting John for future calls.”

All in all, I enjoy helping others and problem solving. With so many variables regarding a member’s reason for inquiry, it is imperative to listen to the member’s inquiry while devising a plan to resolve the issue at hand. This process has allowed me to help each member regardless of how trivial or daunting the task may be and convey to each member that FEP is here to help. Personally, nothing is more enjoyable than a sense of accomplishment after a day resolving problems and being of service to those who need help.

John O’Brian – Florida Blue (Federal Employee Program)

 


“Getting it right” for our members

“I've worked in customer service for years and it's not every day you come across someone like Sharon who seems to really care.”

As a supervisor when I hear SQM or World Class Certification, I immediately think of Sharon Kelley. I have had the pleasure of working with Sharon for more than 5 years now at HealthNow NY. Over that time, I’ve learned many things about Sharon, but the most important is that she loves taking care of our members, every, single, day. When Sharon begins her calls with our members, she gives her all and 100% attention, no matter what. Her commitment never ceases to amaze me or our entire FEP team. Recalling a specific time that Sharon went above and beyond the call of duty, there was a time when she received a phone call from a mom in distress trying to find a solution for her son that was in need of emergent inpatient mental healthcare. On that day, Sharon began the call around 10am and worked endlessly, through lunch, to find an answer for this concerned mom and her son. Sharon championed for this member’s care by making countless phone calls to providers and facilities, looking for answers and hope. The scenario luckily ended with the member being connected to the care he needed, thanks to Sharon’s determination and never-ending problem-solving skills.

Sharon bringing over 30 years of experience in helping our members is what sets her a mark above. She is so dedicated to our members, reinforcing their understanding, and supporting their needs. Sharon also lives by and truly cares about being a World Class Certified representative and ensuring our overall SQM success. Sharon pays close attention to her SQM and Survey responses and uses each one to sharpen her customer service skills and implement improvements whenever possible. That is the level of dedication that Sharon brings to the table each day which that drives our SQM success stories and, most importantly, ensures that our members are completely taken care of. This energy supports and bolsters our overall customer experience throughout the entire FEP department. Sharon’s dedication to “getting it right” for our members has consistently and effectively “rubbed off” on our entire team, and she’s helped strengthen our customer-centric culture.

  • “Sharon has been the SQM cheerleader and advocate for the department. She gets everyone excited about SQM and inspires them to work hard to become World Class Certified. She truly cares about the members and doing the best job she can for them, and the department wouldn’t be what it is without her! She receives numerous customer compliments day in and day out and here is just one of them: “Just wanted to reach out to you and let you know that one of your employees by the name of Sharon did an awesome job on helping with me with a claim that was in collections. I spoke with her yesterday for the first time and we could not get a hold of anyone so I had told her I had no problem calling them again by myself since she had given me the correct information to get it figured out. I woke up this morning to a voicemail from her and she had actually decided to take on the claim herself and get it done for me. I've worked in customer service for years and it's not every day you come across someone like Sharon who seems to really care about helping people on the other side of the phone. Let her know I said thank you again for a pleasant and easy experience!”-Manager of FEP

Sharon is the epitome of a World Class Customer Service Representative. Our FEP team and organization is truly lucky to have such a seasoned and dedicated professional onboard. Therefore, we believe that she is the perfect candidate for SQM CSR of the Year.

Sharon Kelley – HealthNow New York Inc.

 


There for our members when they need help the most

“Scarlet goes above and beyond then goes even higher and further!”

Scarlet Johnson is a customer advocate for the member experience team that supports our Federal Employee Program (FEP) members. She is important to our team because of how far she is willing to go to help anyone in need. Whether it is a customer who calls with a question or even a co-worker who needs some encouragement, Scarlet always leaves a positive impression with everyone she encounters. Words like “genuine, real, compassionate and patient” are used often to describe Scarlet’s interactions with our members, and they also say how “kind and reassuring” she is when answering their questions in an understanding way. Here are two examples of sentiments shared by her fellow team members:

  • “As someone who reviews and transcribes the World Class member comments, I get to hear what our members have to say about her. Scarlet leaves an impression … they tell us how she was so kind and understanding and how she made sure they knew exactly what was going on while she took care of everything for them. I hear the same from her coworkers. Scarlet goes above and beyond then goes even higher and further!”
  •  
  • “I wanted a Customer Advocate to visit my training class and speak about what customer service is about and what first call resolution (FCR) means and why it is important for our members. I knew right away I wanted Scarlet to be that person. I chose her not only for her great FCR scores, but mainly for her passion to advocacy, service and our members. Even though it was a little out of her comfort zone, Scarlet was amazing during her presentation. My team was so impressed with what Scarlet had to say and how she spoke from her heart about what it means to provide service to our members. She also spoke to my second new hire group and served as a mentor during their training program. Scarlet has always volunteered to help out the new customer advocates and share any information that might be helpful.”

