2023 Top Agent CX Success Stories

Finalist Success Stories

Katheryne Beninato – 407 ETR

My name is Katheryne Beninato, and I am a Commercial Account Executive for 407 ETR, based out of Ontario, Canada. I have been part of the 407 ETR family for about 18 years now, and I enjoy every single moment! 

I have pursued various departments within the company, specifically within Customer Operations. I first started as a Customer Service Representative in our Call Centre, also worked as a Customer Advocate in the Office of the President, and currently work as an Account Executive in the Commercial Relations Department. I really enjoy building a partnership with our top business customers. I work with very high-revenue clients and provide them with top-level customer service. I like to demonstrate a concierge experience for the client, and they really appreciate this. I have the best team members and management! I am also part of the Culture Club, and I am eager to help my colleagues with various initiatives throughout the year. I was able to Chaperone last year for One Big Day, a day of volunteering which was very special to me.  

I take pride in the work that I do, which demonstrates my commitment to 407 ETR and our customers. I know that my experiences bring value to the company. I have my share of stories that have immensely impacted my life and the company in a positive way over the years. Particularly, I have one story that I would like to share.  

One day, our team acquired a new top revenue business client located in Ontario, which specializes in surveying equipment. I had the pleasure of meeting with their Fleet Manager, who works remotely out of British Columbia. Among other tasks that he is responsible for is taking care of the 407 ETR account management for their company vehicle fleet. He maintains the account and is responsible for taking care of the whereabouts of their transponder units, which they have leased from 407 ETR. Their company utilizes our transponder units during their trips on the highway to save Camera Charge Fees each day.  

As I started to introduce myself and build a partnership with their business this past year, I had multiple Teams Meetings and conference calls that were crucial for him as he was told to handle the account but knew nothing about how 407 ETR worked.  

Every meeting we had was very positive and he was happy to learn about the solutions that I could offer him while assisting with their account management. He really enjoyed learning about how our business operated, as he was not aware of our processes and procedures, as he does not reside in Ontario or know where the highway is. I would take my time to explain how our processes work and answer all of his questions.  

One day he was very confused and was eager to set up a conference call; he was trying to track down some of their transponders. He was really stressed out and was worried this was going to cost their company a lot of time and money in fees. In particular, Replacement Fees, which we charge if a transponder unit is lost or stolen. There was one unit that we had to cancel and mark as lost, as they looked for it and could not track it down. He was certainly worried that it would take him a long time to figure this out, as he does not live within the province. He was so upset. I let him know that I would cancel the transponder immediately as a proactive measure to ensure their company was not liable for further Toll charges, and I waived the Replacement Fee for him. He was ecstatic, to say the least!  

What he was not aware of was that I could run some data for him and provide a specific detailed report gathering information about their 407 ETR account, in particular their transponder IDs. I told him that the report was not a guarantee but that I would run it anyway. He had some glimmer of hope, which seemed to help calm his nerves a fair bit. I worked quickly to obtain a report from our Analyst to determine the possible license plates that the transponders corresponded to.  

Around the same time, on a subsequent interaction, we met so I could deliver the report results, and it was not a bright and cheery day. I could sense he was not his spirited, upbeat self. It was when the BC wildfires were happening, and I could pick up that he sounded down and tense. I first took a couple minutes to ask him how he was feeling and to let him know our thoughts were with him during this difficult time. We had a heart-to-heart conversation about how the fires affected his beautiful region. I just wanted to show my support. He could sense that I genuinely cared as I took time out of my day to acknowledge how he was feeling. He really appreciated the effort during a very critical time, both with his demanding workload and with the challenges of the fires.  

By the end of that call, I was able to provide him with his full data report and had resolved his service issues for the missing transponders! It really was a positive outcome. “Thanks so much for your response, another mystery solved!” he said in a follow-up email. “Katheryne Beninato provides an exceptional level of customer service.” I am sure he appreciated my quick effort to provide him with a solution, along with the report, which made his job easier. He was finally able to find some relief in his day through a very trying period in his life. 

This story demonstrates that I am determined to get the job done and look for the best alternatives for our business clients. If something is not working well, I will think of a fix or workaround to ensure the customer has the best solution. My SQM stats demonstrate my commitment to customer experience.  

In 2023, I was SQM World Class certified and reached SQM World Class Service at 98%! My Contacts Resolved was 99% and my CSR CSAT was 99%. My First Contact Resolution was 80%. As we work with business clients, there are times when we have a few contacts to make before we reach a solution. I am determined to hit these targets every month.  

I would like to end this with some words of praise from my interactions with our amazing customers:  

• “Very polite, very helpful and got everything we asked for completed - overall a great experience.” 

• “I can't say enough about how great the account executive is, every time I need help, she goes above and beyond.” 

• “Katheryne was super friendly and was able to resolve my question within a matter of minutes. Further to that, she said she would email me a copy of the documents I requested, and that was also processed within the same business day. Excellent customer service from our Account Exec. Katheryne.” 

• “Only one email was needed to resolve my request, and Katheryne looked further into our account and history and initiated a better resolution than my initial request”. 

In summary, it is important to treat each customer interaction with integrity and tenacity – this has an unforgettable impact on the organization. Both of these values are special qualities I take seriously as I aim to build a collaborative, unique, and long-lasting experience for the customers that I have the pleasure of supporting as a Commercial Account Executive with 407 ETR. 

Linda Amer - 407 ETR

I am nominating myself for Agent of the Year for 2023 based on my metrics, hard work, and the recommendations of my fellow colleagues.  

Working for 407 ETR has been a privilege and a great experience in helping to serve our customers with any issues or inquiries that they may have. Resolving issues in a timely and knowledgeable manner on the first call brings me joy and satisfaction, especially having worked here for many years. 

Being a part of an organization where I can demonstrate my abilities to provide world class customer service and by achieving 88% world class in 202,3 along with 98% calls resolved, and 97% customer satisfaction, is just one of the things that proves that with hard work, dedication, and loyalty providing positive customer service can be achieve and recognized.  

Some positive feedback that I’ve received from customers includes:  

• “She was amazing and helped me clear up a lot of issues, and she was professional and very well educated.”  

• “I just wanted to tell you I had an issue with accessing my email and my billing, and Linda took the time to resolve the issue step-by-step until the issue was fixed, and she was extremely professional and helpful and deserves recognition for all her help.”  

In one situation, I received a call where the customer was an older gentleman who wanted to update his account information. During the conversation, he mentioned the fact that he was going to have knee replacement surgery, and I told him how my mother just had the same procedure. In doing so, I was able to express and show understanding, empathy, and acknowledge his concerns. This made the experience for the customer more positive, and because of that, the customer was satisfied not only because his call was resolved but it was in a way that a customer service representative also cared about him as a person, his wellbeing, and burdens. He was very appreciative and spoke to my manager to say that I was “amazing, fabulous, and to give (me) a raise and a big hug for me”.  

Hearing that positive feedback made my manager and my peers happy, and they celebrated that I was able to provide such good service to him and to achieve overall satisfaction. 

Providing positive and exceptional customer service on a business and personal level makes me a better representative and drives me to maintain that level to show that there are people like me who can contribute to the company. 

My goal for the future is to continue to achieve and exceed in providing excellent and great quality world-class customer service when dealing with customers, so people like myself are always recognized and rewarded for the hard work we do for our company in the coming years ahead. 

Feedback from 407 ETR Team Manager, David McClure: 

• I am happy to support Linda in her nomination for Agent of the Year 2023. She consistently produces great results and gets excellent feedback from her customers. She is a leader on our team with her positive encouragement for others and a great sense of humor. She always strives to provide the best possible service to our customers. I support her and wish her the very best in this quest to become SQM CSR of the Year! 

Moveena Sharma — Alberta Blue Cross

This individual takes action to enhance customer experience – either directly or in an enabling capacity – resulting in a measurable impact on customers’ lives, our employees, and our business. Their actions positively impact a high volume of customers or strengthen the lifetime relationship of a single customer with us through their empathetic interactions. 

This individual demonstrates accountability for resolving an immediate customer pain point via effective follow-through to resolve that pain point. 

The impact of this individual’s actions prevents recurring or future pain points associated with the customer experience while doing business with us. 

The outcome of the actions taken by this individual is seen and amplified beyond their interaction, team, division, or the organization to broader audiences, notably other potential customers, such as through public testimonials, word-of-mouth referrals, or social media recognition. 

Summary of exceptional Customer Experience (CX) - Moveena 

The Customer Services department manages over 600,000 inquiries in a year between the hours of 6 am to 6 pm, Monday through Friday.  We support benefit plans for groups, individuals, government, and French-speaking members in a variety of access channels, including phone, webmail, and the Member Services Site for self-service. In Customer Services, we are committed to providing world-class service to every member interaction, and we hold ourselves accountable to strict service standards and targets. We promote member experience and support the organization by resolving health and benefit inquiries, issues, and escalations by providing accurate information and correcting the members' accounts by way of coordination of benefit adjustments, plan merges, and payments, to name a few.  

Moveena Sharma is a Customer Service Phone Representative who has been with the department for over 17 years.  Her commitment to service is unparalleled, as demonstrated by her exceptional results.  Moveena boasts a 100% CSR customer satisfaction rate, coupled with a 100% resolution rate.  This means that 100% of the members consider their interaction with her as World Class – you can’t get any higher results than that!  She received  55 compliments from members last year.  Here are just a few that stand out: 

• “Moveena was very professional, knowledgeable, and went the extra mile to ensure it would be handled properly.” 

• “I want to share praises about Moveena’s service today.  I find that in these stressful times, it can be difficult to find someone who has an understanding of the situation and can resolve the matter in a timely fashion. Moveena did just that!” 

• “This young lady was extremely pleasant and very knowledgeable. She even wished me a happy birthday.” 

• “She was very informative and pleasant.” 

Moveena is an exemplary Alberta Blue Cross employee; her quality and productivity scores, coupled with everything that was said, cast Moveena among the stars. Our members are always her top priority, and she ensures she provides first call resolution to our members! 

Ruby Albrecht – Blue Cross and Blue Shield of Kansas

Cus-tom-er- serv-ice: noun = the assistance and advice provided by a company to those people who buy or use its products or services.   

To me, customer service is active listening, empathy, problem-solving, and basic communication. It’s about tuning in to what our customers are saying, and sometimes what they are not. It’s being there for them during their happiest time and their darkest days. It’s thinking outside the box. It’s breaking things down into simple terms so they can easily understand. It’s treating every single member like they are a member of my family.   

After reading through my feedback on our interactions, I can truly say I’m proud to be the one they get to speak with. Here are just a few of my favorites: 

• “Ruby is not only the epitome of great customer service, but just a great human being as well. Wow! As a law enforcement officer, I understand how you treat someone during a tough time is what makes or breaks the experience!” 

• “She was absolutely amazing. She took such great care of me. I had so many questions about coverage! She was very thorough; she didn’t rush me. She even went out of her way to call the hospital for me. I just can’t say enough great things about her. You just don’t get that kind of customer service with anyone anymore. She went above and beyond, and I just needed someone to know that because you don’t get that very often.” 

• “If I had a question and needed to call back, I would love to talk to Ruby every time!” 

• “Can I just tell you, Ruby was exceptional. She was patient; she stepped me through this. It’s daunting. It’s scary. She was so sweet. Very patient. Very knowledgeable. I just wanted to share that. She should train others!” 

I take great pride in my customer service. Amongst my peers, I achieved the highest level of customer satisfaction of 93% for 2023. While I have had so many great member interactions and memorable calls, I have one that is special to me in so many ways, and today I would like to share that with you. 

I will refer to my member as John for privacy purposes. 

I received a call from John, who was feeling overwhelmed, scared, and alone. In fact, he stated in the first few moments of our call that he “had a bad feeling”. John had recently had a traumatic health event. He was seen by a provider who took charge and got him to the right place at the right time. This saved his life. 

John had been feeling short of breath, having heart palpitations, and knew something wasn’t right for months. He had talked to his primary physician many times and had been told he just had asthma and he would be fine. Luckily, he didn’t quit advocating for himself. He was finally seen by a doctor who listened to him and took his concerns seriously. As it turned out, it was his heart. The doctor told him he was a ticking time bomb. He was sent by ambulance to the Hospital, where they performed lifesaving procedures. 

John was terrified about how this would all be covered. He was scared and even apologetic at times for needing to seek medical care and use his insurance. He was worried about the ambulance ride, the medications, the testing, and everything in between. More than his material needs, John just needed to talk and for someone to listen! 

As he told me his story, tears were streaming down my face. John is 63 years old. 

On January 25th, 2021, I lost my dad. My dad was 64 years old, only one year older than John.  He had not been feeling well for over two months and tried to seek medical care multiple times. He was continuously told it was asthma or indigestion. My dad fell over in a parking lot while attempting to pick up his new inhaler in the hope he would start feeling better. The physician who called his time of death told us he died of VFIB. Due to COVID and doctor’s offices being closed to anyone other than established patients, I was unable to advocate for him. He left this earth too soon and left me feeling heartbroken and helpless. 

Being able to listen to John work through his recent traumatic event, as well as being there to reassure him that we will take care of him through this process, was one of my greatest joys at this job. 

After listening to John, he asked me if I had any experience with this. I couldn’t hold my “professionalism” any longer.  I apologized to John for having emotions, but the call was very personal to me. I broke down and shared my dad’s story with John, telling him I was so proud of him for continuing to advocate for himself. John had expressed he didn’t want to be on all the medications or do the follow-ups, but through sharing my story, I was able to change the way John saw his future. 

This call was incredibly difficult for me. When he first started to tell his story, I could tell this was going to touch home with me, and it was a sign he was connected to me. Sadly, I was not able to help my dad during the time he needed someone the most, but in a way, I was able to be there to help John. He just kept saying to me, “I’m so glad I talked to you”. Crazy enough, I was able to speak with John a second time two months later regarding another matter. We both remembered each other and the stories that were shared that day. He said, “I’m glad I was able to talk to you today. God works in mysterious ways.  Maybe I was supposed to get a hold of you again today”. 

There are a lot of things that rock you after losing a parent. Even the slightest change becomes hard and confusing. I had this sense of sadness changing careers to BCBSKS after my dad’s passing. I felt like I would never get to share it with him. Something about that call made me feel like he was watching and so proud of me. 

