2014 Agent – Great Customer Service Stories

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Are You Alright?

“It never really occurs to us that through meaningful customer service interactions both parties can leave the call changed for the better.”

Working as a customer service representative we always assume we will be the ones helping the customers. It never really occurs to us that through meaningful customer service interactions both parties can leave the call changed for the better. I had one such experience with a customer who called in sounding very upset. After she went through the motions of verifying her identity, I decided to deviate from the standard follow-up and asked her if she was alright. She seemed taken aback by my question as if someone on the phone from a company should not be asking about her actual well-being. She gave a sharp intake of breath and explained her exceptional situation to me. Her mother had been recently diagnosed with a terminal illness, and her father was having trouble keeping afloat with the love of his life in mortal danger. She let me know she had been estranged from her parents for a few years now, and wanted to offer them an olive branch in the form of making a large lump sum payment to her father’s account, really just hoping she could find a way to get back into a better standing with her parents before it was too late and she lost her mother. Her story hit very close to home as I had recently lost my grandmother, whom I had not been too close to myself.

Her situation gave me pause, and I told her how to go about fulfilling the payment, and offered her some anecdotal advice. I let her know about my grandmother, how I’d slowly become estranged from her as well, and how her illness had been so sudden. I let her know some possible next steps to take based on my own experiences, how to help out with more than just money, and let her know no matter how estranged one got, going to see her mother and father, offering her support to them, being present was more than enough to get the lines of communication back up and running. She started to take deep breaths, trying to keep herself composed. She asked me if my grandmother had survived, and if we’d gotten closer. I told her my grandmother had passed, but before she did, I’d spent many evenings by her bedside, getting to know her very well. I told my customer no matter what sort of hardships she’d been through with her parents, it was different now, and if it was within her power to do so, she should go to her parents, and simply offer to be there. She lost her composure then and began to cry softly over the phone. I apologized, thinking I had said something wrong, or that I’d made the situation worse. She sniffled and said simply that I had given her hope.

All she had needed was some reassurance, someone to tell her to just do what she could, to listen and to share. I could feel my own eyes water but I kept it together. I wished her the best, and told her to keep strong. She thanked me profusely before hanging up. I paused writing my notes. She’d called for something so simple and even simpler words “are you alright” could act like a therapeutic session for a customer. I replayed the conversation in my mind and realized it was the first time I’d opened up about the last weeks of my grandmother’s life. I was glad those memories, painful or otherwise, had helped a customer, and a family.

Jordana White – 407 ETR

 

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Fight for the Right

“We are an intricate part of a member’s survival plan.”

As a Customer Service Advocate, you are privy to situations that are sensitive. You take on the role of the customer’s advocate and fight for the right of a patient that is often too sick to concern themselves with policies and procedures. Daniel is the consummate example of being a true advocate for our customers.

Last fall, Daniel received a call from Mr. and Mrs. Doe regarding their new policy. Understanding this was a new group policy, Daniel presumed they wanted to know general information about their policy. Little did Daniel know that the conversation that took place on that day would profoundly influence his commitment on enhancing the customer experience. The Does were a family like most other families, they were consumed with work, raising children and establishing a simple way of life. They were living a quiet existence until they were given the worst news any person could ever receive: “You have cancer.” This was the news given to Mrs. Doe, the matriarch of the family. This completely devastated the Does and shook their current way of life and future plans.

During her initial call on that fall day, Mrs. Doe had already begun her biweekly treatments. She had received several Explanations of Benefits from her previous insurance company when Mr. Doe’s employer abruptly changed insurance carriers. As anyone could imagine, unexpected change is uncomfortable, but unexpected change that directly affects the outcome of a life-threatening medical diagnosis can be downright frightening. Coverage, provider network and out-of-pocket expenses were questions that required thorough clarifications. Daniel could hear the unnerved tone in her voice. He knew that simply answering her questions would not be enough. She needed special care. Through gentle, leading questions, Daniel was able to identify her most pressing concerns and render the necessary support and patience needed to resolve her inquires. She presented several issues that needed immediate attention. She had mounting medical bills that were unclear and felt they were processed incorrectly. She had upcoming procedures that required pre-authorizations and because this was a new policy to her, she needed clarification on her duties as a patient. A person in her condition did not have the strength nor will to be concerned with what this would entail. She had one job, one obligation: to get better, for herself and her family.

Daniel made calls to her providers to untangle out-of-pocket disputes. He also made sure that services rendered to Mrs. Doe around the time her family transitioned to BlueCross were filed to the correct insurance company and made sure she understood her patient responsibility regarding those claims. Once one issue was resolved, he would contact her to give an update and then begin to work on her other concerns, ensuring that she was kept informed of each and every step of the process so she could concentrate on her health.