One experience stands out and exemplifies how natural and empathetic Scarlet is in her role as a customer advocate. A few months ago, she spoke with one of our members who was having difficulty contacting the FEP employment agency to report the recent death of his wife and change his insurance coverage. Because he is legally blind, he could not read or complete the required death certificate paperwork on his own. He wanted someone’s help to fill out the forms over the phone, then mail a copy for him to sign. After being unable to obtain assistance, he contacted Highmark for help where he reached Scarlet.

Scarlet helped the member navigate and understand the process, then facilitated a joint conference call between them and the FEP employment agency. According to the member “the FEP employment agency representatives were not understanding of my simple request [until Scarlet intervened] and voilà magically they suddenly understood.” Throughout the process, Scarlet served as a liaison on several phone calls over a two-week period to help the member complete the required paperwork. Together they successfully updated his policy so his premium rates could be adjusted accordingly.

Our member was so grateful and wanted to let us know in the strongest way possible how very fortunate we are to have Scarlet on the team that he contacted the market president for Highmark Blue Cross Blue Shield of West Virginia. Below is a portion of the member’s testimonial, which exemplifies how Scarlet was there for this member at a moment when he needed her the most:

  • “It is with a heavy heart that I try to sort out all this legal stuff [following the death of my beloved wife]. In the process of wading through the legal maze I had to reduce my exorbitant BCBS premiums after my wife passed away. The process was not an easy one, but fortunately I had the highly professional and competent assistance of Scarlet in your BCBS WVA Service Center. I found Scarlet to be highly professional, competent, compassionate and caring. She has great critical thinking skills and can think outside the box to get things done. She has a great command of the BCBS policies and procedures and a laser focus to accomplish tasks and get the job done. She is a sterling example of what the BCBS brand should be and you are very fortunate to have the services of this professional. This has been an exhausting and traumatic event and my world has literally been turned upside down with the death of my beloved wife. I could not have waded through this process without Scarlet’s assistance.”

Scarlet’s member interaction also caught the eye of senior leadership, with the heartwarming story being shown as part of a video presentation during an enterprise-wide management meeting. Subsequently, the story was also shared with all Highmark Health employees through email and via the internal video streaming portal. Additionally, there are plans to include the message as part of Highmark Health’s 2020 Annual Report, demonstrating the powerful, transformative impact Highmark is having with its members and why we stand out from other insurance carriers.

Scarlet Jones – Highmark Health

 


Great Customer Service

“I can't speak highly enough of her. I just am very grateful that she was the one who answered the call.”

In the short time since Courtney began her career with Horizon Blue Cross and Blue Shield of New Jersey in April of 2020, she was among the highest scoring in her class and was always ready to learn something new and share her knowledge with her peers.

In her first month of having surveys pulled, she received recognition from SQM with a survey tagged as “Outstanding Customer Feedback.” The caller stated:
“She took the time to answer all of my questions and looked into some information that she didn't have readily available in front of her. I really felt like she was trying to resolve my issue and get my question answered. I felt like I got great customer service.” 

This began the path of Courtney’s continued success with the organization.  

In 2020 she had a total of 25 SQM surveys pulled with an amazing Resolution rate of 96% and First Contact Resolution rate of 84%!  She also achieved a 96.83% agent satisfaction from our members, along with a quality score for the 4th quarter of 99.68%.

Courtney is very caring and empathic with the callers and takes her time to ensure they feel valued and that she is able to help each of them, no matter what their issue or concern may be. I have received numerous kudos calls from our members who have had the privilege of speaking to Courtney and the general consensus of her callers mirror this one:

“She was very courteous, she was very professional, and she was knowledgeable. She was actually, probably, the best customer service rep that I've contacted in years. I can't speak highly enough of her. I just am very grateful that she was the one who answered the call.”