Customer Service is not only my career path but also one of my many passions in life. 

I leave you with these two quotes: 

“Do it with passion, or not at all.”–Rosa Nouchette Carey 

“The best way to find yourself is to lose yourself in the service of others.”–Mahatma Gandhi 

Dana Plowman — Blue Cross and Blue Shield of Kansas City

Dana’s numbers speak for themselves. She is a top performer. She had a 98% SQM certification rate for 2023, with 57 of 58 surveys as World Class, while achieving 98% call resolution, 98% overall quality assurance, and 100% customer satisfaction. 

When she started at Blue Cross Blue Shield of Kansas City (Blue KC), she had to receive additional coaching and mentoring due to her lack of confidence. She received low-quality scores and struggled greatly with remembering the call flow.  Through much perseverance, she practiced the call flow and became more knowledgeable of the vocabulary; therefore, her quality scores greatly improved. Today she has made the recap her own and, as her team lead states, has asking for the survey down to a science. 

It is so good; we recommend Dana’s script for her recap and survey to our new hires and current CSRs struggling in this area. Dana is always willing to go the extra mile. She never turns down a task. She helps our trainers stay fine-tuned, helps with call shadowing, mock calls, mentoring, and team activities. She does anything asked of her without hesitation and in a positive light. 

She is always engaged, praises everyone’s accomplishments, encourages team unity, and when she does help mentor the training classes, she does it with such passion that she wants everyone to be better than her. That is the team player that she is, and she sets a very high bar to reach. 

Dana never gives up on her members. She will research, call out to providers, and do whatever it takes to help a member resolve their issue as if it were her own family member. An example of this is when she helped a member who had found her claims were denied because she changed from her PPO to an HMO plan. She received bills from her doctor and lab that totaled over $800. Dana researched and found that since they are in a contingent county, if the provider agrees to resubmit and bill directly to Blue KC, they will be considered an in-network provider, and the labs will also process as in-network. It took Dana several follow-up calls to the provider, but they agreed to help, resubmit her claim to us directly, and continue so she could remain a patient of theirs at an in-network status. She was very grateful and has now switched back to her PPO plan as of January 1, 2024.  

Below is the gracious voicemail that this member left for me about Dana:  

• “I am a member of Blue Cross Blue Shield, and I have been working with Dana, and I just wanted to tell you she has been so helpful, so caring, and so understanding. I want you to know you have a really good employee, and I hope that you treasure her because she has really helped me through a lot of getting my bills paid, and she didn't quit, even when it took extra to get it to go through. So, I just want you to know that I appreciate her and I appreciate everything that she's done for me, and I wanted you to know that she worked really hard and she's done very good at her job and she should be recognized for it.” 

Below are some other SQM testimonials of how Dana shines: 

• “She was paying attention, as I had misunderstood what she was telling me. And I thought that these items I was calling about were not covered, and she reexplained it to me. To correct me that I was covered, and she was personable.” 

• “She was great. She put in extra effort to resolve my issue, was really friendly, and communicative.” 

• “She explained everything clearly, and she was very thorough. She is very kind. Just found out the information quickly. I was not on the phone long at all, and just very good customer service.” 

• “She was very kind and calm, and patient. And when, so basically, something happened that she's never seen that has happened before, and she didn't, like, give up and tell me anything. She worked on it until we solved this.” 

Dana goes the extra mile for our members, is a great team player, and is very dedicated to the company at Blue KC. She volunteers for one of our ERG (Employee Resource Group) sub-committees, volunteers for events outside the office to represent Blue KC and is looking to get involved to represent Blue KC in more ways in 2024. She supports our team. She is the true Better Together. 

If her numbers don’t speak to it enough, our members do: 

• “Hi, I was just on an hour-long phone call with Dana, and I just wanted to tell you thank you so much for employing people like her. I was told that my mammogram was going to cost $930, and I asked them to run it again, and it came back, and it's only going to cost $300. It's so easy to avoid a mammogram anyway. I called Dana, and they had run it through their system but not through Blue Cross's system. It took an hour and multiple phone calls to find that out, but the cost to me is now $0, and it just reiterated to me that every time I talk to a provider, I'm calling Blue Cross to double-check because you guys are amazing. Dana went the extra mile, and I can't tell you how much I appreciate it. Thank you and have a good day.” 

• “I have been on the phone with Dana and she has just been so helpful, and I appreciated all the time she spent with me sorting out several different little issues. It is so nice to talk to someone that I can understand and that was eager to go the extra mile. They got more information than I even knew to ask for, so I just wanted to tell you that.” 

• “I was just on the call with Dana, and I just want to say that Dana was amazing and made everything really comprehensive. I was a little bit confused about everything and very lost, and she went above and beyond, and I really appreciate her efforts today.  As someone who is a young adult and trying to figure out how insurance works, I just want to say thank you to you and Dana. She deserves it, not only for her kindness and for her clarity but also for helping me resolve this issue I called about. “ 

This is why Dana Plowman deserves to be the agent of the year. 

Laura Kudrin – Blue Cross and Blue Shield of Kansas City

I would like to nominate Laura Kudrin for CSR of the year. Laura has continued to grow in her knowledge and the connections she establishes with members daily. One particular case from last year stands out as she worked endlessly to resolve an issue for a member. 

The member had lab work done in 2022. He began receiving bills in 2023 and was even turned over to collections. I reviewed the claim, and we reprocessed it and paid it in full. The member began calling in early 2023 to resolve the issue, sending the remit and EOB to the provider. The provider assured that the member’s outstanding balance would be taken care of. A couple of months later, the member called me back, irate because he had received yet another notice from the collection agency. Laura called the lab again and kept getting told they had received the remit, and it would be updated by the week's end. Laura continued to follow this claims issue for the next 2 months without the provider reconciling the member’s account.  Laura then contacted the Provider Relations department, and they attempted to assist in resolving the matter. Finally, in November, Laura made one last attempt, and they had finally adjusted the member's account to a zero balance. 

When Laura called the member to update, he was totally shocked that the representative had continued to work on his issue and even stated he had totally forgotten about it since it had been months since the initial call. He had advised early on that he did not want to be the “middleman” and only wanted to be contacted once it had been resolved. He was so appreciative that Laura stayed the course and was able to get his account zeroed out and out of collections. He went from being extremely upset to being overly appreciative. This was such a win for all of us! 

Other members have stated: 

• “I just wanted to give Laura her flowers and her props. She has been a phenomenal resource. I initially reached out to her during my pregnancy last August, and up until this point she has been so accommodating and so prompt in her response time getting back to me about claims being denied for all of these various coding issues that I have been dealing with throughout my pregnancy even after I delivered my son. I just wanted to say that she has been phenomenal, and she has helped me so much! Her demeanor, the way she gets back to me even if she doesn’t receive a follow-up call back from my provider. She calls me to touch base with me. I just wanted to thank her for everything she has done for me and my family. She is wonderful!” 

• “I just wanted to let you know she did a great job explaining everything to me, and I really appreciate it. She is really patient. She let me ask questions. She really helped me clarify. It was just really good because I have been really confused about my surgery and billing. I was just so happy to have her as my contact with Blue KC in order to get all my confusion processed. Hope I get to work with her again if I need some help!” 

• “Wanted to leave you some feedback on a very special person, Laura K. She just spent many minutes with me explaining something I was not understanding. The whole situation has been solved. I have been educated, and I can’t say enough wonderful things about her. She was wonderful. She was kind. She took the time to really satisfy everything. I understood what I was seeing on my screen and how things worked. Wanted to let you know you have a special person working in your department!” 

The story, along with numerous compliments, is a great reason why Laura is so deserving of this nomination. 

 

Shelley Dotson — Blue Cross and Blue Shield of Kansas City

A call center representative has many hats they wear throughout a day, from helping with benefits, to resolving claims questions, or just being supportive and positive with the member on the line.  Not everyone is cut out to do a customer advocate job, but those who are could have never been prepared for the incident that happened with our call center representative, Shelley Dotson. 

It was a normal day with calls, regarding benefits and other normal questions, until Shelley answered a call from a man who was literally at his wits' end. Our representatives are taught how to de-escalate a call when a member is upset, but this member told Shelley he was ready to end it all and had a gun ready to do just that. The steps into action that happened this day were a true team effort, but the real hero in this situation was Shelley. She reached out via chat to a senior representative who was on duty and asked her to reach out to 911, explaining that she had a suicidal man on the phone with her.  She continued to talk to the man by asking him questions; they spoke of family, recipes, anything that could take his mind off the horrible act that he was contemplating.  Shelley remained calm with the member and told him that she would like to continue to talk to him and help him through his thoughts.  All the while, our senior rep Dystenee, was talking to the 911 dispatcher and relaying to Shelley questions they needed answered.  Shelley slowly asked the member to empty the gun and put it down, and he agreed to this. She then asked him if he had other guns in the house and asked if they were put away in a safe place.  She relayed this information to Dystenee to pass along to law enforcement.  Shelley asked the member if she could have her friend in law enforcement come by and check on him, and gained his permission to have the police come by and ensure his safety.  She continued to talk with him using small talk to pass the time, while reminding him that her friend was going to be stopping by to check on him.  She talked him thorough locking his gun back up so it wasn’t an issue when the police officer came by his home, and he did as she asked. All the while, she continued to talk to him about his family and grandchildren and how sad they would be without him.  I was listening to the call and was in such amazement at how Shelley handled this member and how wonderful of a job she did in de-escalating the situation.  I have been within operations in a call center for 10 years, and never have I ever experienced or had a call that was like this. 

Shelley is an outstanding representative on a normal day of calls, and always goes above and beyond.  On this day, Shelley was amazing with her compassion, caring, and selflessness.  She gave 110% to keeping this member safe and showed him that his self-worth was invaluable.  I can’t say that all of our call center representatives could have handled this call with the grace and compassion that Shelley did.  She doesn’t only deserve this award, but she deserves the recognition of the excellent customer service representative that she is.

 

Raziya Martin – Blue Cross Blue Shield North Carolina

Raziya Martin is very committed to her role as a Customer Service Representative. She has been servicing Federal Employee Program line of business for almost two years. Her attributes include being a diligent worker, an active listener, empathetic, a collaborator, professional, adaptable to change, and knowledgeable on all services and products. During 2023, Raziya finished the year with stellar customer service performance. 

Quality-92% 

World Class Calls-89.66% 

Calls Resolved-93% 

First Call Resolution (FCR)-81% 

Customer Satisfaction-94% 

Raziya’s performance is a testimony to the meaning of a customer service representative role. She is a strong advocate for our customers, and she uses her ability to probe and clarify, being able to take deep dives into complex issues, while setting clear and concise expectations. She is relentless when it comes to delivering stellar customer service and building trust with our customers by keeping her word. “Every Customer Matters.” 

Raziya’s passion for serving and meeting the needs of our customers is proven on every call, and this is what sets her apart from her peers. She strives to make sure her customer gets a resolution to their questions or concerns by any means necessary, even if it means escalating the issue. For these reasons, we would like to nominate Raziya Martin for the 2023 Agent of the Year award. 

Stephanie Sibert 2023 Agent of the Year Nomination

Stephanie Sibert finished 2023 with a stellar performance: 

Quality-94% 

World Class Calls-96.43% 

CSR Customer Satisfaction-90% 

Calls Resolved-89% 

She consistently met all the customer service performance standards, month over month. For these reasons, we would like to nominate Stephanie Sibert to receive the SQM Agent of the Year Award! 

Stephanie is very committed to her role as a Customer Service Representative. She has been serving our Federal Employee Program line of business for almost two years. She is a collaborator, very professional, adaptable to change, and deeply knowledgeable about the services and products. Stephanie’s dedication and commitment to her role, our members, her peers, FEP customer service, and the Blue Cross North Carolina organization are a testimony to what the customer service representative role should be. 

Stephanie delivers genuine care, actively seeks solutions, goes the extra mile, and follows through to ensure the customer’s needs are met. It is about creating a positive and memorable customer experience, even in challenging situations. She inspires others to provide great customer service, which involves setting a positive example, offering support and guidance, and cultivating a culture of excellence and continuous improvement within the customer service team. This is what Stephanie Sibert does daily. 

Her passion for serving and meeting the needs of our members sets her apart from her peers. She is an active listener, empathetic, and solution-oriented. She strives to make sure our customers get a resolution to their questions or concerns, and no stone is unturned, even if it means extensive research or escalation. Stephanie received kudos from her peers and new hires for sharing best practices and her knowledge. Below are several testimonials she has received from her customers and peers. 

• “A member called to say what a wonderful job you did with answering all his questions and making his call a pleasurable one! He said you were extremely helpful, courteous, and wonderful! He wanted to make sure you knew how much he appreciated your help and kindness. Thank you for making his experience a memorable one. Keep up the magnificent work!” 

• “Stephanie, thank you for being a great support to the team. I appreciate you!” 

• “Stephanie, thank you for always taking the time to answer my questions.” 

• “Thank you, Stephanie, for always being willing to help.” 

Stephanie not only goes the extra mile, but goes above and beyond on every call. Her efforts are shown through her quality performance of 94% for 2023. 

Finally, Stephanie has a relentless pursuit of delivering stellar customer service and building trust with our customers by keeping her word. Her motivation and determination come from knowing that our customers are satisfied and in a good place after each call. This is who Stephanie is and what she loves to do: serving people because “every customer matters!” 

Tammie Tolotta — Blue Cross Blue Shield North Carolina

Tammie is an asset to our team. She assists her teammates as she can, she is always approachable and friendly. Tammie stood out from the rest of the team because of her year-to-date SQM scores, showing that Tammie has made a good impact on each customer she has spoken with. She has stood out with her other metrics; she exceeded adherence every month of 2023 and kept her errors extremely low. 

Tammie has assisted many difficult customers. Recently, she had a customer who had been trying to get a refund check since 2022. Tammie did her full research and found an error in the termination that kept the member from getting the refund. With Tammie’s research, she provided the customer with the information regarding what really happened with the refund check. The member knew immediately that they had the right agent for the job. We had the check issue resolved within 48 hours, and Tammie was able to call the customer back to advise them that the check was finally on the way! 