Approximately a month after their initial contact, she was so impressed with his service, she felt compelled to send an email of thanks. In her email she stated: “Without Daniel, I am not sure I would have made it through this process. Being a patient is very stressful, and I am very sick most days. It is hard some days to put my feet on the floor and get up at all. I feel like Daniel has become a trusted partner in my survival plan!” Her last statement really resonated with me about the role of Customer Service Advocates. We are often forgotten, but we can make a traumatic situation better. We are an intricate part of a member survival plan. What a monumental duty!

Our company highlighted Daniel and his story in a Customer Service Week video shown to employees throughout the company to educate them about what our Customer Service Advocates do.

Daniel Waterman – Blue Cross and Blue Shield of South Carolina

 

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A True Customer Advocate

“As an advocate, when we all work together as a team, we can get anything accomplished.”

There are times when you go above and beyond and there are times when you really go ABOVE and BEYOND. This is the case for Erika Worthy, a Customer Service Advocate who handled an escalated issue earlier this year. A member called because his coverage had not been reinstated. He had contacted his employer and was given a standard response that this issue was being “worked on”. However, when Erika received the escalated call, the member explained that he had an autistic son that needed medication right away. The member stated they could not afford the cost of the medication and that they did not know what to do. The member was frustrated with the situation and was looking for someone to help. Erika understood the urgency of the situation and jumped in as she normally does to resolve escalated issues. She started working on every possible solution to get the issue resolved. In between making phone calls to other areas, Erika called the member back just to let him know of the progress. She let the member know that no matter what it took, she would get it resolved. After several calls to various people, Erika was able to get coverage active, but the work did not stop for Erika. She called the member and conferenced the pharmacy to make sure they were able to run the prescription for the autistic son. Erika had resolved the issue and the member was thrilled. The member stated he had never had a customer service experience where someone did not want to “pass the buck”. Erika’s shift had ended an hour-and-a -half earlier, but she stayed late to on this issue. She was on a mission to get this resolved for the member and did not want to put the responsibility on to someone else. When Erika got home, she was still worried that the member did not get the prescription, so she texted a coworker to follow up with the pharmacy to ensure the prescription was picked up without any issue. When talking about this issue, Erika contributed her success to the team. “As an advocate, when we all work together as a team, we can get anything accomplished.” Erika said situations like this make her proud to be an advocate for the member.

Erika Worthy – Blue Cross and Blue Shield of South Carolina

 

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Building Trust to Obtain Resolution

“I helped establish trust with the member by being open and candid about what changes I had the capability of making.”

It’s a popular expression that you never have a second chance to make a first impression. Though this may be true, one particular experience I had with a caller would suggest that first impressions can be overcome. While I’ve received angry calls before, this caller was absolutely livid from the moment the call began. This member would soon be going onto Medicare and he wanted to make sure that his spouse did not lose her coverage. Normally, this is a fairly easy transition, but this family had purchased their BCBSVT plan through Vermont Health Connect (VHC), our state exchange. This adds an additional level of complexity as VHC is required to handle all enrollment and billing and removes BCBSVT’s control of resolving these types of issues. This member had been dealing with VHC on the issue for months. During this time no progress had been made in terminating his plan and activating his wife’s coverage. Instead he had been instructed to overpay his premium to keep a two person plan active while they worked out the changes.

He was frightened at the possibility that his policy would end and leave his wife stranded without coverage, agitated by the amount of money he was forced to overpay, and furious that his concerns weren’t being heard by the representatives from VHC. These well-founded emotions manifested in an irate aggression toward whoever was on the other end of the phone, and in this case, it happened to be me. There was very little that I could do to directly resolve his concern. However, it was clear that the member was going to need an advocate on his side to get this issue taken care of with the state’s exchange. I started by spending an extended amount of time working with the member, first acknowledging the myriad concerns that he had and empathizing with the anger that he was feeling before even considering moving to a solution. These kinds of cases are challenging, because while the member views my company as the insurance, there is a limited amount of control I have over the enrollment for the member. However, simply stating that this wasn’t something I could help with would not bring resolution to the member.