Courtney Gilfillian – Horizon Blue Cross Blue Shield of New Jersey

 


Taking the Time to Help Customers Make the Right Choice

“She takes the time to really explain and cares if the customer leaves with the best outcome…”

I would like to nominate Meagan Cockrell for SQM CSR of the Year. On more than one occasion, she has helped a customer who was struggling with the final post forbearance options to make the right choice for them and their families.

One example stands out to me: At the time of the call, a customer reached one of our team members in regards to documents due for a standard modification. Upon review of the account, Meagan found that the customer should qualify for a COVID-19 modification, which is pre-approved and does not require the documents which he was frustrated about having to provide at the start of the call. Meagan offered to speak with the customer to better explain the option to him, as he was hesitant to move away from the standard modification. Meagan spent over 45 minutes with the customer explaining the differences in the standard modification and the COVID-19 modification. Ultimately, the COVID-19 modification was pre-approved, offered a lower interest rate, and would offer the customer a far better outcome for his situation. After discussing all of his concerns at length, he chose to move into the COVID-19 modification.

Meagan consistently helps the customer make the right choice, even if it is not easy to bring them to that solution. She takes the time to really explain and cares if the customer leaves with the best outcome possible for them. The time she took with the customer will put him in a far better place with the modification process. His post modification will allow him to have a lower interest rate with a lower monthly payment afterwards.

This was just one of the customers that Meagan has impacted in this way.

Meagan Cockrell – Mr. Cooper

 


Helping Our Members Get the Urgent Care They Need

“I take pride in my job and love helping our members.”

I have always loved working in customer service because it provides me with the opportunity to help and resolve all callers’ situations. Working for Regence is a rewarding and satisfying job which I look forward to every day. I never know what to expect, as each call is very different from the last.

I had the opportunity to help one of our members who had a serious health condition. The member was waiting for treatment at a wound-care facility because of an accident she had been involved in, and she needed help getting a referral from her Primary Care Physician. I noticed that she had called the previous day and was informed that her health care provider would call her once her request was completed. I could hear that she was in great pain and in desperate need of medical services. She shared with me that she had been working with her doctor, and she had been unable to make an appointment because the doctor was booked six months out. I knew I had to do something. I began researching and calling nearby facilities to find one that was in her network. I contacted her provider’s office to have her referral handled as a high priority to speed up the process.

Over the weekend, she ended up in an urgent care clinic, which provided antibiotics and recommended she receive urgent treatment at a wound clinic. Monday morning, I again contacted her doctor’s office and stressed the urgency of her need to be treated. The office stated that her referral should be approved and finalized in a couple of hours. I called her back to let her know that the referral was being finalized and we should be able to make an appointment by end of day. Soon after, I called the wound-care center and was informed they had received the referral, and that they were speaking with Her to schedule an appointment for the next morning. I called Her back to make sure she had the appointment scheduled, and she did!

I take pride in my job and love helping our members through this confusing health care system. It was heartwarming to know our member would soon get the care she desperately needed to start her healing process.  

Chrissy Chandler – Regence BlueCross BlueShield of Oregon

 


Scotia iTRADE’s Client Experience Model (CEM)

“I will continue to apply this to all my client interactions in order to provide them with the best world class customer service that we all strive to bring to all our clients.”

Scotia iTRADE’s Client Experience Model (CEM) breaks down the flow of a client interaction into 4 different components: Relate, Discover, Value and Commit.

The Relate phase starts by simply building rapport with the client in order to earn their trust. Clients want to feel that they are in good hands and they expect a certain level of professionalism, confidence and knowledge from a representative. Clients also want to speak to a representative who is friendly and shows empathy towards the client. These factors will essentially build the foundation towards a memorable customer service experience. I recall receiving a call from a very upset and elderly client regarding their RRSP account which was no longer accessible online. During the call, I remained calm under a tense situation, apologized for the inconvenience that the client had been experiencing thus far and took ownership of the call. Just by doing these few things, I was able to earn the client’s trust and he was comfortable in letting me assist him with his issue.