Tammie takes the time to listen to her customers. She is patient and shows understanding. She is knowledgeable, and she cares. She does not stop until she can provide the member with an answer. Not long ago, Tammie experienced a difficult member. No matter what she said, the member seemed to have a dispute or was dissatisfied with her responses. Tammie took the time to ensure she explained the benefit in full detail. She offered to send the member benefit explanations to them, walk them through the website for them to see their benefit information, as well as show them how they can view claims once they are processed. She was able to calm this member down, so they were in a space to listen to her, versus being in an angry, upset space. 

Here are words from other customers describing their experiences with Tammie: 

• “She seemed to know what she was doing as opposed to some of the others in other places. She answered my questions and listened. That seems to be hard to get: somebody who will get into everything you have to say first and then tell you what you need.” 

• “She immediately resolved and answered my question. She was very nice. She was helpful, very helpful.” 

• “She was very professional, very efficient. She handled my call and quickly got the response. She took care of what I needed and did not put me on hold for long. Excellent customer service!” 

• “Yes, very satisfied, because it was quick and easy. She had no problem with it. I did not have to go through a bunch of hoops to get my answer.” 

• “They were extremely knowledgeable and addressed all of my issues in one communication without having to do any follow-up work.” 

Just about every customer response states how knowledgeable, quick, efficient, and patient Tammie was with handling their call. She is so polite, so helpful, and gives them what they need accurately. You can tell from the customer’s comments on her surveys that they appreciate her assistance. 

Tania Warfield-Graham — Blue Cross Blue Shield North Carolina

Tania stands out above the rest because she does not hesitate to initiate activities in our team chat to help build team morale. She is known for starting dancing parties and movie trivia in the team chat to inspire and bring laughter to the group. She is one of the most compassionate individuals, not only to her customers but also to her peers. She has volunteered to calibrate with other agents on the team to assist with call resolution and CSAT. She has numerous KUDOS from customers and other business partners within the company. 

Tania turned a dissatisfied customer who had a medical emergency during her call into a very satisfied customer who eventually lived and enjoyed discussing his experience with Tania. It is important to Tania to prioritize her customers and ensure that their issues are handled promptly and effectively.  She is passionate about serving her customers while establishing a personal connection to help enhance the brand. 

Please read on to hear what took place during that critical call and how Tania helped save a customer’s life: Tania took a call from a customer who happened to be the senior manager of a prestigious BCBSNC group. Little did she know what was about to take place on that call and how she would end up defining what “going the extra mile” really means at BCBSNC. 

Here is how the customer described the call experience with Tania: 

“Tania showed genuine concern about me. She could have easily dismissed the call after she completed what I asked, but she didn’t. I was calling to find out the closest hospital that was in network, and she heard me slurring my words. I expressed to her that I was on my way to the hospital. I told her that I had had this same situation prior and had gone to an out-of-network hospital, and it took a long time to get those bills resolved, so they would not affect me negatively. 

Even though I tried to tell her I would be okay, she stayed on the phone with me. There were two times I lost my bearings. I did not know where I was, and she remained calm. I am not sure if this is BCBSNC training or not, but if so, Kudos! If not, this shows what she did out of sheer concern for me as a person and not just a call. She spent 20-25 minutes with me. This meant the world to me. I was turned around and trying to get into the hospital. I was in the parking garage, but I could not get through the garage. She called someone in the emergency center, and when I walked in, they stated that they saw me walking in. But I was going the wrong way. While I was being admitted to the hospital, I did not get the same treatment that Tania provided me. I put the person at the hospital on speaker phone, and Tania provided the hospital with the details of my situation. She was more caring than the hospital admitting person, who could see my distress. 

I do not take our conversation lightly. I could have run a red light or even gone off the freeway. My two kids would have been orphans, because my wife passed away previously from COVID. I do not know what kind of reward she qualifies for, but she deserves the team member of the year award. If our company were to ever leave BCBSNC, I would find a way to stay. She must have taken an oath of Do No Harm. She even called my daughter and let her know what was going on. Afterwards, the hospital called to follow up with me about my experience with them. I told them that if you want to ensure your patients are taken care of, you need to call BCBSNC and find out what they do and how they do it. Speaking with Tania was the best call of my life to date.” 

 

Tierra King — BlueCross BlueShield of South Carolina

Tierra is a true rockstar on our team. Every member she interacts with receives the same level of respect, empathy, and urgency. Whether they need an ID card, benefits, or have an urgent pharmacy request, Tierra treats the callers as a top priority. Even when Tierra gets pulled in many different directions during the day, she handles her callers with empathy, grace, and kindness. Her quality scores support how seriously she takes her role as an advocate for our members. She is also extremely helpful to her peers, assisting with answers to challenging member scenarios in Team Chats. No matter how hard a member’s issue may be, Tierra is always exceedingly kind, gentle, and determined to resolve the issue. Tierra is the definition of World Class Service and is more than deserving of this award. 

In her own words: 

“My passion for exceptional customer service shines through in my daily interactions. My positivity, helpfulness, and professionalism have a significant impact on my customers. 

My best memory of a time I provided great customer service was when I assisted a mother with getting medication for her sick child. The mother called in and was frantic about her son's illness. Her emotions were super high. She had been trying to get medication for several days. It was one of the first calls I took right out of training, and I was nervous. But hearing the worry in my customer's voice helped me to put my nervousness aside and to make her my top priority. 

This customer called at the end of the workday. I had to call the pharmacy twice and contact our internal pharmacy department. The member and I were on the phone for over an hour. During that time, I calmed the customer down by using positive language, being empathetic, and remaining patient as we worked with the pharmacy department to get her son his medication. When I resolved her issue, the member thanked me for all my hard work and told me how much she admired my work ethic. Again, this was one of the first calls I took, and it brought me so much joy to assist her and turn a negative situation into a positive experience.” 

Brooks Walton — BlueCross BlueShield of South Carolina

Brooks is a new advocate to the Member Service Center and provides our internal and external members with a great impression from the beginning of each call. With each call, Brooks goes the extra mile for each member he meets.   

In addition to attaining World Class status, Brooks strives to become a better advocate so that he can assist his co-workers and new trainees with their workload and calls.  

One of our members lives in Texas but flew to California to receive specialty services for her children. The member contacted Brooks because her claims were processed as out-of-network. Not only did Brooks check the provider network on SouthCarolinaBlues.Com to verify that the provider was in-network, he contacted both Plan to Plan offices in California to confirm which BlueCross location was in-network with the member's provider. Brooks worked overtime so that he was able to contact Plan to Plan because of the time differences. The member’s claim was escalated and remained under review for over 30 days. During this time, Brooks followed up with management and kept in contact with the member to provide an update and resolution after the research was completed. 

We are fortunate to have Brooks on the team and look forward to his continued success.

Cindy Sovde— BlueCross BlueShield of South Carolina

Cindy Sovde is a Claims Customer Service Advocate III on the State Operations’ Dental Customer Service team, where she has proudly served our members for her entire career. This is Cindy’s second consecutive year obtaining World Class status, and she was a finalist for CSA of the Year. Cindy’s vast knowledge and experience afford her the opportunity to be classified as a Dental Customer Service expert. Whether helping an inquisitive caller or mentoring a new employee on the team, Cindy has proven time and again that she is a leader.  

In late 2023, Cindy received a call from a distraught member. The member had recently sustained a fall in their home, which left them with a broken partial denture while displacing the anchor teeth that had been used to secure the appliance. The member was understandably upset as the partial denture accounted for most of their top teeth. Secondarily to their appearance, the member was worried about how they would be able to eat since they were a severe diabetic, and a healthy meal was key to normal blood sugar levels. The member had called their dental provider and, unfortunately, did not receive a compassionate response. Living on a fixed income, the member worried if or when they would be able to afford treatment. Through a voice cracking in fear, the member asked Cindy to guide her through her available benefits.  

Cindy did what Cindy does best: she jumped into action! Cindy has the unique resource to draw upon both her experience as a Customer Service Advocate & her time she spent working alongside dentists in a dental office before coming to BCBSSC. Cindy took the time to review the member’s benefit plan with them and reassured the patient that the responsibility would not be as much as expected. Still hearing concern in the member’s voice, Cindy offered to call the provider’s office with the member on the line to help explain the accident. After reaching the office, Cindy took the time to explain the situation to the benefits coordinator. Cindy’s extra time and efforts allowed the provider to understand the severity of the situation, get a plan of treatment started, and prepare an estimated cost that the patient could expect for the services. Before hanging up the call, the member said that Cindy was, “A bright light when I thought there was not one.” 

As a leader on her customer service team, Cindy leads by example. To her, each call is a new opportunity for her to help someone and hopefully brighten their day. She focuses on the issue at hand while building a strong personal bond with each caller. It’s because of this that Cindy has become an advocate asked for by name from countless callers. Cindy understands that low customer effort plus resolving an issue on the first call equals customer satisfaction. She recently received a kudos from another caller that sums it all up perfectly, “Cindy is a world-class representative and a value to your organization!”

Deadres Woodruff — BlueCross BlueShield of South Carolina

Deadres began working with BlueCross BlueShield of South Carolina in October 2016 as a CSA II in customer service with the Major Group Division. In 2020, Deadres was promoted to CSA III and was part of a team that launched the first concierge team for Major Group. Those teams were supporting three large high high-profile groups. The pilot program was phenomenally successful! Those groups were incredibly pleased to have a concierge team for their employees, so they extended their contract with Major Group. It was a great team effort, and she was 1 of only 5 CSAs at the time. 

Midway into 2023, Deadres’ constant hard work and dedication afforded her the opportunity to promote to customer service coordinator with the National Alliance Division. 

Deadres’ World Class Certifications started in 2017 and continued every year from 2019 through 2023. 

Deadres stated: “I attribute success as a World Class call customer service advocate to, first and foremost, excellent training, coaching, and Blue Steps, which are tried and true processes! Having compassion and the ability to show empathy for members are also on the top of my list, as is thinking creatively by anticipating information a member may need beyond what they called for. Rounding out this list are going above and beyond to assist members, and the ability to utilize resources and tools to assist members.” 

Deadres has had many World Class calls and continues striving for success by constantly passing QCs with perfect scores of 100%! She also has several Kudos in 2023, while continuing to focus on customer care and dedication to resolving her calls with first call resolution. 

Here’s feedback from a KUDOS call: 

• “Deadres went above and beyond to make sure her billing issue was resolved. Deadres took full accountability in providing a resolution. She did not leave my side!” 

Her coach provided feedback regarding Deadres commitment and dedication to overall performance. 

• “Deadres is a dedicated advocate who is committed to every customer she speaks with. With every call, she takes a personal interest in the member's questions and concerns to ensure the member gets the best solution with options for their inquiry. Her dedication to using the BLUESTEPS framework aids her in providing solutions to customer satisfaction. Her ability to connect with the members at the beginning of the call and keeping them engaged to the end is phenomenal. When customers leave a call after receiving service from Deadres, they feel as if their issue has been resolved and that she cared.” 

In conclusion, Deadres shows up every day willing to be the hero, throwing on her cape of compassion and vigilance, and she prevails outstandingly.

Erin Jarrell — BlueCross BlueShield of South Carolina

Erin was assigned to assist a member who, at the time, was having a difficult time ordering medical supplies. The member’s condition required Erin to contact the medical supplier several times due to our member having a difficult time with the ordering process. Erin then advocated on the member’s behalf and intervened between the member and the medical supplier. After several phone calls going back and forth between the provider (medical supplier) and the member, Erin was able to find a resolution between the two and order supplies on the member’s behalf. Once the member explained, due to her condition, often the previous supplies would be too big, and she would now need to purchase smaller bags due to irritation to the skin. Eventually, Erin was able to help with the ordering process until the relationship between both the medical supplier and customer (our member) was resolved. Erin not only helped resolve the member’s issue, but the concerns and trust between the member and provider were resolved as well. Today, the member can call and order supplies that she needs for her livelihood. Erin not only took the member out of the middle as the frustration grew daily, she eased the member's mind and gained the trust of resolution.

Mykia Perry — BlueCross BlueShield of South Carolina

Mykia Perry may not have the most tenure with BlueCross BlueShield of South Carolina relative to her teammates on our Priority and Escalations team, but the fact that this is her second World Class Certification in her 3 short years with the company proves she has master level customer service skills. With 179 World Class Call surveys in 2023, Mykia had more of the coveted survey results than anyone else in the State Health Plan. No matter the situation, Mykia is always willing to go above and beyond for all our members.  

It's often been said that Mykia’s calming voice and relaxed demeanor are felt in her calls, and this was evident in early 2023 while on a call with an upset member. Having just received a life-altering cancer diagnosis a few days prior, the caller reached our call center seeking benefits information. Shellshocked and angry, the caller began to unload her frustrations on Mykia. Mykia quickly gained control of the call so she could better understand the caller’s request. The caller was trying to find out what her policy would cover in relation to chemo treatments and a local provider to render the required treatments. Hearing fear in the caller’s voice, Mykia reassured her by saying, “I cannot imagine the emotions you are going through right now, but together we will make sure you get the care you need.” Researching the member’s plan was the easy part of the call, but then came locating a provider near her. Mykia uncovered 3 different options for the member within a 50-mile radius. Relieved to hear what she found, the caller asked for Mykia’s name and direct contact information. Understanding the seriousness of the recent diagnosis, Mykia reached out to our case management team. With the diagnosis being so new, the caller had not been assigned a Health Coach yet, and Mykia was able to help get this coordinated. Early enrollment in this program means the caller would soon have someone with a clinical background within BlueCross BlueShield of South Carolina who could help answer the difficult questions that may arise. “You are an angel and the person I want to help me beat this cancer,” the caller replied as she cried. Mykia reassured the member she could call her directly at any time with questions.  

Since their initial call, Mykia has had the opportunity to speak with this member on several occasions to provide dedicated & personalized service. As of their last conversation, the caller is still receiving treatment but has a brighter outlook on the future. This level of “going the extra mile” isn’t the exception for Mykia but rather her norm. She is devoted to helping others and gets satisfaction knowing each incoming call is another opportunity.

Crystal Stevens — Blue Cross and Blue Shield of Vermont

For me, Blue Cross and Blue Shield of Vermont has redefined what the customer experience can truly be. As a representative, I take immense pride in the care that we provide to our customers each day. We are not here to simply respond to inquiries and answer questions. We are here to make meaningful connections with our members, who are also our neighbors. To anticipate their needs, educate them on their options, advocate on their behalf, and see them through to resolution. This is what motivates me to strive for excellence daily.  