I helped establish trust with the member by being open and candid about what changes I had the capability of making and assured him that I would stay with him through every step with the state representatives. I performed a conference call with the member and VHC. I helped explain the situation with the member on the line and when the conversation would slip off track, or unclear answers were being provided to the member by the VHC representative, I helped to redirect and seek clarification to ensure the member’s concerns and issues were accurately resolved. Ultimately, there was little that could be done at the time of the call, but I advised the member that I would personally attend to his policy to ensure that his wife never lost coverage through the transition and would make certain that every part of the process that could be done through the insurance company would be completed. Once VHC got his wife’s enrollment to BCBSVT, I made sure that all balances and claims were transferred from the old policy to the new one without any lapses in coverage. I proactively called her primary care physician to provide them with her updated policy number and alerted them that they would see an adjustment to their claims. I also alerted the member of this to ensure they understood each part of the process and ensure they did not experience anymore unpleasant surprises. Throughout this process, I kept in steady contact with the member so he’d be alert to any possible changes.

During one such conversation, I had just finished explaining where the insurance was in the process of moving her wife’s coverage when he stated that he needed to speak with my supervisor. Gruff to the point of being inscrutable, I connected him to my supervisor with a fair degree of trepidation. What followed was an unexpected email from my supervisor passing on the message from the member’s conversation: He said that in his entire professional and personal life, he has never dealt with a more helpful, polite, efficient, and just an all-around good employee. He (the member) said Anden deserves some recognition and he was very impressed with this young man’s professionalism. He went on to say that if he was still in business he would steal Anden from me and hire him in a second. Considering the virulence of his anger from the original call, it was difficult for me to imagine him expressing such positive sentiments. Every change within the state’s system moves slowly and the change for this member was no different.

My first fiery call with him was on 09/16/2014 and as of the time of this writing, I’m still monitoring the account for possible errors, disenrollment or misapplied premium amounts. Every morning, I check to confirm that his wife’s account hasn’t been terminated by accident and every two weeks, I take five minutes out of my day to call the member to confirm that everything is going well even if the state’s system hasn’t changed. On my desk, I’ve pinned a small thank you letter he and his wife mailed to me on Christmas as a reminder that no matter how a call starts, how difficult the problem may be, you can make a difference and positively change the lives of others.

Anden Drolet – BlueCross BlueShield of Vermont

 

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Swift Action to Obtain Urgent Resolution

“Cindy knew she had to fly into action to help this member and his daughter in their time of need.”

One morning Cindy received a call from a member who recently received an urgent call from his daughter’s college. The member’s daughter was severely depressed and the college suggested his daughter seek inpatient mental health treatment right away. With the father frantically driving from Vermont to Massachusetts he had little to no time to research inpatient facilities. By the tone of the member’s voice she could tell that the member was desperately seeking help as this was nothing he has ever experienced before. Cindy knew she had to fly into action to help this member and his daughter in their time of need. Cindy discussed with the member the benefits for inpatient mental health treatment, however it was very difficult for him to focus in his current state of mind and the member explained they wanted to just get to their daughter and then discuss benefits at a later time.

The next morning Cindy spoke with the member again and found a treatment facility, however this treatment facility was not in contract with the local Blue Cross and Blue Shield plan. Cindy knew the only option was for the member to submit a request for an out of network prior approval, which could take 48 hours. The member had called the facility, they had a bed available for her that day and the member was becoming concerned that she would not be able to be admitted today due to the approval process. Cindy took immediate action and ownership of the member’s concerns. Cindy was able to reassure the member that she cared about the situation and would work on this right away. She comforted the member and told him that she would get back in touch with him as soon as possible. Cindy took it upon herself to become the member’s voice and began to work across several departments to get the member’s out of network prior approval authorized. Leaving the member hanging was not an option for Cindy, and she was going to do her best to make sure that the member was able to get the treatment they needed. One of the benefits of being a small company is that Cindy could work closely with other departments. She explained the urgency of the situation and the prior authorization representative agreed to expedite the request. All the while keeping contact with the member so that he was aware of every step being taken.

The very next day Cindy was able to contact the member and inform him that his daughter’s authorization has been approved. She knew her experience with this member was not over, there would need to be a follow-up in a few weeks with members as services were being paid upfront by the member. A few weeks later Cindy contacted the member to check-in and the member was thrilled to hear Cindy’s gentle and calming voice. Cindy knew that once the member’s daughter completed treatment there would be a large claim that would need to be submitted and processed. Fast forward a few months and the member and Cindy have had many conversations. The member was happy to report their daughter was discharged and seeing a counselor on outpatient basis. The member now needed Cindy’s assistance in submitting a subscriber claim for their daughter as the inpatient claim was over $50,000. Cindy didn’t hesitate and initiated the next phase with the member. Cindy’s job was not to process claims, however she knew this was a huge financial burden on the member. What normally takes 30-45 days, Cindy accomplished in just few weeks. The claim was processed directly to the member. Cindy was committed to provide World Class Service to our members. Through proactively working across several departments, Cindy was able to expedite the out of network prior approval, and again a few months later expedite a large claim for the member relieving a large financial burden. This type of above and beyond service really sets Cindy apart as a World Class representative.