The Discover phase involves being able to identify the true nature of the issue. By actively listening and asking probing questions, representatives can determine the root cause of a client’s problem. Only by determining the issue can the representative provide an appropriate resolution to the problem. As I asked the client some open-ended questions, I was able to determine that a RRIF account was opened on behalf of the client and the assets from his RRSP account had been rolled over to the new RRIF account since he had reached the age of 71 however, we required some documents pertaining to the new RRIF account. Further to this, he did not receive any of the documents or communications pertaining to this as his mailing address and email address were not up to date on our systems. In this case, the root cause of the issue was not simply that we required some missing application forms in order to get his RRIF account restriction removed, but also that we did not have the proper information on file for the client which led to this incident.

The Value phase entails presenting the client with the right solution to their issue. The solution should be tailored to the client’s needs and adding value to the interaction will result in exceeding the client’s initial expectations which will only lead to a positive client experience. In order to provide the client with a proper resolution, I explained to him the full process of how RRIF accounts are opened on behalf of clients in the year that they turn 71 and I updated his contact information on our files to prevent further miscommunications from occurring. I also walked him through the process of locating each of the documents required for the approval of his new RRIF account and assisted him in completing the application forms.

The Commit phase brings a close to the CEM model by ensuring that we have not only met but exceeded the client’s expectations. In order to properly conclude a client interaction, it is important to answer any further questions that may arise to clear any doubt and it is also important to set proper timelines for the next steps. In my case, I set expectations as to when the client could expect access to his RRIF account online once again, offered to email him once his RRIF account was active and explained how RRIF payments are processed so that he understood the functionality of his RRIF account vs. his previous RRSP account.

Although this issue may have blown up from a simple incorrect address, by following the exemplary CEM model, I was able to turn a negative client experience into a positive one and I will continue to apply this to all my client interactions in order to provide them with the best world class customer service that we all strive to bring to all our clients.

Mahul Patel – Scotia iTRADE

 


Impacting Lives with a Patient-Centric Approach

“Once I built her trust and she allowed me to help, we started seeing results.”

To create a positive customer experience, each interaction with the customer needs to be treated as an opportunity. Every time we pick up the phone we have the opportunity to “wow” a customer, retain a customer, or lose a customer. As an agent, I shoot for the “wow” factor, and if I miss on wowing that member, at the very least we can retain that individual. I would like to share a story of how I was able to retain one of our dissatisfied members.


For the sake of not using our member’s real name, I will refer to her as “Beth”. I first spoke with Beth back in 2016 as a result of her concerns being escalated. Beth, who is a mother of two, would fight tooth-and-nail for her family; however, she found herself at a crossroads in her life. Beth was behind on her self-employment taxes, her daughter had injured her knee, and medical bills were piling up. Each time she contacted customer service her back was against the wall; she had no other option but to demand results. Her calls became increasingly aggressive, resulting in myself stepping in. To put it bluntly, I have feared three women during my lifetime: my mother, my wife, and Beth. Beth found herself in a hole, and her hostility was a cry for help.

I found the best way to help Beth was simply to listen and empathize with her. I can remember conversations, at first, which would last over an hour, sometimes completely unrelated to her issues.  Once I built her trust and she allowed me to help, we started seeing results. We started small by looking at the family’s medical bills. I had Beth come to my office to meet face-to-face. She brought in a stack of medical bills that I separated into two piles: ones she owed, and ones she did not. We set up payment plans with each provider for the bills she owed. I then called the providers to make proper adjustments for the bills that were incorrect. In doing so, we determined there were thousands of dollars being billed to her in error.

The next order of business was getting her daughter the care she needed. The complications from her knee injury were far too complex for our in-network providers. We made calls to other providers throughout the state looking for an orthopedic surgeon who could do her surgery. It took some time, but we found a specialist that was able to assist. We went through the process of getting authorizations in place, and her daughter had a successful surgery. It would take months of therapy to get her back on her feet. Near the end of her daughter’s recovery, I remember speaking with Beth and she broke down. She was crying, but not because of sadness, but because of joy. She was starting to see the light at the end of the tunnel.

The last order of business was her taxes. I have an accounting degree, so I had a basic understanding of her needs. Even so, her issues were far too complex for me. She found an accountant and we worked together to collect insurance tax documents from 6-7 years prior. Slowly, they plugged-away at getting caught up on taxes. Every year during the annual enrollment period I help Beth renew her coverage for the upcoming year. One question on the application asks if you have reconciled your premium tax credit from prior years. For 4 years we had to mark “no”, but in 2020 we were able to mark “yes”.
 