Vermont experienced catastrophic flooding this past summer. Entire communities were shut down, roads washed away, and many homes and businesses endured devastating damage. This flood impacted our families, neighbors, co-workers, and our members in a variety of ways. The day after the flood, I received a call from a member who lost everything. They weren’t even able to provide me with their ID number, as it was floating in their home that they were no longer allowed to access. To make a bad situation worse, this member’s CPAP machine was also destroyed in the flood, and she needed to understand her options on how to obtain a replacement. CPAP machines can significantly improve sleep quality and add great value to those who rely on them each night. I knew what a difficult time this member was having, and I was bound and determined to help this member get their replacement.  

We do have a policy on how to handle situations involving damaged equipment, but that typically requires coordination with the homeowner’s insurance and proof that the equipment is damaged. In addition, CPAP machines typically require an approved authorization. Given the state of emergency impacting a large population of Vermonters, that didn’t feel like the right path for this unique situation.  I let the member know that I would research what options we have available and would get back to her.  

I reached out to my team leader, who reviewed with our manager, and that is when something magical happened. Recognizing that this would not be the only member impacted in this way, our leadership team quickly pulled together to develop a process that would benefit other members who had lost their equipment and supplies in the flood. The meeting included representation from Customer Service, Payment Integrity, Utilization Management, Provider Relations, and Communications to map out a process to waive prior approval requirements, ensure claims would be processed to bypass any frequency edits, and that providers and members could obtain information about this exception process on our website. We not only resolved the issue for this one member but also took a proactive approach by anticipating the need and creating a process that would support others as well. This ensured our CS team could quickly resolve the issue for any additional calls that may come our way. 

I let the member know that I would help her obtain a new CPAP machine. She provided me with information about who her ordering physician was and who she wanted to use for a supplier, and I got to work. I made calls to the doctor’s office to request that they send a prescription to the supplier. I called the supplier to alert them of what had happened, that a script for a new machine was forthcoming, and should be handled urgently due to the flooding. They were also made aware that, based on the circumstances, we were waiving the authorization requirement. Given the state of things in Vermont at the time, getting the new CPAP to the member took longer than we would have liked, but I kept my member informed throughout the process. She shared with my team lead that she was very grateful for all we did for her during this difficult time. She said she didn’t know where to start, so she started with us, and she was glad she did, as we were able to resolve her problem.  

With the help of many, I was able to successfully aid the member in getting her machine replaced, while reassuring the member that we would assist and guide her throughout the process. This taught me an extremely valuable lesson about teamwork and collaboration among co-workers. The help of the people that I work with has made me feel confident in knowing that I can rely on them whenever I need assistance or guidance, and for that, I am truly grateful.  

At the end of the day, my goal for all the members that I interact with is to: 

• Value the member’s time 

• Have a pleasant attitude  

• Provide knowledgeable and resourceful information  

• Strive to exceed-rather than just meet expectations  

Following these best practices is what assisted me in ensuring this member had the best experience possible and left a positive lasting impression of Blue Cross on the member.

Deb Kasper — Blue Cross and Blue Shield of Vermont

On October 17th, I answered a call from a member who was nearly frantic.   

She needed to have surgery for a malignant neoplasm, and there were no surgeons in Vermont who specialized in this delicate surgery. She had done hours of research, finding a provider with the appropriate skills and someone who would be in her network. She had finally found one over fourteen hundred miles away.   

The surgery itself required an authorization, so once that was submitted and approved, the member booked her flight, her travel and lodging, and began the anticipation for the upcoming day. Suddenly, she received a phone call from her provider letting her know that the entire surgery would be an out-of-pocket expense because they did not accept her insurance. They were going to cancel her surgery.  On top of the stress of anticipating this upcoming surgery, and after spending a large amount of money on travel and lodging, she said that as a small business owner, she was not in a position where she could pay fully out-of-pocket for a surgery.  The member was in a panic! Her provider was telling her that without a single case agreement – a contract telling them what they would be reimbursed – they would not proceed with the surgery. 

After checking the National Find A Doctor Tool for the Blue Cross Association, I confirmed the provider was in-network and that she did have an approved authorization on file. We teleconferenced over to the Hospital together. I confirmed this information for them to avoid the surgery being cancelled.  I also confirmed that the member’s deductible and out-of-pocket maximum had been fully met for the year, the member would have no liability, and the procedure would be paid in full up to their allowed amount. 

Upon speaking with an employee at the hospital, we were advised again that they needed a single case agreement (SCA) even though I confirmed they are in-network for the member and that an approved authorization letter had been sent to them, also confirming they were in-network.  I also advised that BCBSVT could not do an SCA with a network provider, as it was against Blue Cross Association rules. They wouldn’t budge. I wasn’t going to give up; this was too important. I then reached out to the Providers Home Plan, who also confirmed the provider was in-network. The representative there also reached out to the hospital to explain that an SCA is not necessary or appropriate. To my surprise, however, they came back and told me BCBSVT would “just have to give them what they want”. I knew that wasn’t sufficient, or within our association guidelines, and continued to focus on advocating for our customer. 

I reassured the member and told her not to worry, I would get everything resolved for her. I told her that I would not be closing my case until we had resolved her concerns. My next step was to bring in reinforcements! I collaborated with our Authorization Department and our Provider Relations Department. Together, we engaged with the provider relations team of our Sister Blues, who manage and enforce provider contracts. Through that process, they were able to assure the provider that they could service our customer, even though they live in Vermont, they are considered a network provider and would be reimbursed appropriately based on their contract. 

After 10 days of outbound calls, interdepartmental collaboration, working with the other Blues plan, and advocating for our customer, the provider agreed to give this member her needed surgery, with no impact on her already scheduled dates. That final phone call to the member included a sigh of relief for both parties; she was elated with the good news!  

No matter where our members go, in state or out, we are Vermonters serving Vermonters, and that support and trust we build with our customers is the most important part of our job. We will always see them through.

 

Terry Bicknell – Blue Cross and Blue Shield of Vermont

Last fall, I took over a case from another representative who had been unexpectedly out of the office. The member’s tone and demeanor was very gruff and frustrated from the get go, as he had been waiting several weeks without resolution. His CPAP machine was broken and unrepairable, so he needed our help. 

The patient was in desperate need of a new CPAP machine, but was being told by his provider that he couldn’t get one without having an additional sleep study done. He had recently lost one of his parents and shared that he was struggling emotionally and hadn’t slept in nearly three weeks. 

He had advised that he had no faith that I would call him back or resolve his issue. 

Respectful of his frustration, I collaborated with my peers and put a plan into action to resolve his call. The biggest challenge was time. I was having a hard time getting in touch with the provider, and due to the holidays, our office was closing at 3pm the next day and we wouldn’t be reopening for four days. After spending an hour on the phone with him, I had a plan in place to help this member get a resolution. I used all resources available, including our provider relations team, our authorization department, and our customer service leadership. 

By 8 AM, that next morning, the team had begun pooling their resources. Our provider relations team had escalated the concern to their contacts, our Utilization management team was combing through medical policies, and our CS team was real-time monitoring all areas of progress to ensure we would follow up with the member. In addition, I referred this member to case management. Due to the stress he was under, his lack of sleep, and other emotional factors, I wanted him to know that he had an advocate. 

I then collaborated with integrated health. They confirmed because his machine was broken and not repairable, older than five years, and out of warranty, that a sleep study was not a Blue Cross and Blue Shield of Vermont requirement to obtain approval for a replacement machine. One of our biggest barriers was solved! 

Because a CPAP machine requires PA, I took the member out of the middle by calling his primary care provider to initiate that request a and obtain a new script. I walked them through the process and conveyed the urgency. Once we got an approval on file, I could then coordinate with the durable medical supplier to get a loaner machine ready for pick up before the holiday weekend.  Because I wanted to ensure all the Ts were crossed, and that I was going to see this member through, I also confirmed that no detail was missed. I had them ensure the loaner had the appropriate setting and SIM card so the machine would require no additional work before use.  

Lastly, in order to close the gap and ensure concierge service and resolution, I made one final call. 

With two hours to closing, resolution was obtained and the member’s needs had been met by one o'clock that afternoon. 

With stellar teamwork and heartfelt collaboration, we validated the member’s concerns, identified the barriers, and put an actionable plan into motion that change a member’s perspective from anger to sincere gratitude. 

When I called the member back I let him know that I kept my promise, I tried to identify with him on a personal level, and shared that I too suffer from sleep apnea. My CPAP is my lifeline, as I’m sure it was his. 

I planted a tiny seed by reminding him that I cared about his issues, and as a team, we successfully sought resolution on his behalf. 

His whole demeanor had changed from one of blind anger and lack of faith to one of hope and appreciation. He thanked me and wished me a very happy Thanksgiving.

Kandis Workman – Regence BlueCross BlueShield Plans

I am nominating Kandis Workman for CSR of the year based on her support of the members she has helped throughout the year. Kandis is proud to be a CSP because she loves helping our members, being the first point of contact to brighten our members day and building bonds with them. She does this so the members know they can trust both us and the information we are providing. Kandis genuinely cares about each of them and strives to make our members smile and know that she cares about them.  

In her own words, “Every day I come to work, and I get ready to clock on, I know I am going learn new things and grow. Every call that comes through my phone, I know I am giving my absolute best. Being a CSP, for me, doesn’t stop at just helping our members out and giving my all to them, but to my team and other CSPs as well. I do this in many ways; by checking in with them to see how they are doing, by asking if they need help, by telling a joke, or helping with their work. Being a CSP is fulfilling for me in many ways, such as when a member is going through a hard time and I get to help them with their needs. I love that I have the chance to send them a gift or card to just saying I am thinking about them, I am here, and we are here to help them through these times of trial. It makes my day being able to turn a member’s day around.” 

Last year, we supported a member who stated that they might take their own life, and Kandis immediately got a welfare check requested. While this is normally where the call stops, Kandis went a little further by sending the member a card to tell her she was thinking about her. It’s the little extra care that makes all the difference in the world to our members, and Kandis has shown that time and time again.  

Kandis has also worked hard to help take the burden off of our members, and she works tirelessly until issues are resolved. She had a situation last year for a claim from 2022 where an in-network provider was making the member submit their own claims. Kandis contacted the provider multiple times and worked with Provider Escalations to resolve this issue for the member. Not all situations have a favorable ending, but in this case, Kandis worked to help the member find a new provider due to the past issues. Kandis holds her composure and supports her members even on the tougher calls.  

Example feedback from a member: 

• I just spoke to Kandis and I wanted to say she was calm, cool, and collected, though I wasn't. I mean, I found out that my provider is not in-network and she listened, and she was very kind and she is doing a great job. I asked if I could give a survey or feedback and she said she could transfer the phone call to where I could leave a message. She is doing an awesome job and you are lucky to have her on your team. 

Leslie Haecker – Regence BlueCross BlueShield Plans

Maya Angelou once said, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” 

While we certainly strive to educate our members on every level, it is that last part that makes Leslie a member favorite; Leslie ensures that our members feel supported and know that they are not just another name on a computer screen. Leslie feels that helping our members and connecting on their level, to help them understand how their health insurance works, is a very important part of her daily interactions. She strives to ensure that they leave the conversation with answers that they can understand and to provide a knowledge base that members can build upon for future services.  

An example of this was last February when an expecting mother contacted Customer Service overwhelmed with all she needed to do before the baby was born. The member had previously contacted Customer Service to ascertain her maternity benefits. However, she received a bill for an ultrasound and was confused about the processing details. The member explained that she previously was advised that the provider would bill all maternity services at one time, after birth. She was very overwhelmed with the prospect of additional bills coming in that were unexpected and with obtaining a breast pump. Leslie heard the frustration and panic in the member’s voice and began to problem solve. She became a point-of-contact for the member while educating her on the claims processing system. Leslie diligently worked with the member and was able to get her in-network options to purchase a breast pump and to help her have a better understanding of her maternity benefits. The member was very grateful that Leslie took the time to listen to her concerns and empathize with her. She felt seen and supported, which wasn’t something she expected to feel when calling her insurance company. Leslie is a shining example of excellent customer service.  

In the team environment, Leslie leads with a positive and inspirational attitude that is contagious. Leslie collaborates with her teammates when needed to ensure that our members’ needs are addressed in a timely fashion. Last March, a member received a bill from a provider advising to contact us as we needed additional information and threatening collections. The member contacted our Customer Service Team after hours, when the provider’s office had closed for the day, asking for help. The Customer Service Professional who took the original call also worked the closing shift. She recognized the urgency and emailed Leslie the details, asking for help in making an outbound call. Leslie was able to make the requested outreach first thing the next day advising the provider that we have the information needed to proceed with processing the member’s claim. She also requested that the member’s account be placed on hold while the claim was being processed to ensure they were not sent to collections. The member was grateful for the quick resolution and excellent Customer Service provided. Leslie has also served as a mentor to our new Customer Service Professionals while they go through training and first enter the floor. She is patient and supportive in a manner that helps ease the new hire jitters. She is highly regarded among her peers and leaders.  

For further consideration, our members have the following comments regarding the Customer Service experience Leslie provided.  

• I was very pleased. She made sure that I understood everything she said. It was a real pleasure to talk to her.  

• I am very satisfied. The last couple of days, she got everything straightened out for me. Please note her name for her service to me.  

• She gave me excellent information regarding whether my doctor was within my network and was very helpful. She helped me understand what was covered by my Plan. I am very appreciative and thankful. 

Candice Smolick – Capital BlueCross

In the past year, Candice has demonstrated her commitment to Service by achieving her SQM World Class Certification, exceeding all quality goals, exceeding inquiry timeliness goals and FCR results of 80%, and has been recognized as an Adherence Super Star. 

Candice is a role model to her fellow coworkers by demonstrating strong listening skills, empathy, and patience with Members. She is known to be able to calm frustrated callers, and handle escalated, sensitive situations with care. When asked about how Candice puts our Members first, she commented:  

• “I try to put myself in their shoes. When they are frustrated, I understand why they are because I listen and acknowledge their concerns. I also try to make the solutions straight to the point and relay the information with confidence in a way that people without an insurance background would understand”. 

Dependability is crucial within a growing team, and Candice has proven time and time again that she is not only reliable but willing to go the extra mile. 