Cindy Tilotson – BlueCross BlueShield of Vermont

 

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Determination, Team Work and Empathy

“I wanted to ensure the member did not need to make any more calls.”

My call began like many routine calls with a member checking the status of a claim. I followed my usual process, checked on the claim and noticed it had not yet been processed. Based on some notes I was reviewing it looked like it was awaiting additional information before the claim could be finalized. I thought I would simply need to relay this information to the customer and the issue would be resolved and I would move on to the next customer. That is not what happened. She began to tell me her about situation involving the difficult ordeal she had to go through in order to be reimbursed for services she had. Normally claims are sent by providers’ offices and patients do not need to be involved with the claim process, but she had submitted her own claim and was intently waiting to be reimbursed.

The member explained that earlier in the year she had admitted herself into a substance abuse rehab facility, and through a cracking voice due to the tears she was trying to hold back she told me she had paid for the services up front by emptying her 401K fund. When she was finished with the treatment, she discovered the facility did not participate with insurance and she was stuck with the difficult task of trying to submit her own claim for the services that she says saved her life. She had tried calling her doctor who erroneously told her to call another Blue Cross plan out of state. She had been sent in multiple directions and put forth great effort and felt like she was getting nowhere. It had been over six months since she had been discharged and the issue was still unresolved. I could tell this member needed someone to take ownership of her case as she felt alone and overwhelmed. I assured the member she would be making her last call and I would resolve her dilemma personally. I coordinated with our Inter Plan Program (IPP) department and our member ombudsman to proactively obtain the information that was missing. We were able to push through the issues that arose and obtained all the necessary information to key a claim, but then a new problem emerged. The services she had received required a prior authorization which unfortunately had not been obtained before she was admitted. Additionally, she only had benefits with in-network providers, requiring additional authorization for the out of network provider. Normally we would just deny the service outright, but considering the situation, I reviewed this case with our Integrated Health Management (IHM) team to see if an exception could be made.

As a team we decided to proactively try and obtain the clinical information we needed to do a retro-review for the member. I made sure to inform the member where we were at in the process and went to work again. I wanted to ensure the member did not need to make any more calls, so I collaborated with the out of state Blue Cross plan and had them contact the provider to obtain the clinical information. We quickly obtained the information, but it wasn’t sufficient. Still determined to see this member through to the end, we kept working to get the information we needed. Over the course of about two months, I made weekly calls to the member to keep her updated as to the progress of her claim. Once the information finally arrived, our IHM team was able to establish medical necessity and authorize the services retro-actively. This allowed our IPP department to process the claim to the member’s benefits. I was finally able to make the last call to her advising of the final processing and the total amount of the check she would be receiving which paid for almost all of her expenses.

As a courtesy, I followed up with the member one week later to ensure she received her payment. The member was so relieved she had called our call center and only had to make one call in order for us to resolve her difficult ordeal. Through determination, team work and empathy, I was able to turn this out-of-the-ordinary call into another one of our everyday success stories.

Heather Young – BlueCross BlueShield of Vermont

 

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Follow-up to Gain a Member’s Trust

“Although Paula may have not had the member’s complete trust at the end of that first phone call, she gained his trust when she in fact did call him back as she promised.”

Diligence and tireless effort is all in a day’s work for this World Class CSR. Often times in Customer Service, it’s easy to forget that what you do makes a difference when you take call after call, day after day especially in an industry such as health insurance that is ever changing and highly stressful. As a Customer Service Representative for CareFirst Blue Cross Blue Shield, Paula Miller makes a difference every day, but to one member she made all the difference in 2014. Paula received a call from a member who had received a collections notice stating he owed over $11, 000.00 for claims that were overpaid. The member felt he didn’t owe us this money because he had already paid the money to the provider for medical services rendered. Most of us would be quite anxious and worried to receive such a large bill and this member was no different.

Paula immediately started putting his mind at ease by reviewing the potential overpayments on his account and reassuring this member that she would get to the bottom of it. The amount of claims to review were extensive and Paula needed more time than was feasible on that first phone call. She explained the service steps she needed to take and committed to calling him back the next day. The member was hesitant to let her go, but Paula reassured him that she was going to fulfil her commitment to call him back. Although Paula may have not had the member’s complete trust at the end of that first phone call, she gained his trust when she in fact did call him back as she promised. The result of Paula’s research that first day landed her with a very complex issue involving Medicare and a large volume of claims which took many days to fully resolve.