I can honestly say Beth is a different person now than when we first met. I took a patient-centric approach with Beth. I treated her as an individual who needed help, and the best way to do so was to listen and empathize. To this day, I continue to speak with Beth, and believe that our interactions transformed her into a loyal customer.

Jason O’Connell has been with Security Health Plan since 2014. During that time, he has proven to be an integral part of our Customer Service team. He quickly became trained on all of our core product lines and became a licensed insurance agent. Jason handles one of Security Health Plan’s Answer Center locations completely on his own, located in Stevens Point, Wisconsin. He has been our sole representation in this area to assist members both on the phone and in person who come into the answer center.

Jason was chosen as our internal Customer Service Agent of the Year for 2020. He is so incredibly willing to help with anything we ask of him and does so with such a positive attitude! On top of handling the answer center by himself, he also does a lot of other side projects and extra duties such as assisting with our online chat program, being a subject matter expert for complex third-party administration questions or issues, enrolling members into Marketplace plans, and taking escalated calls from our newer agents if they need assistance.

Jason has continuously improved on his SQM metrics year after year. He finished 2020 with a 97% World Class Call Resolution, which was a 3% increase over 2019 and a 7% increase over 2018. Jason continuously has a very high CSR Csat percentage as well. He finished 2020 with a 98% CSR Csat as he did in 2019 as well. Jason’s Call Resolution was 98% for 2020, a 4% increase from 2019. Jason has received multiple positive member compliments over the years and is recognized often for his attention to detail and making sure the member is not put in the middle. He does an excellent job with our members both in person and on the phone, and also with other agents in the department. He is a great resource used by many.

Jason O’Connell – Security Health Plan

 


Ready to Assist as a Supportive Team Member

“She is making a personal connection with them, making them feel as if they are the most important thing in the world…”

Feedback shared from Kay’s Peer:

I am nominating my peer Kay Landers for CSR of the Year.  Kay is a great peer and keeps others on the team inspired to provide excellent customer service. She is also a human database of knowledge. Our team has a great supervisor, VSP has great resource materials, and a great support team to assist us, but we often turn to Kay for support as well.

Kay is supportive and encouraging. She is also great at explaining a process or procedure when I have been unable to locate or figure out something on my own. Kay is always positive. I sat near her when we were in the office and she was always just as positive with her callers, always putting their needs first.  You can hear when she is responding to a caller that she is making a personal connection with them, making them feel as if they are the most important thing in the world in that moment. She takes customer service and her SQM results very seriously.  I just love her energy and that she is always there to help her peers on the team.

The information that I have shared is why my teammate Kay Landers deserves to be CSR of the Year, she embodies the true spirit of putting the customer first and making sure their issue is resolved on the first call.

Feedback shared from Kay’s Supervisor:

I have supervised Kay Landers for the last 4 years as a Hybrid CSR. Kay is a well-rounded agent and likes to excel at all she does. Kay is an extrovert and was a one-woman party planner and decorator-extraordinaire when we were in office, so I wasn’t sure how she was going to handle the changes. This year was no exception for Kay as she embraced the changes brought on by the COVID-19 pandemic, and the changes that came as a result of moving to a 100% remote work environment.

Kay is one of the biggest cheerleaders on my team. She is always active in our MS Teams chat, offering to assist a peer with an account or claim question. Kay does this while also trying to balance the business and her metrics, without sacrificing the quality of her work.  

When it came to her SQM metrics, Kay was determined to meet the goals, despite taking on a skill development opportunity in another work area this year for almost four months. She thrived in her temporary job, but could not wait to return to the call center, to dust off those customer service skills, and get back to providing World Class service to her callers. Kay easily adapted upon returning, and immediately began wowing her callers.    

Comments from a selection of her surveys read as follows:

  • “She was extremely kind, she knew what she was talking about, and she gave me time to do what I had to do to reset my password. I would give her 25 gold stars.”
  • “The rep took the time to listen to my questions and looked at the information, provided all of the information in very good detail with patience and courtesy. They were very helpful in explaining things clearly, so that I could understand it.”
  • “She answered all my questions. She was very helpful and very polite. I was very happy with her help.”
  • “The rep that I talked to was very knowledgeable, patient with me, and friendly. I will definitely call her again.”

These comments are just a small example of some of the remarks left by members that she interacted with. It is no wonder she ended the year with 100% Calls Resolved and 94% CSR Csat and World Class calls.

Kay Landers – VSP Vision Care