Candice is an outstanding employee and makes a positive impact with everyone she meets, and it shows in the member feedback that we receive for Candice. We would like to share a few comments about Candice’s service skills from the voice of our Members: 

• “She was very helpful, very thorough, and very professional. It simply took 45 seconds until I was actually talking to a real person.” 

• “She was very attentive and had me on hold a couple times because it wasn't a common question that I was asking. She got back to me fairly promptly, and I was happy with it.” 

• “She was genuinely interested in the question I was asking.” 

• “She went above and beyond and spent quite some time on the phone with me going over different claims that I had had in the past because we were trying to figure out coverage, and she helped a lot.” 

We appreciate your consideration in recognizing Candice for the amazing work she does.

Monica Vanhoorelbeke – Consumers Energy

I am writing to formally nominate Monica Vanhoorelbeke for the prestigious title of Agent of the Year. Monica has consistently demonstrated an exceptional commitment to customer service, going above and beyond on every call she takes. 

Monica's dedication to understanding the unique needs of her customers is truly commendable. She invests time in building a deep understanding of their requirements, ensuring that she can provide tailored solutions that exceed expectations. This personalized approach reflects her genuine commitment to delivering outstanding service. 

What sets Monica apart is her remarkable display of compassion and empathy on each call. She not only addresses the immediate concerns of her customers but also takes the time to connect with them on a human level. Her ability to empathize creates a positive and supportive environment during interactions, leaving a lasting impression on those she assists. 

In addition to her empathetic approach, Monica excels in ensuring that her customers fully comprehend their accounts, billing details, and next steps. She takes the initiative to provide clear and concise information, making complex matters understandable for her customers. Monica's commitment to transparency and communication is evident in her efforts to empower customers with the knowledge they need to navigate their accounts seamlessly. 

One of Monica's most outstanding qualities is her genuine care for her customers. This care is not just a professional duty for her but a deeply ingrained aspect of her approach to customer service. Her sincerity shines through every interaction, leaving customers with a sense of trust and confidence in the service they receive. 

In conclusion, Monica’s exceptional performance, coupled with her compassion, empathy, and dedication to customer understanding, makes her an ideal candidate for Agent of the Year. Her impact on customer satisfaction and the positive image she brings to our team are truly commendable. 

Thank you for considering this nomination. I am confident that Monica's contributions make her a deserving recipient of this esteemed award. 

Amanda Vasconzuelo - Florida Blue Federal Employee Program 

Before I was a service advocate, I was a member. I think that is what makes me so passionate about my work. After months of suffering with misdiagnosed asthma, I spent a week in the hospital to find out the asthma was really pneumonia and that it had destroyed my heart so badly that I now have heart failure. At my age, I thought my life was over. It wasn’t until Florida Blue called and I got to know countless customer service representatives and the wonderful Registered Nurses that listened to my fears, frustrations, complaints, and tears that I learned to accept my diagnosis and move on positively. I said in my interview, and I’ll say it again, and to anyone who will listen: Florida Blue saved my life. After a year of healing, when it came time to go back to the workforce, Florida Blue was the obvious choice, and I was lucky enough to be chosen. I took this opportunity to “pay it forward,” and when I was fresh out of training, I got my chance.  

A member in her late twenties called for a provider directory for a psychologist. I remember the dull void of her voice, it called to my heart in a familiar frequency, she took deep breaths in between her requests, quelling her frustrations that echoed off the speaker as if in anger. I kept my cheery disposition despite my nervous energy and asked if she had a preference in whether she wanted a psychologist or psychiatrist. She muttered, “What’s the difference?” I advised that one doctor can prescribe medication, and the other cannot. She asked for both. I happily advised that I could definitely send her a list of both in her area. While searching, I asked if there was anything else she would need while I sent out the second list. She scoffed and asked with a forced laugh, “Could you get me a new arm?” Nervously, I chuckled back and said that we would if we could. That made her truly laugh, she then took a heavy breath, and I knew the flood gates were opening. I had been there before, sitting at home as she was now, I knew what was coming, and I waited. She then told me about the injury that took her arm and how she felt her livelihood was gone, her friends had all left her, and how she felt her life was over. Those words hit me like a wave crashing to shore. I never thought I would sit at my desk, headset on with silent tears falling down my face for a stranger, but there I was. It was my time to say the same words an agent had once told me. 

I said, “Your life isn’t over, it just looks different. It’s your new chapter, so write it.” She cried a little and explained that life is just so much harder now, and so I reminded her that the very fact that she survived the injury makes her strong and anything that she needs during this difficult time, FEP is here to help.  She told me that she didn’t expect to be anything more than a number to an insurance company, and I told her the same thing I tell anyone who asks, “You’re more than a number to Florida Blue.” We ended the call with her calling me ‘Amazing Amanda,’ and I left the call feeling weightless.  

She was the first of many members I have had the chance to emphasize, excel, and resolve issues with. I remember quite a few. 

• A member who needed a follow-up after a hospital stay, but couldn’t get the office to set an appointment. He told me they were being mean to him. I got that appointment set up for him in less than ten minutes. 

• A member with countless claims that she filed herself because she only believes in holistic medicine, and her out-of-network acupuncturist wouldn’t file the claims. I got them all faxed to me and sent to the claims department. She would call monthly and ask for me by name.  

• A member who worked for the IRS and used to work for the Reagan administration. She just needed me to look over a few claims and explain them to her. I did so, all while getting an excellent history lesson. She thanked me for my patience.  

• A 70-year-old cancer survivor who needed a transfer to Caremark. Not that special of a call, but he and I share a birthday, 40 years apart. I make sure to blow out an extra candle for him each year now. 

The members I get on my line aren’t just contract numbers, they’re people with complex stories, emotions, fears, hopes, and dreams just like me. I don’t take any call lightly, and I never forget that the person on the other line is just that: a person. 

Ashlea Dollgener – Florida Blue, Federal Employee Program

As a young girl, I was given the task of collecting my grandmother’s mail. I often found some ads, a couple of pamphlets, and unfortunately, various bills for her cancer treatments and oncology visits. I could see the stress on my grandfather's face as he sifted through them, shoulders hanging low. I imagine this scenario happens daily for most of our members.  

When I initially became an employee of Florida Blue, nothing could have prepared me for how rapidly I would develop a passion for assisting our members. "She went above and beyond for me", a phrase most stated in my SQM surveys. When I clock in every morning, my heart follows right behind. I carry my solemn experience with my grandparents and take consolation in the fact that I can make a difference for every member who calls in to our department. It starts with my smile and willingness to do everything I can for the person on the other end of the line. Every detail on their claim gets reviewed, benefits are read, and no question is left unanswered.  

An experience with a member that I hold dear was with a woman who recently lost her husband. Her loss was unexpected, and she was in shambles as she was left with the daunting task of sorting through his debts. I listened, heartbroken, as she recalled fond memories of their life together. Without children or family nearby, she was desperate for a listening ear, and I was more than willing to be there for her. "I don’t want to let you go, you made me feel less alone today", she admitted. Later, a survey came in where she stated that I embody everything that Florida Blue should strive to be and that I solidified her love for this company. This showed me how much of an impact empathy can make in our members’ daily lives. 

As the year went on, I stood out amongst my peers and began receiving opportunities to mentor our new hires, listen to live calls while providing feedback to agents, and have my calls be an example of how to provide World Class Customer Service. I soon realized that my intensity and drive for customer satisfaction had served as an inspiration to others. I began receiving emails thanking me for sharing my passion because the agents saw a refinement in their own performance. I am elated to see how leading by example has provided not only our agents, but members as well, a better understanding of what being a part of Florida Blue means. Florida Blue stands with the mission statement: To help people and communities achieve better health, and I take pride in being able to assist in achieving this goal.

Lisa Guelde – Florida Blue, Federal Employee Program

At the beginning of my journey at Florida Blue FEP in October 2022, I set my daily goal to imagine myself on the other end of the phone. This would help me take empathy and understanding to the highest level. The stories varied between happiness due to the birth of a new baby to sadness and pain after a devastating diagnosis. There were, of course, the normal calls with address updates and ID card requests.  Each call varies, so one must pivot and regroup quickly, even though fighting tears, perhaps from the previous call. 

As the days turned into weeks and then months, I realized they were ‘my calls.’ There were days when I didn’t know if I would succeed, but I reminded myself that my calls were waiting, and members needed me. I’m a social worker by trade; it’s just what I do and who I am. There were moments where my determination to make things right for a member seemed to linger in the air, almost meshing with insecurities and ‘what ifs.’ 

I recall vividly the first lung cancer diagnosis call I received: I froze. There I stood in the memory of my momma’s battle with stage three-B, then stage four lung cancer, that eventually led to seeing her exhale for the last time. I sat there at her side that day, January 11, 2017, taming her hair and trimming her nails. With her final breath, I became that introverted little girl who was safe when I was with her. My tiny hand was dangling from her back pocket as if she might get away.  At that moment, she did. She got away, but there was joy in that she had no more pain, and that my 3 kids and I would see her again.  Momma always said there was a reason for everything and a reason why I had to be with her during her final transition. This call seemed to whisper quietly in my ear as part of the ‘why’.   

This whispering call was a frightened and desperate husband, while in a state of shock and frantic racing thoughts. He said his wife of over 60 years was diagnosed with stage four lung cancer that had spread to her brain, and there was nothing they could do. He was angry as he raised his voice that she would be coming home on hospice. He then whispered ever so gently, “What am I going to do?” 

As a result of my experience with my momma, I knew the exact lonely space he was in; not as a spouse but as a daughter caught in a whirlwind of surprise, fear, numbness, anger, anxiety, and grief all simultaneously. I quickly redirected the whispers of my pain and said to him, “I know this is devastating news, and you, along with your wife, are in quite a heavy fog right now. Will you allow me to help?” He responded with a quiet, “Yes, please.” 

I immediately obtained the hospital information from the member, and with his permission, I called the hospital directly and spoke with the oncology case worker. I explained that their patient's husband was understandably not taking his wife’s diagnosis well, and I wanted to confirm that any service that the member needed was arranged prior to her discharge. The caseworker confirmed that all services were set, and all that the member had to do was to be there at the house when the hospice provider arrived with the equipment. 

I explained all of this to the member and assured him that all he needed to do was be at the house when the company arrived. They would set everything up for him so that the arrival of his wife at home would be smooth and less stressful for them. 

The line was silent as he fought back tears. He thanked me for my kindness, understanding, and patience. He said that he and his wife have been FEP Florida Blue members for almost 50 years, and before his call, he was uncertain as to whether anyone would care.  He thanked me for caring about him and his wife that day.  As the call closed, the whispers lingered, and I could hear my momma saying, “See, I told you there was a reason.” 

Marnee Heppner – HCSC FEP

Marnee consistently goes out of her way to ensure members’ needs are met on every phone call. She does her best to remain upbeat and bring sunshine to her callers while assisting them with their issues in an efficient manner. She is also very tenacious when she sees a need and makes sure to see it through to the end.  

One example of this occurred when Marnee was in a training class to process refund requests, and the trainer indicated there were approximately 50 claims that needed payments to be taken back due to a policy termination. Because Marnee is involved in our Seasons of Life team, she quickly recognized that the policy should not have been terminated. She notified the trainer, but the trainer advised her to go ahead and complete the recoupments. Marnee felt so strongly about the case that she completed further research the following morning and was able to have the policy immediately restored to stop the refund requests from being completed and prevent undue stress to a policyholder’s widow. 

Every single month, members leave numerous survey comments attesting to the efforts she puts forth that cultivate loyalty from our customers. Here are just a few examples: 

• “She made it a priority to make sure that my issue was resolved. She followed up. She seemed very caring and made it a high-level concern due to my son's location, and showed empathy. Overall, Marnee was great, and I'm glad that she was my customer service representative for this transaction, which could’ve been very frustrating.” 

• “The representative listened carefully, understood my problem, connected me to Social Security to resolve an issue there, and then got back on the line with me and showed me 3 different options for resolving the issue. Overall, she was very thorough, and we fixed the problem.” 

• “She went way above and beyond in finding out my answer. I don't even know how to explain what she did, but she somehow had to put in all the stuff I needed and then figure out what my out-of-pocket expense would be. She even did a three-way call between me and the doctor in order to get all the information she needed. So, it was exemplary service.” 

• “She not only resolved my issue, but she did it very efficiently. She was able to call the provider, determine preauthorization in a matter of seconds, and was able to get my appointment booked without any issues. She was perfect, professional, and very well organized. She took care of everything. She made it perfect.” 

• “I was satisfied with her kindness, her ability to help me, her ability and willingness to go the extra mile to make sure I got the accurate information, her ability to be patient and understanding, even though I was frustrated. She was willing to go the extra ‘smile’ to help me with my situation.” 

Ron Brooks – HCSC FEP

Strong, steady, reliable, eager, and diligent in handling our members’ issues. These are just a few of the qualities that make Ron Brooks deserving of Agent of the Year honors! Ron has an incredible ability to connect with her callers on a personal level and create loyalty. 

Ron never hesitates to go to the heart of the matter and takes it upon herself to not only listen to callers’ concerns but make as many outgoing calls as necessary to resolve problems; she then goes back to the members to reassure them that the issue is corrected. Ron personifies customer service. She quietly goes about her day improving the lives of all who reach her. She is always one of our most productive agents, taking more calls than virtually anyone while consistently producing some of the highest FCR, CSAT, and World Class Contacts numbers in the department! 

Ron receives countless comments praising her service. Below are just a few examples: 

• “She was very professional, and she sounded very knowledgeable. She explained to me what she was going to do, why she was going to do it, and she got back to me in a timely manner. She was well-spoken.” 

• “Ron was able to answer all the questions I had and gave me additional information that I didn't even know to ask about. She was extremely helpful, and now I feel confident that I understand how Blue Cross Blue Shield and Medicare work together to provide me coverage and retirement. I'm really happy that I called because now I don't have the lingering concerns or questions that I'd had for quite a while. She explained everything to me. She was great!” 

• “Ron was extremely helpful. I was desperate and needed information and help for my own situation, and she gave me so much information and kept the conversation to where I was very calm. When I got through it, I felt very good after talking to Ron. I got all my answers.” 

• “She was very honest and observant of what I was thinking about or doing. She went above and beyond. She’s very nice, pleasurable, a true asset to the company.” 