Through Paula’s efforts and collaboration with our claims and accounts receivable departments, she was able to remove the $11,000.00 financial liability from this member. I can’t even describe all the calls and emails it took for Paula to resolve this, but there were no less than 20. And although the actual steps to resolve took significant time in Paula’s day, she never failed to give the member an update every two days. She truly gained his trust in her, but also gained his trust back with CareFirst Blue Cross Blue Shield. This member took the time to speak to Paula’s supervisor when the issue was resolved to let her know how much he appreciated Paula’s hard work and follow up. Even when she had no update to report, she still checked in with the member so he knew he was not forgotten. Paula never failed in providing these updates until this issue was completely resolved. This is typical of the service Paula provides daily and why she deserves to be World Class CSR of the Year.

Paula Miller – CareFirst

 

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Own Every Call

“For a small moment in time he is their warrior.”

When we think about the characteristics that we would want all customer service advocates to possess, there are several traits that come to mind. Knowledge, compassion, empathy and leadership are just a few. Selflessness, willingness to advocate on behalf of others, and thinking outside the box to find a solution for a member, these are the other qualities. A customer service advocate should bring these traits to work every day. Eric Marks does just that. Eric provides a world-class level of service on each and every call by using these traits to ensure our members have their issues resolved on the first contact with our call center. Eric has been a customer service advocate for two years and has grown into one of our strongest silent leaders. He leads by example but often fades into the background. He does not seek recognition or accolades for providing world class service. However, Eric strives to take ownership over the issues he finds our members in. This isn’t just a one-time occurrence for Eric. He is always resolving issues for our members. Eric’s goal is to help whomever he comes in contact with.

For instance, one Friday night after 5:00 PM, Eric’s path crossed with one of our members who needed help with his medication. The member was new to our plan and was trying to get his prescription filled at the pharmacy before the weekend. The member was at the end of his rope when the phone rang at Eric’s desk. Eric immediately recognized that this member had a trying experience up until this point. Eric took ownership of the issue and worked with our internal drug support team to figure out why the prescription was being rejected. Once they figured out what was wrong, Eric reached out to the pharmacy and asked them to rerun the prescription. The fix put in place by drug support worked and the pharmacy had the medication ready for the member upon his arrival back to their store. Eric called the member and let him know his prescription was ready and even told the member how much it would cost. The member was grateful for this. He could not thank Eric enough. Eric found a way to get the much-needed medication for the member when the member truly felt as if all hope was lost. Why? Eric wanted to own the issue and make sure the member did not have any additional issues with this prescription. Eric wanted to take care of this matter on the first call. He did just that and helped solidify the member’s perception of how much his health insurance carrier cared for him as a person. This was due to Eric’s willingness to put his own needs aside on a Friday night and get the job done.

Over the course of his two-year tenure, Eric has only had two escalated phone calls. This is phenomenal. This is a true indication of his ability to own every call. He listens to the caller’s needs and even hears the needs when the member is not speaking them. Eric has an innate ability to understand what the member is trying to say. He is a calming force on the phone. He de-escalates any issue and works to find a solution to whatever the problem our members are facing. He takes on their problems and for a small moment in time he is their warrior as he finds a way to get their needs taken care of. By always putting our members first, handling their issues on the first contact, and providing superior customer service on every call, I believe Eric Marks is a wonderful representation of what a customer service advocate should be.

Eric Marks – BlueCross and BlueShield of South Carolina

 

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What Does it Take to be a Real CSR?

“I chose to serve.”

One memorable call I had was five minutes right before the end of my shift and I was excited to finish the call as soon as possible. Instead, I got an angry and troubled voice. The customer was so furious he told me that if I could not assist him I should connect the call to a manager or someone else. Though I was tempted to pass the call off, I knew that he needed help and I needed to do something to help him. I decided to provide my empathy statements differently from the standard responses and not only did it lessen the aggravation, but it also gave me the opportunity to bring up his account information and learn that there was a four month negative credit reporting dispute.

As the customer’s emotions hindered him from explaining the situation thoroughly, I used effective probing questions to obtain more information. Bit by bit, the story unfolded making me realize that the situation was far more challenging than what I thought, but I encouraged myself not to give in and to focus on the goal of resolving the call. The customer’s mortgage servicing rights were recently transferred to Nationstar. He was very particular with all his payments so he had set up an automatic payment with a third party vendor to make sure all his payments were made on time. However, the customer was unaware of the transfer to Nationstar and his payments were sent to the prior mortgage servicer address instead of being sent to the new payment processing address. The customer had made multiple attempts to submit a credit dispute to our research team. However, the research team’s instruction was that the customer must contact the third party vendor and ask for a letter stating that it was the third party vendor’s error of sending the payment to the wrong payment processing address. He rebutted that he already made the request to them but failed to get such a letter.

Being fully aware of the situation, I realized that it was up to me to fix this and no one else. I told my customer that I would be the one to talk with the third party vendor to help him with the request. We attempted a 3-way call, but we got an uncooperative representative. I kindly asked the representative if there is a way he could contact someone to make a follow up on the request. The representative decided to connect us to another agent who agreed to email me the required document. I let the customer know that I felt even more confident now that the situation could be corrected. Before concluding the call, I contacted his prior mortgage servicer to get more details. This time, the customer thanked me for my patience and willingness to make another conference call though it was getting late in the evening.

After the last conference call, I learned that the prior mortgage servicer forwards any excess payment to the new mortgage servicer automatically but could take up to 30 days after the transfer. I filed a credit dispute, which I escalated to the research team with the attached supporting documents. I monitored the submitted research request daily, and contacted the customer as soon as I got a response.

A month passed when our CEO received a letter from this customer recognizing my efforts. I could have passed the call off that day. I could have gone home when I was scheduled to. I could have given him a canned response about contacting the third party vendor as he was instructed prior, but I chose not to. I chose to serve.

Jerry Dormido – Nationstar Mortgage

 

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Strong Partnership with Support Team Ensured a Positive Result

“I wasn’t sure if our procedures would allow for anything to be done, but I wasn’t willing to give up just yet.”

I often handle call types where customers are concerned about interest or other charges on their credit cards. Recently, I handled a call with a credit card customer that from the opening had the potential to be challenging. This caller came in quite displeased and clearly had a very negative view of the credit card company. He started off by introducing himself as a professionally employed individual with knowledge of the finance sector. Reading between the lines and factoring in his tone, he was warning me that I better get this interaction right!

As I listened intently while he explained the situation, I learned of a $3.50 statement balance that went unpaid for two statement periods, which resulted in a delinquent status being automatically applied to his credit file. He kept repeating how he could not believe that such a small amount could negatively impact him and then he shared more details that helped explain his level of displeasure. He was in the process of applying for a mortgage so the timing could not have been less ideal.

To start, I explained how the small unpaid balance had ultimately been the root cause of the situation and educated him on options to avoid this issue in the future. He explained that the card is not used frequently, and that his wife used his card in error. He had not checked for statements or payments, as he did not realize it had been used. This client was not speaking of his credit card company in a very positive light and I knew that this interaction was our only opportunity to turn around his view. I told him I was not sure if our procedures would allow anything to be done, but that I was not willing to give up just yet. I wanted to see if there was anything creative we could do to change the impact that this small error was having on his credit score.

I understood why he was upset, so my empathy was certainly natural. I did not know at this point if I could earn back this client’s trust, but I wanted to try. While the customer was on hold, I escalated his concern to have his credit file reviewed. It did take a bit longer than initially anticipated, so I refreshed the hold a couple of times, and ensured he knew I was working on a solution. As a part of the escalated credit review process, I was able to remove the delinquency status from his credit bureau file, which immediately corrected his credit rating. I was finally able to deliver good news to the client and he became speechless. I simply reassured him that I meant what I said when I told him I understood and was not going to give up.

This tough situation was resolved in one call, which made me proud, but I could not have done it without the help of our support team. With the help of my Team Leader, we were able to immediately engage the proper channels and resolve with positive results – all while the client was on hold. This correction of the client’s credit file not only improved his view of his credit card company, but also allowed him to secure the best rate for his mortgage.

Patty Nauss – Millennium1 Solutions

 

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A Path Towards Resolution

“What started out as a frustrated member going through a difficult experience was now a satisfied customer.”

Getting a call from an upset member with a denied claim is never easy. It takes an abundance of focus displayed through listening skills and patience, as well as the ability to empathize with what the caller is going through and why they are feeling frustrated. Heather took such a call from the spouse of a member with a denied claim. Her husband had recently undergone a risky surgical procedure, and he needed follow-up care to help his recovery and achieve the best possible outcome. Unfortunately, the member’s healthcare providers had not submitted all of the documentation that was needed and so the claims had been denied.