• “She was very polite, she knew everything so well, and it was easy for me to understand the things she was telling me. Every time I would call for something, I would love to talk to her. Her name was Ron, and she was just beautiful. I thank you, and I thank the Lord for having an employee like that.” 

• “She was very professional, and she seemed genuine in handling my concerns and trying to help me. She was also very friendly, and I appreciated the fact that she didn't seem rushed, and she took care of me and understood what my needs were.” 

• “The representative went out of her way to look up a past claim and went and talked to someone with Medicare and called the medical provider as well. She spent two hours with me, and I know exactly where I stand now, thanks to her.” 

Ursula Rorie – HCSC FEP

Ursula has worked extremely hard on improving her skills and ability to reach a resolution on the first call. She has received many customer compliments that reference her patience and empathy on her calls.  I’ve submitted one of her calls to be used as a training example of excellent non-technical skills.  She followed all steps in the recommended call strategy and was spot-on with the end-of-call message.  Her end-of-call messaging never seems rushed or forced.  I received a compliment from a member who stated that Ursula helped her by calling the provider for her and explaining what was needed. The member said she was able to clarify to the provider what was needed and went the extra mile to resolve her situation. 

Many of our members have left messages of appreciation for Ursula’s kindness and professionalism. Here are a few brief compliments she has received: 

• “She went through all my concerns and all my questions and explained everything to me in great detail. Any questions I had that I didn't understand, I asked them. She responded and gave me the right answers. I was happily satisfied, and it took approximately 20 to 30 minutes for the entire phone call to get all my answers resolved.” 

• “The representative was very knowledgeable, very helpful, had a very nice personality, was easy to speak to, answered our questions, and was diligent in looking up the information. She was very patient with my husband and me, was able to resolve our issue, and was very pleasant on the phone. She had good business acumen and very good phone manners.” 

• “Ursula was excellent. She listened and answered, and found solutions to all of my problems with the claim. We worked together very well to try to get the issue resolved. Thank you! Please reward her for being so patient and being so knowledgeable, and getting the issue resolved.” 

• “She was quite knowledgeable. She looked up my claim and put in a great deal of effort to contact the people who are trying to get the payment. She had to dial 3 different numbers to do that, and she informed me every time within seconds of what she was doing and what was happening, and how it was going. She was going to do some more research and contact me back.” 

Aileen Corless – Horizon FEP

Aileen moves mountains every day. 

I have nominated Aileen Corless for Agent of the Year due to her exceptional qualities and contributions to our team. Aileen's customer service skills are outstanding, and she consistently brings a positive attitude and friendly demeanor to her work. Her ability to actively listen to our members' concerns allows her to provide efficient call resolutions. Aileen excels in handling complex cases, where she utilizes her problem-solving skills to successfully address members’ challenges. She is dedicated to delivering world-class service and consistently achieves First Call Resolution. Aileen's commitment extends beyond her work as a call center agent. In her spare time, she has been actively involved in speaking at hospitals and institutions, providing support to individuals receiving substance abuse treatment. Aileen's passion for shedding light on addiction and promoting recovery is truly inspiring. Additionally, she sponsors adult women in the early stages of recovery, further demonstrating her dedication to helping others. Considering all of these reasons, along with the positive feedback from our members, I highly recommend Aileen Corless for the SQM Customer Service Agent of the Year award. 

• “The representative was very respectful, knowledgeable, and took care of my issue right away.” 

• “She was very polite and very patient.  She answered all of my questions and more. She was very thorough.” 

• “I thought Aileen was very intelligent, and she was very helpful. She was very nice. She seemed experienced, understood my problem, and took care of it quickly. She deserves a high score.” 

• “She was amazing, and she was very knowledgeable. She looked up all of the numbers, all of the information, and found out what the problem was. I have Medicare and Horizon BCBS secondary, but the billing doctor did not send it over to the secondary. I called the billing department, and they said I have to register my insurance. I was not registered, and I had to update my coordination of benefits. Aileen said my coordination of benefits was updated but they never sent us the EOB. She put in two phone calls, and then she wrote a letter, but not to pay the bill because I'm not really responsible for it. This is the first time it's ever happened to me. Aileen said she would handle it. It's their mistake, and she was an absolutely amazing person. She's knowledgeable, and the woman needs a raise. She is empathetic, she understands the problem, and she doesn't transfer you to anyone else. She's fabulous.” 

Miguel Negron – Horizon Blue Cross Blue Shield of New Jersey

In 2023, Miguel received 41 surveys with a result of 98% Call Resolution and 80% First Call Resolution. 

Miguel has been with Horizon Blue Cross Blue Shield of New Jersey for a little over 2 years, and his experience shines through! Miguel cares deeply for our members, and he understands their concerns. He listens attentively and answers all questions thoroughly. He strives for First Call Resolution on every call.  

Here is what some members had to say about Miguel- 

• “Miguel was very efficient and knowledgeable. He immediately found the right resources and answered my questions.” 

• “Miguel was super nice and explained things in a way that I could understand and got things done quickly.” 

• “Miguel was very professional and helpful.” 

Miguel works on a dedicated line where white-glove service is expected on every call. It is this level of service that defines the care that Miguel strives to provide to each of his members. 

The call that really exemplifies Miguel’s caring about his members is a call regarding questions about test results. The member called about the surgery she had and wanted to know if the results were available yet from her surgery. He was on the phone looking for the pathology results, which the member wanted to know about. Miguel offered to call up the pathologist to see about getting the member her results and proceeded to make the needed outreach. He offered to research this for the member and call them back with the results. The member wanted to give Miguel a Kudos and was in tears for all of the help he had given. Even though Horizon did not receive the results, Miguel took his time and made the needed outreach to help guide our member in the right direction so she could get her results. 

The key to Miguel’s success is his knowledge and genuine interest in resolving member inquiries and taking ownership and accountability for the issues at hand. Miguel demonstrates to each of his customers that he cares about their issue, regardless of whether they are his first or last call of the day. 

Miguel is a valued asset to our organization and well-deserving of this honor.

Almitra McKenzie-McMillan - Marchon/Altair

The Golden Rule to “Treat others the way you would want to be treated” has been my mantra when it comes to delivering excellent customer service. Actively listening to what the caller is saying, displaying empathy, and utilizing my critical thinking skills to find a resolution have always helped me when faced with a tough situation. During my interaction with a member last February, this mantra was called to my mind. 

I started the call with my usual greeting, and on hearing the tone of the member’s voice, I knew that something was off. She was looking for a frame from our Marchon collection. At this point, I had been with Marchon/Altair Eyewear long enough to recognize the names of frames we carry regularly, and this was not one of them. I prepared myself to do a search to find something similar as I pulled up the frame in our system. Sometimes I am wrong, and the unfamiliar frame is in stock, but this time it was not the case. My assumption was correct, and I prepared to do a deep dive to get the patient something they would love. I like to know a little bit about the patient as I do my search, as it helps me decide on recommendations for frames, and she graciously answered my inquiries. Her patient was an elderly man living in a senior residence and had their glasses stolen. He was looking to replace them. I believe in taking care of those who took care of us, so I quickly jumped into action. I thought of my grandparents and how they would feel if they were in a comparable situation, and how I would hope that someone would take care of them. I knew that the patient would be very particular about any new frames and that they would have to match the missing pair. 

As I thought of the situation, I started to feel anxious and ran a quick search in the Marchon collection. I did not see anything comparable, but I knew that Flexon would have options. I was right! I was able to find three similar frames. I was silently giving myself a pat on the back, but that celebration did not last long, as it was noted that the Flexon frames were more expensive than the ones offered in the Marchon collection. It was a real palm-to-face moment. How could I have missed that? We knew that the Residence was willing to replace the frame, but at a reasonable cost. Knowing this, I offered the account a 40% discount and to have the frame of their choice sent on patient approval, so they can return it to us should the patient not like it. I also waived the cost of express shipping so they could receive the frame the next day. She perked up and was excited, but then concern crept back in. She wanted to make sure she got it right for her patient, but did not know which frame to choose. She decided to reach out to the patient’s wife and get her thoughts. Thinking again of my own grandparents, I chuckled to myself, knowing that there was no way my grandpa could buy something new without getting my grandma’s approval. Knowing that, I offered to wait on the line while Taylor called the patient’s wife. I felt confident with my options because I knew the Flexon classics are popular among our older patients. Fingers crossed, I anxiously waited to resume our call. When she returned, she sounded a bit defeated as she was not able to reach the patient’s wife on the phone. I had to think quickly, and offered to email pictures with the wholesale and discounted pricing so the wife, as well as the home, could make an informed decision as to which frame they wanted to go with. I also said that once there was a decision, to simply reply to my email, and I would process the order with the 40% discount and free shipping. She agreed and I quickly composed an email with the required information. I waited on the line to make sure the email was received. 

She thanked me for all my work and the time I spent with her trying to find something for her elderly patient. In all, we must have been speaking for at least 15 minutes on the phone. The next day, they got back to me and let me know the patient chose the Flexon E1111 in gunmetal. I quickly processed the order and had it sent out to their lab of choice.  

Once completed, I could not help but smile. I was proud of my growth as a customer service representative here in Eyewear. In the past, I would have felt stress and doubted myself when presenting frame options to an account. I would sound confident and explain my reasons for presenting the frames, but underneath it all, I was unsure. At the end of the day, “you have to fake it until you make it,” and I think I have arrived. With my newfound confidence, I can find options for our accounts faster, I have a better understanding of our products and the price points, and I am able to zero in on what our accounts are looking for. Not every situation presented goes as smoothly, and sometimes there is no option available for me to offer, but I can always say that I tried my best, and in doing so, our accounts recognize and appreciate the effort. Here at Marchon/Altair Eyewear, we genuinely care, not just about our accounts but also the employees who help them. With this call, it was an honor to care for those who cared for us, but I am only able to provide this service because of the amazing support team I have here at Marchon/Altair Eyewear.  

Here is what two other clients had to say after speaking to Almitra: 

• “She was knowledgeable, quickly navigating whatever platform she was using to help me find a frame that had broken and needed a replacement. She advised me on how to return the frame for credit and made sure I understood by asking me if I had any questions for her before ending our call.” 

• “Almitra was very informative. She knew how to answer all my questions, and she educated me on things I was not aware of.”

 

Phillip Bailey – Marchon/Altair

As a customer service representative, one of my responsibilities is to provide a call back to a customer to advise them that the frame they ordered is not available, and whether it is on back order or no longer available to purchase. At times these can be difficult conversations to have, especially when a customer is upset and waiting on a frame.  

Recently, I had to contact a customer to advise them that the frame they placed an order for is no longer available, and I immediately offered to help find a similar frame for their patient. The doctor was not happy about this situation, and I felt and understood immediately what I needed to do: make this right and find a frame for their patient. The doctor wanted a frame that was like the one he previously had, so that the patient would not see much of a difference, as the patient loved the frame he had been wearing. It was off to a difficult start when the doctor stated he had never had this happen before, trying to find the exact same size and color needed for a patient. After hearing the doctor’s statement, I felt even more determined to look and find something for the patient. The doctor offered to send his frame off the board if I could not find a frame. I did not want to end this call, leaving a task for the doctor to perform. I knew I needed to do more. 

The doctor suddenly stated he was standing in the “Supermarket” and could not make an immediate decision, and would not remember this conversation. I advised the doctor, no worries, and I would be happy to email the details of the conversation and the resolution for the patient. With that said, I knew I needed to put in extra effort to find a frame for this doctor and his patient. 

As I was looking for a similar frame and realized we did not have the specific shade of brown, I did find a similar color in a different collection. I attached the images in the email. Before sending the email, I called the doctor to advise him and to offer to send the frame on “patient approval,” and if the patient did not like it, I would send a call tag label to pick up and return for credit. 

The doctor thanked me for going beyond trying to find a frame for his patient. His tone in the second call was much happier than in our first interaction, which I understood completely. He let me know how much he appreciated what I did, as it saved him time restyling his patient. When I began my shift on Friday, I received an email from the doctor: 

• “Thank you so much! The Genesis frame is as nice or nicer than the JA frame. I appreciate your concern and effort. Have a nice weekend.” 

Finding the right frame for this patient made me realize why I do what I do each day. I am beyond thrilled that the patient liked his new frame. The doctor’s kind words made me feel great about what I do here at Marchon/Altair Eyewear. “Helping his customer see every possibility and bring his patient their best vision to life.” 

Another member shared with us that she normally does not call and place orders: 

• “When speaking with Phil, he was a gentleman. He was very patient, extremely helpful, and was able to find the frame and tell me exactly what frame it was, and placed the order for me.”  

Another member let us know: 

• “Phil was great, pleasant, and extremely helpful. He was able to get what I needed and get it done immediately for me. There was no placing me on hold, no transferring to another department; he took care of me.” 

Samantha Barron – Marchon/Altair

Positive greetings and friendly interactions have a bigger impact than we may realize. It sounds like such a simple thing, but sometimes the smallest things make the biggest impressions. We have all been there, when we call a customer service phone number, and we feel like they are just reading from a script, and we are just another phone call to them. It can be frustrating at times, especially when you are calling customer service because you are having an issue. It feels like they do not care. Taking that extra step to "go off script" and interact with the customer on a personal level changes the mood of the phone call entirely. 

I handled a phone call recently where I saw the customer was located near where I live in Tennessee. I asked the caller if she was enjoying the sunshine finally, because it had been raining every day for a little over a week. With excitement she said, "Yes! Oh, my goodness, it has been raining nonstop here!" As we were talking, I realized we both have toddler boys who love to be outside, and how excited we were to finally be able to have fun with them outside over the upcoming weekend. After helping her out with what she initially called about, I thanked her for her order and wished her a great weekend with her son. She thanked me as well and wished me the same. She ended the conversation with, "I hope I get you every time I call! " I left that phone call having an enjoyable conversation with one of our premier customers, feeling great about what I do in customer service. The call was about a warranty order. Those phone calls usually take about two minutes. Even with the added conversation I had with the customer, it was still a quick phone call. It only took an extra minute of my time to make a positive impression on the customer.  