As a result of this denial, our members were facing a very large medical bill from the hospital, not to mention the stress of worrying how they would be able to pay for these services. They called customer service to find out why their claims had been denied, and what could be done about it. The call was connected to Heather, and she immediately recognized by the tone of the member’s voice that they were very upset and frustrated with the claims denial. Heather immediately put her great soft-skills on display; she took the time to listen and acknowledge the member’s concerns, and after hearing what the member had to say, Heather offered to review the claims, find out why they denied, and then determine what steps, if any, can be taken to resolve the issue.

After reviewing the claims in question, Heather immediately spotted the root cause of the problem — the member’s claims had been denied because we were missing some specific information and, without it, we could not determine whether or not the services rendered were medically necessary. This basis for this decision had been made available to the provider, but they had not taken any actions yet to provide the missing information. So, Heather made an outreach call to clinical review to find out what exactly was missing, and then she relayed that information back to the member so that they could take a specific list to their provider and get them to send the missing records to us. This helped to put the member at ease, because she now saw a path towards resolution. Towards the end of the call, the member was very grateful for the assistance that she received. What started out as a frustrated member going through a difficult experience was now a satisfied customer that knew exactly what needed to be done to get her husband’s claims paid.

It came as no surprise when, on the very next day this member got surveyed by SQM, she told them about the great experience she had. Here’s what she had to say: “She was very helpful. She answered all my questions. She looked up everything and actually consulted with another department to make sure that she was giving me the correct information gave me a phone number to make sure this information got to the correct place it needed to be overall, she was very kind very informative and just very good at her job.

This is just one example of how Heather frequently goes above and beyond to help our customers. She doesn’t just answer the question for them; she explores the issue and looks at it from every angle to identify problems, anticipate needs, and make sure that all of the issues get resolved before the end of the call. For the year, Heather has received 36 surveys from SQM, and 32 of these were rated as “World Class Calls” (that’s an 89% WCC rate!). As a result of her outstanding performance in all of our key results areas as well as her demonstration of our core values, Heather was promoted to Sr. Customer Service Rep in September of this year, and in this new role, Heather will be mentoring our newer associates and teaching them the meaning behind words such as “World Class Service” and “First Call Resolution”, expectations Heather lives up to each and every day.

Heather Sundheim – Premera

 

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A True Service Hero

“Ended up saving over $700 a month in premiums!”

Leslie has been nominated twice and has won one of our highest awards as a Service Hero in 2014. She is an outlier on her team as far as receiving member compliments. Members regularly ask to speak to her Supervisor directly or send emails, notes and cards.

One day Leslie received a call from a member. Our member was in the waiting room at Providence Hospital where she had a scheduled follow up appointment. She had learned that her provider would be considered out of network and was confused by what that meant and how it occurred. She was having a difficult time finding a provider that would see her due to her numerous medical issues. Our member was on both Medicare and Individual policies. The individual policy impacted the network and reimbursement options that she could utilize. The individual policy was over $700 per month in premiums and our member indicated she had previous visits at Providence Hospital that she was concerned we would not cover. Leslie promised the member that she would help her. Leslie moved ahead with contacting Providence to review the claims and discuss if a payment reduction or financial assistance was an option. The good news was that the 2014 claims on file were not from Providence and they were processed out of network in error. Noticing this, Leslie sent them to our claims division to make the adjustments needed. From there, she worked on setting up a case management referral. Leslie contacted sales and asked for a packet to be sent to our member and asked about options outside of open enrollment for plans. She then called our member back and explained that if she qualified for LIS (Low Income Subsidy) through Social Security she could move to a supplement or Med Advantage plan. Leslie continued on to let her know that the LIS and sales literature had been mailed to her for review. She then provided her with a sales contact number. Leslie continued to remain in touch with our member for the next 6 weeks as she was in and out of the hospital to ensure that she was receiving the required information and could support any questions she may have. Our member was effectively moved to a much lower cost plan due to Leslie’s help and as a result ended up saving over $700 a month in premiums!

Leslie Wassmuth – Regence BlueCross BlueShield

 

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More Than Just a Customer Service Representative

“I truly feel that I am my member’s advocate and advisor.”

Many Medicare members have unique challenges. Most are over 65 years old and many have physical or emotional disabilities. I remember one particular member who called in crying and upset. She had recently lost her husband and she was dealing with major pain management issues. She was just one of many who are all alone and have no one else they can depend on to help them with their medical concerns or insurance issues. The member was so distraught that I asked if I could call 911 to have someone check on her, she refused, so I decided to call her hourly until I could find a counselor and pain management provider for her to see quickly.