With every phone call I take, I try to find something to say to the customer that is different than the last. Whether it be about the weather, how their name is so cool and unique, or even asking how they enjoyed their week or weekend. These small gestures truly make the smallest difference on phone calls. Being a positive and friendly person is contagious. I’m sure we can all agree, positive phone calls in customer service make our job much easier and more fun. 

One member said Samantha was “Very Pleasant” and sounds like she enjoys doing what she is doing. Adding, “She knew what she was talking about, and made it a quick call. She did an excellent job.” 

Another member had this to say after speaking to Samantha. “She was amazing! I did not have to wait long to speak with her, and when I got to her, she was genuinely nice. She addressed my issue; she understood what I was talking about and had a handle on it quickly. I could not ask for anything better.” 

Chandra Hawley – Mr. Cooper

In a recent interaction, Chandra went above and beyond to assist the customer in regards to assistance to help bring the account current. The customer went through a hardship that caused the loan to fall behind, and Chandra related to them and built a rapport during this time. She put the customer at ease about being behind, gave the empathy needed, and made the customer feel relieved. Not only did Chandra process a payment for the customer, but she also walked the customer through options to help with the remaining amount that was left owing on the loan. The customer was given an SQM survey on her experience with Chandra and said: 

• "The representative actually listened and made me feel heard. She was understanding, she didn't belittle me, and she made me feel hopeful about my situation. After processing my payment, she also gave me options for my remaining balance and even started a modification application for our remaining balance. She provided exceptional service! She's a joy and a blessing". 

Chandra does this with every customer she speaks with. She will build a rapport with them, she listens, and makes sure the customer knows they’re being listened to. She empathizes and celebrates with them on the ups and downs of their hardships. Chandra will also fight for the customer to ensure they are getting the best service from her, but also from Mr. Cooper. I believe Chandra is a great candidate for SQM CSR of the year.

Gregory Stenberg – Mr. Cooper

I know Greg is definitely worthy of this award, as he not only is quick and often jumps in our Teams Chat to help his fellow agents, but he does this while going beyond all expectations, helping our customers. 

Just one of many examples, and from a large amount of compliments he gets, one customer wrote about how Greg is a very rare asset to our company. The customer explained how Greg truly took ownership of his issues and followed through from start to finish while calling him back along the way. He pointed out how Greg walked him through the process step by step, and was absolutely fantastic to work with. Greg was very effective and timely. He called Greg a true lifesaver. I would call Greg that as well, as he keeps his compliments up and helps with so many other agents and projects. He is also a great Challenger of Convention as he is the first to point out issues with changes and question them with specific loan examples and snip-its for a good visual. 

Greg has an outstanding record of SQM metrics with a 92.68% for the year. Thank you, Greg, and thank you all for consideration. 

Helen Carrington – Mr. Cooper

I could not think of another agent who would be more deserving of the title of CSR of the year than Helen Carrington. 

There is not one customer who could walk away from a call with her thinking that they weren’t taken care of. She is consistent in making sure each one of her customers knows that she appreciates them, will handle their situations fully, and will understand everything she did for them. She makes sure she educates her customers and makes them experts in handling their own mortgage. She refuses to let a caller leave her care if their issue hasn’t been fully resolved. 

As an example, she had a customer call and advise that they had received several calls and didn’t understand what was happening to their account. She started the call by assuring the customer that she was going to take care of their concerns. The customer thought someone was trying to scam her since she had sent her payment already, and she was scared that someone would take her money. Helen stayed calm and explained the payment history, changes made to the account, and when we would try to send any payment reminder calls to her. She took time to teach the customer how to get on our website to view this information herself. She educated her on the multiple options available to make the payment. She also took time to build rapport with her and let her know that she cared. She stayed on the phone for an hour until the customer was set up and self-sufficient. Helen made sure to let the customer know they weren’t alone, and we would take care of any new questions she may have. The customer was so happy with her interaction that she sang her praises when she was given the opportunity. She said, “Helen was absolutely excellent! She was patient, kind, professional, and easy to talk to.” She said that her communication skills were great, and she was the right person to have talked with that day. She also said Helen was just what you need when you want customer service. Finally, she said Helen was definitely an asset to Mr. Cooper, and she couldn’t say enough about her. 

Mariah Clark – Regence BCBS FEP

Mariah consistently goes above and beyond for our members to ensure the reason for their call is resolved before she finishes her final interaction with them. She researches alternative options for our members to resolve even the trickiest of situations.  

An example of this from 2023 was when Mariah received a call from one of our subscribers as his wife had received a bill from her provider. She was able to assist the subscriber by three-way calling his wife to obtain verbal authorization to discuss the situation with the subscriber. Mariah quickly identified the issue, obtained the needed information from the member, and contacted the provider to place the account on hold to allow insurance to resolve the issue. 

The member was concerned the issue would interfere with future services, but Mariah confirmed she would monitor closely to ensure that it was resolved as a priority. The member was grateful not to have to worry about receiving further bills from their providers. 

This is an example of the due diligence Mariah provides on all her calls. She relates to each member and ensures they have a clear understanding of any next steps that will be taken and when to expect resolution. 

Megan Evans – Regence BCBS

When answering a phone call, you must be prepared for whatever the member on the line has called about. How a phone call starts can set the tone for the entirety of the call, and having a friendly demeanor at the other end of the line makes the member more willing to share their concerns or questions. I make sure to sound welcoming and friendly to assure our members that I am here for them. 

Members want to know that I am willing to do what I can to help, whether it be calling providers, researching their questions, or providing accurate information. To make sure members are satisfied on the first call, I listen and take notes of all their concerns and questions. Providing an accurate answer on the first call informs our members that I am knowledgeable, and they can trust what I am telling them. I feel I’m sought out by our members for my outstanding customer service skills, and I leave a lasting impression with the members I help. 

The comments below reflect the gratitude and level of customer service that I consistently display. These are just some of the comments from members: 

• “She solved my problem in a very professional manner. She’s well-spoken. I could understand every word she said, and she was a very good help to me. I really appreciate what she did. Thank you very much.” 

• “The young lady was so kind, respectful, and professional. She knew what she was talking about, and answered every single one of my questions.” 

• “The representative was knowledgeable, friendly, and answered my question promptly and thoroughly. It was a nice change to see there are still good customer service people that can help.” 

• “The representative that I talked to went beyond and above.  She really helped me find out if my insurance covers each item and helped me find a specific doctor. She sent the list, and I know it took her extra time to find it, and I really appreciated that.” 

• “The young woman was very personable, very friendly, and she corrected me and helped me do what I needed to do. It was an overall very enjoyable experience.” 

It gives me joy at the end of each call when the member's question or concern has been completely resolved, and they truly are grateful for my help.  Being accurate, empathetic, timely, friendly, and willing to help goes a long way with our members. They want to know that calling in will result in solutions from a caring CSR and that they can always lean on us for help with a simple question or something much larger that could impact their life. In doing these things, I have been able to give excellent customer service on my calls, leaving the members satisfied. My SQM World Class Call Surveys score of 96% shows the gratitude my members have when they are surveyed and gives me a great sense of pride in what I do every day.  

Sara Mccollum – Regence BCBS

Sara makes sure to take her time with each of the members she interacts with daily. She makes sure to collect the full information from her members so that she can assist them to her fullest ability. In the cases that she is not able to assist them, she explains in detail the reason behind it. She informs them as to the next steps she will be taking or what steps the member needs to take.  

Sara’s attention to detail and desire for the highest member experience are reflected in the compliments she receives from the members she works with as well as her peer interactions. 

In one example, a member called in with concerns about some of their wife’s claims that were being denied. Their wife had been undergoing injections related to their cancer treatments. Sara took the time to go into detail as to why their claims were being denied and helped them see that the true issue was a pre-authorization. After reviewing all the information, Sara was able to work with the provider on submitting an appeal, and the claims were then adjusted to be paid without member responsibility. Sara made sure to take on the responsibility so that the member did not have yet another thing to stress about as they expressed frustration on the call that they felt they were running in circles. On top of following through on the claim until there was a satisfactory outcome, Sara took it upon herself to send out a member gift so the member could have some comfort while undergoing treatment. This attention to detail and compassion truly sets Sara apart and shows her level of outstanding customer service.  

Some other examples of Sara’s compliments from members are as follows: 

• “I have been working on some issues with my claims and have had to call in more than a few times. Once I received Sara as my representative, she took over the issue. I no longer had to keep calling in to get the issue corrected. Sara followed up with me repeatedly, and then she was able to completely resolve my claims issue. Regence is lucky to have her working for them.” 

• “I called in to customer service and got connected to Sara. She went above and beyond to help me with my claim. She stayed on top of the issue, and even though it took a couple of months to resolve, I never felt forgotten about and Sara made me feel like I was a priority.” 

Not only does Sara strive to be the best CSP for our members, but she is also always willing to jump in and assist her peers on any tips or tricks that can help them provide superior customer service. She has done numerous side-by-side, been a mentor, and a part of different work groups. Her dedication to her work is shown day in and day out.

Suzanne Happs – Regence BCBS

I have worked in customer service for about 30 years, and I have always enjoyed helping people. At Regence, I can go one step further by contacting providers, vendors, and community resources to answer member questions and resolve member issues. It gives me a profound sense of accomplishment and empowers me in everyday life. 

It is not just about customer service to me – I consider each call a unique experience. It is about showing each member that you care; that you are there for them and willing to go beyond on every call. I start each call with a friendly greeting, including a mention of the state that I am serving them from. I ask probing questions, show compassion, and use my resources on every call to make sure I not only understand the issue or questions, but that I also have the tools to resolve the issue and answer the question. 

While there can be similarities between member calls, each member sees things differently. You must listen, be empathetic, notice their cues, then continue by giving them an exceptional personal experience. 

I received a call from a member who lives alone and needed help when she did not know what to do. When the member called me, she was very distraught, had been in pain for a while, and did not know what she should do. The member had been going to her doctor for pain in her neck but had not gotten any relief yet and was looking for a case manager to help guide her with what her next steps would be. Using internal resources, I submitted a request for a case manager to contact the member. 

While talking with the member, I had learned that she had a post-mastectomy bra that was about 10 years old, falling apart, and hurting her. The member did not know that she had benefits for replacement bras. In fact, her benefits covered four mastectomy bras every calendar year and one prosthesis per side for the useful lifetime of the prosthesis. I was also able to find her a supplier that was local to her by utilizing my available resources. The member was very thankful she had an advocate for her. It made me feel so good to be able to help her and provide some comfort for her. 

At the end of the day, I know I may not have changed the world, but I know I have made someone else’s day brighter. And they make my day brighter each time they thank me for all my help. For that, I thank Regence and my team of supervisors and coworkers. 

Because I believe in going beyond for our members and following through with promises to follow up with members in a timely manner, I had a successful 2023. My 2023 SQM scores were 98% World Class Calls (WCC), 98% calls resolved, and 98% Customer Satisfaction (Csat) out of 42 surveys. I am extremely proud of my scores in 2023. 

Shelby Stangl - Security Health Plan

A Security Health Plan Nurse Care Manager reached out to me and asked if I would be a Concierge for a member. The care manager informed me that the member was not happy with the denial for physical therapy or with Security Health Plan in general. I reached out to the member and offered to look into the reason for his denial, but not until after he expressed his frustration with the health plan and the denial. I explained the denial reason: he reached reasonable outcomes and/or functional goals had been met. This did not make sense to him. He was following the therapist’s instructions and improving and felt that additional therapy towards a full recovery was a reasonable expectation. Eventually, I was able to review his appeal rights, but he was reluctant, as he stated he had never had luck with appealing denials with Security Health Plan in the past.  Realizing I had not earned his trust yet, I offered to reach out to his Primary Care provider to ask if they would be willing to submit an appeal on his behalf. I worked with his Primary Care provider’s staff, and they successfully submitted an appeal to Security Health Plan. The member was approved for seven more sessions. He was grateful for my help and asked if he could call me directly for all of his insurance questions. I explained our Concierge services and was happy to provide him with my direct listing. 

The member calls on a regular basis as he gets very frustrated with the “loopholes”, as he calls it. An upcoming surgery for a total knee replacement had him calling often. He had a specific idea of how he wanted everything to go, but the “loopholes” posed a problem. He wanted to know the discharge date after surgery, which turned out to be one week in a rehab facility and home health care after that. The unknowns of the surgery and recovery process caused him great angst. Depending on the physical therapy evaluation after surgery, it was possible that he would be sent home the following day. This would mean he would have to rely on his daughter for help, and he did not want to inconvenience her as she worked full-time. To help him better understand how his surgery and recovery would look, I called his surgeon’s office, and together, we spoke with a nurse who explained the process in detail. He was not only concerned about the surgery and recovery process, but the cost of it all. A longer stay in a rehabilitation facility would incur more out-of-pocket cost. Despite much hesitation, he eventually said he could not take the pain anymore, so he would have to trust me and Security Health Plan that all would go well. His surgery and recovery went well, and after I reviewed his claims and out-of-pocket costs, he was relieved and delighted when his out-of-pocket costs were much less than he expected. 

This member’s calls can be long at times, and one of these calls was audited. I did not remember all that we discussed, but after reviewing the SQM survey, I quickly remembered our conversation. There was a claim for an Emergency Room visit.  He laughed as he went into detail about what took place and what his experience was like. It is clear that I have earned his trust and he is very comfortable discussing his medical conditions with me.   

Through our conversations, I learned a lot about him. He lost his wife two years ago and really misses her. He still owns their home and loves having his children and grandchildren come stay with him during holidays and special events. He keeps a very tidy house. He goes to the gym daily to work out and meet up with his buddies. What impressed me the most is his willingness to help others. He loves to plow snow. He helps elderly people keep their driveways clear all winter but will not accept a dime from them. He is a kindhearted, no-nonsense kind of person who has no time for “loopholes”. 

What I have learned through my years with Security Health Plan is that patience and going the extra mile to help others make a difference, not only for our members, but for everyone involved. To this member, I am Security Health Plan. That is my role as an employee and a Customer Service Agent – to be there for our members.    

When I was preparing to be out of the office for a week, I let him know that if he had any questions while I was out, he should call the Customer Service number, and if necessary, I would follow up with him when I got back. His response was, “No, I will wait for you to come back. You get things done right the first time.” 

Background Written by Katie Johansson – Workforce Analyst:  

Shelby Stangl has been with Security Health Plan since September 2011. She is one of our most tenured agents, and her dedication and loyalty to our membership is unmatched. She has specialized in our Medicare line of business and is a key player in assisting our elderly, disabled, and low-income members due to her extreme wealth of knowledge in this area. Shelby assists agents over the phone as well as in person at the main office. She has been receiving surveys the entire time we have been partnered with SQM, since October 2015. She has been a part of countless process changes and different implementations over the years. Regardless of what changes come her way, there is something that never changes, and that is her always choosing to put our members first. She always focuses on quality over quantity and always goes the extra mile to make sure our members understand the information. She is always looking out for them and finding opportunities to help improve their situations, such as through the ADRC (Aging, Disability and Resource Center) or some other qualified programs that will provide additional medical coverage or financial assistance for our members. 

Shelby had a terrific year for 2023 and has been seeing positive increases across the board over the last several years on her KPI’s. Shelby had 57 surveys for 2023 and finished at a 96% FCR, which was a 3% increase from 2022. She tied her Contact Resolution at 98% and had a 3% increase in her CSR CSAT, finishing 2023 at 100% CSR CSAT.  She finished 2023 with a World Class of 98%, a 1% increase from 2022, and one of the highest in the department. Shelby also had one of the highest quality averages in the department, finishing 2023 at 97.58%, well above our department goal of 92%. Out of the 57 surveys Shelby received last year, 49 of them had outstanding feedback for her. Below are some of the outstanding comments Shelby has received from our members: 

• “I'm a happy camper. I called Shelby several days ago to ask a different question, and she ended up giving me information that is going to save us money in the long run. She called me back to make sure that we'd gotten the paperwork that she said she was going to send, and we did. She followed up. When I had another question yesterday, I called her directly, and she again was able to help me. She went out of her way to make sure that we were satisfied customers. I don't know Shelby's last name, but she's in Marshfield, Wisconsin. She was great. I could not speak highly enough of her.” 

• “I'll tell you what, the one I talked to every time, Shelby, don't you ever lose her. She knows what she's doing and she's very helpful.” 

• “Shelby is always very helpful, and if I have any questions, I just call and she takes care of whatever I need.” 

Response from Manager Nicole Lightfoot:  

Shelby has a reputation for her helpfulness in difficult situations. She can navigate more than just your health care and is able to connect members with resources for rides to their appointments, county benefit specialists who can assist them with additional assistance programs, and drug rebate programs. Many staff across the organization have reached out to share their appreciation for her assistance with complex cases and difficult members. Shelby is patient, knowledgeable, and helpful. Members quickly pick up on her caring attitude and her willingness to help. They have left voicemails of appreciation for her help and the resolution that Shelby provided. 

Todd Leonhardt – Security Health Plan

I had a recent scenario where a member called in who was having an extremely difficult time with not only medical but emotional issues. She was having a myriad of problems that included a divorce, blackouts, and not having anyone around to assist her. The member had contacted the county to get assistance, and due to age and still being married, she was not eligible for any help. The member also sees her PCP and mental health provider frequently, and was not having any success, often thinking of suicide. I verified the member was in no immediate danger, and we went over mental health benefits, always staying positive with her and commending her on working hard to take the proper steps to get better. The member felt she was all alone in this process, and I assured her we at Security Health Plan would be a part of the solution for her. The following excerpt was taken from an email sent to me by my supervisor after she had listened to the call: 

• “I know you mentioned in our one-on-one today that you had a long call yesterday regarding a behavioral health situation. I want to tell you that you did a wonderful job handling this call! You remained calm and compassionate throughout the call. You did an excellent job using probing questions, reviewing information, and making sure that she was taken care of appropriately with what is happening. The part that stayed with me is when she broke down a few times and mentioned that she has no one, and you said that is not true because I am going to help you, and we are here for you. This is exactly what Customer Service is about, being there for our members. Thank-you for providing excellent Customer Service, especially during these difficult calls.” 

Background Written by Katie Johansson – Workforce Analyst:  

Todd Leonhardt has been with Security Health Plan since April 2021. Todd is cross-trained on all of our product lines and has proven to be a hardworking and caring team member. Todd had a 94% quality average for 2023, scoring above our department's goal of 92%. Todd had 58 surveys in 2023 and had one of his best years yet, seeing increases across the board. Todd finished 2023 with an 88% FCR and a 97% Call Resolution, tying his 2022 metrics. Todd had a 5% increase in his CSR CSAT over 2022, finishing the year at 97%. Todd had a 7% increase in his World Class, going from 90% in 2022 to an astounding 97% in 2023, one of the best in our department.  

Any member who gets the opportunity to speak with Todd will quickly pick up on his kindness and compassion. He truly cares for our members and takes the opportunity to always connect and make them feel heard and assure them that he will get their questions answered with a resolution for them. Todd, having owned his own business for several years, really brings top-notch Customer Service to the members he speaks with. Todd consistently goes the extra mile for our members, which has really shown in the last couple of years in his survey stats. Members enjoy working with him and have given him lots of praise. Out of the 58 surveys Todd received in 2023, 46 of them had outstanding feedback comments listed. Below are some of the outstanding feedback that has been received in 2023: 

• “The gentleman I talked to was extremely polite and very knowledgeable. I was very satisfied with my call to the call center.” 

• “I felt he was an outstanding representative, and he was very friendly and reassuring me that he could take care of this. I felt he was very good.” 

• “The customer service rep was very good, and very professional.” 

• “I dealt with a representative named Todd, and he was more than helpful. He went beyond what I had asked to make sure that I was getting the proper stuff. I like the fact that they don't rush you off the phone, and they're very courteous, and they always ask if there is anything else they can help with.” 

Response From Manager Nicole Lightfoot: 

Todd is one of the most member-centric people I have met. He has one of the strongest work ethics I have seen in my 9 years of leadership. When you get Todd on the line, there’s no doubt he is going to take care of you and fully resolve the situation. Todd has stepped up to the plate to help members with complex medical history, members who other Customer service staff have found to be unruly and difficult to work with. Todd manages members with gut-wrenching stories, and he does so with ease. His strong word choices and his compassionate tone easily help him build rapport. On many occasions, I have heard him tell members, “I got you,” and you can hear the sincerity in his voice. Todd follows through to make sure all their needs are met. I can think of a recent situation with an elderly member who needed medical services and had difficulty travelling. Todd came to me for assistance so that this member would not need to transfer medical records to a new facility and travel over an hour for care. Because of his follow-through, we were able to work with the referral liaison team to get this member timely care, close to home. We also were able to implement a process going forward to help many additional members.

Deja West – VSP Vision Care

Deja West took the initiative as a new employee to help deliver World Class Service beyond her callers to the callers of her team and those of other teams. Deja is a self-driven person with a thirst for learning who used her time between calls to learn how to quickly navigate the knowledge database, resulting in quicker responses to callers. She coupled this with her confidence to ask questions to catapult herself to a point where she began voluntarily providing peer-to-peer support among multiple teams. This was especially beneficial for the newly hired representatives as they were able to learn the knowledge article or information needed, quickly help their callers, and resolve the call versus waiting for a longer option. That peer-to-peer support is very impactful, especially for newer employees who are shy when admitting to their supervisor that they forgot something from training. Deja’s actions reduced the frustrations of the agents she helped, increased their morale, and enabled them to provide callers with a very satisfying experience. 

Positivity in a call center is vital to the overall caller experience. Deja understands that agents with high morale will provide a more upbeat tone and be more willing to go the extra mile for their callers. She has made a positive impact on the team since her first day by encouraging others when she notices that someone may be having a hard day, encouraging the team with positivity when it is very busy, and engaging in all activities that are put on for the team. As a leader, I encourage my team, but something magical happens when that peer in the trenches next to them speaks up and says, “We can do this. One call at a time. We got this!” It is powerful, and the energy increases hundredfold. This has a direct impact on how the agents change their approach and tone with their callers positively, with a rally cry from within themselves.  

As a supporter of the business, Deja is extremely flexible with change and a cheerleader within the team, encouraging her peers that the change looks easy, or that it was easy for her. Peer-to-peer encouragement like that has led to quicker acceptance of change. It eliminates the time spent on what we can’t do and focuses on what we can do, which is execute and help members quicker when a peer is a champion of change, such as Deja.     

Deja loves feedback and implements it immediately. She owns her mistakes, even shares them often for the benefit of others and our callers, and takes measures to not repeat them. She is very thankful to me for the feedback. She later follows up with me to show me how she implemented what I have shared with her and how following it worked for her. She is very humble and takes every opportunity to grow.    

Deja's impact on her callers was shown by many praises from her callers, to include some who took the extra time to reach out to me directly. Here are a few of the many impactful statements that Deja’s callers made about her. 

With excitement in his voice, the member called to express how impressed he was with Deja during their interaction, and because of her, he was taking action to email his company informing them they should continue to do business with us into perpetuity. He added that if his company changes insurance companies, he will consider looking for another job. He was so wowed that Deja was able to clearly articulate the answers to his many questions, break down everything for him so he could understand it, and put him on the right track. He exclaimed, because of Deja, we are the only choice for vision. 

Deja was praised by another member, pointing out, “She was very pleasant, and she was able to do what I needed to get done in a very fast manner, and she was able to explain everything clearly. I thought her customer service was exceptional.” 

Another caller appreciated Deja, saying, “It was tricky, but she handled it quickly and efficiently. She’s probably one of the best ones I have ever spoken to with VSP.” 

Lastly, Deja provided a very satisfied caller with one call resolution. “She was very efficient and was able to assess exactly what I needed right away. She handled everything that she could right there on the spot.” 

Deja sets out every day to help people. She has a huge smile and uses it to smile through the phone, creating a positive experience from “Hello”. Deja intentionally lifts the spirits of those around her, which she knows has a direct impact on their interaction with their callers. She has also increased the positive impact on callers through her self-development, not only helping her calls to be quicker and achieve call resolution, but voluntarily helping her peers do so as well while arming them with the knowledge needed. Along with her unwavering professionalism and maturity, being a champion of change, and flexible as needed, implementing any feedback in a positive manner makes Deja the obvious choice for this year’s CSR of the Year. 

Tonia Harper – VSP Vision Care

Feedback Shared from LaTonia’s Peers: 

LaTonia helps as one of the Case Champions on the team, helping whenever a colleague needs help with a difficult case. She is always eager to help us and share the knowledge that she has with the team, not only in team meetings or chats, but in any one-on-one time she is able to get with one of us. LaTonia is very diligent when it comes to responding to questions in the chat. 

Feedback Shared from LaTonia’s Supervisor:  

LaTonia began her journey with VSP in July of 2021 and has been a shining example of what we look for in an excellent customer service representative from the beginning. LaTonia strives daily to take care of the customers, and her consistency has been an influence on the team. When she responds to questions in the chat, for me, it feels like an extension of myself in making sure that her teammates are reminded of the important information being sent in emails and chats. 

LaTonia has been a model of consistency during her time with VSP. She has been my most consistent agent when it comes to getting customer compliments. Last year alone, she had 13 customers who specifically asked to leave a compliment with me, more than double that of any of my other agents.

Below are a few examples of the compliments received: 

• “I wanted to say it was a privilege to talk to LaTonia. She was kind, gave me very good information, and was very easy to understand. LaTonia is a really positive representation of VSP. Thank you for helping those who have bad vision. “ 

• “I just wanted to let you know that LaTonia was one of the best customer service representatives that I have ever talked to as a patient. LaTonia was just phenomenal with her information, knowledge, and patience. She was a great customer service representative and a great one on your team.”  

• ​“I wanted to let you know that LaTonia was super knowledgeable about the information that I was asking about. She was quick and answered all of my questions and was very patient.” 

LaTonia’s efficiency and attention to detail are two of the attributes that she possesses which come out while she is on the phone. This is reflected not only in her stellar performance, but in the comments that she has received on her SQM surveys. Here are a few of those shown below: 

• “She knew how to handle it and resolved it very quickly with no problem.” 

• “She was very professional, friendly, and helped me answer my question.” 

• “She knew exactly what I needed and waited on the phone until I received the form. She was very friendly and very informative.” 

LaTonia has been a steady presence since she started with VSP, and 2023 was no different. She had a wonderful year taking care of customers and showing why she is one of the best reasons to call VSP. 

Richard Salgado – VSP Vision Care

Rich joined VSP in late July 2018 and immediately began his pursuit of World Class Certification. When he fell short of achieving his goal in 2018 due to not receiving enough surveys to qualify, he turned his disappointment into motivation. He is very proud to share that he was World Class Certified in his first two full years with VSP.  

After he participated in an EEO SDO at the end of 2021, he stopped receiving SQM surveys. It was very discouraging for Rich because the lack of surveys prevented him from continuing his World Class streak, and he wanted to be eligible to be called World Class again. Towards the end of 2023, Rich had additional call types added to try increasing his survey opportunities. It worked! He was able to get enough surveys to be World Class Certified again in 2023. 

Though frustrated by his lack of surveys, Rich never stopped caring about SQM, FCR, and customer service in general. He cares immensely about delivering exceptional customer service on every call. He is passionate about FCR and is careful to provide accurate and complete information to prevent callbacks. Working in TPA, he handles follow-up calls where member concerns weren't properly handled on previous calls. A lot of these callers are upset about having to call back a second, third, or fourth time. While you can hear the frustration in their voice, that doesn't faze Rich at all.  He is quick to empathize, apologize, and assure his callers that he is taking ownership to make sure their issues are resolved. He will tell you that he loves talking to angry people and feels an enormous sense of pride when he's able to calm them down and resolve their concerns. In his words, he likes “turning someone's frown upside down.”  He received several Proud Letters in 2023 from members who were happy to sing his praises for going above and beyond while quickly and enthusiastically assisting them.  In the words of one member, Rich is “definitely an 11 out of 10 on any survey available.” 

Rich is a huge advocate for FCR because he hates hearing that someone is having to call back for the same issue they previously called about. Outside of making FCR his personal focus, he puts encouraging messages in our team chat to ensure FCR and call resolution in general are never far from anyone's mind. He is always willing to share his knowledge to help everyone who reaches out be the best they possibly can. Because of this, he was our team’s inaugural choice for CSR of the Month when they were given the opportunity to select a peer to recognize.      

His commitment to helping others improve, coupled with his own concentrated focus on doing what’s right for every caller, makes Rich the best choice for CSR of the Year.