I know that each member needs to be worked with in a manner comfortable to them. I pride myself on being able to quickly determine our callers’ needs, build rapport, and answer the questions they ask and more importantly, answer the questions they don’t know they need to ask. I do this by speaking to my members in a caring, clear, and understandable manner, and tailoring the experience to each member’s individual personality and style. I know that what I tell a member will help them make informed decisions that can directly affect their quality of life. I have a passion for helping our members understand their benefits and take great satisfaction in knowing they received the care they need. I truly feel that I am my member’s advocate and advisor. It has been very gratifying to have the members I spoke with help me become a World Class Certified Customer Service Specialist. But my role at Regence MedAdvantage is so much more than quoting benefits and explaining claims! As important as that is, I get a special sense of satisfaction in taking the member out of the middle by making calls for them and by getting them the information they need.

But, my role in the member’s issue doesn’t end at the conclusion of the call. Knowing that many of my members don’t have anyone to check up on them after surgery or to care about how their treatment or procedure went, I keep their information handy and I follow up with them a week or two down the line. When appropriate, I follow-up periodically throughout the year to make sure members with special needs feel that someone cares about them and is concerned about their well-being. I have followed this particular member for months with her ups and downs and helped her with claims and other appointments. It is always rewarding when I call the member and find her happy to hear from me and doing well. I know I was a part of helping her get to that point. This kind of personal attention is what makes this position so much more than just a job. I always remember that I don’t take a hundred calls a week or more. No, I speak with a hundred individuals with individual needs and make an effort on every call to positively affect their quality of life. And that’s why I look forward to coming to work each day and speaking with our Medicare members, and knowing that they have rated me as a World Class Certified Customer Service Specialist makes me proud and gives me a great sense of personal satisfaction.

Trisha Wells – Regence BlueCross BlueShield

 

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#SAVETHEDAY!!

“After all my years of business with your Bank, I am at my wits end!”

“After all my years of business with your Bank, I am at my wits end!” Those were the opening remarks of the customer wanting to throw in the towel! She had a good credit card payment history and banked with Scotia for many years. She had traveled overseas and left her personal assistant in charge of her financial obligations. Upon the client’s return, she received statements showing that her credit card was severely past-due and had incurred fees, something she had never experienced before. She subsequently visited the branch and was advised that the request for waiver of charges needed to be put in writing. She was quite upset and annoyed with the suggestion given and I suspect this is why she was referred by them to the contact center. By the time I got her, the customer was filled with a wave of emotions. She sounded extremely distressed and disappointed that after all the plans she left in place to ensure her bills were settled on time were not done. The bank she expected to “have her back” was asking her to put it writing. She wasn’t feeling valued like a Customer. It was almost as if she was told to take a number and wait. She was at the point of closing all accounts and settling the card balance. I personally felt hurt just listening to her tell me “she was at her wits end” for something that could have been easily resolved. Right away I knew I had the solution and I was able to help. I made a quick assessment of the account and being empowered to make discretionary decisions, was able to reverse the charges without a letter and restore her account. This action not only retained her business, but created a positive memorable experience and made a fundamental difference in the life of this customer. I also now realize that I may well have by extension, retained the business of her family and friends, and made her a loyal customer of the Bank. Hearing the customer say to me, “What you did for me today really changed how I viewed the Bank and its service standards. You really are making a difference,” left a feeling of intrinsic reward. I truly felt like I was her “new” personal assistant that made a difference and helped to “Save the Day”.

Danielle Angus – Scotiabank International (Jamaica)

 

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I Love What I do

“It struck me that there was more at stake here for both client and firm.”

I love what I do! I truly love speaking to clients, understanding their needs and resolving their issues. It gives me a sense of accomplishment when they tell me that I made a difference in their lives; that they can feel that I genuinely care and that they are very happy that I took care of their needs.

During a call that I received, the client was already extremely upset and her request was to have her funds transferred into her retirement plan account. She indicated she had sent all her documents to us, but fell ill and which was why she did not get a chance to look into it. Now that she was on her feet again, she was shocked to find out that not only she did not receive her payment as requested; she was also taxed a large sum in the process. It was a complicated situation so I had to ensure that I was listening and asking questions to fully understand the situation. It was a lot of money, so I was extremely empathetic. Once I fully understood that it was not something I could resolve on the spot I advised her that I would take full ownership and that this was an urgent matter that I was going to resolve. I provided her my direct number and promised to call her on the same day with an update.

I immediately contacted our back office inquiring why she was taxed for unlocking her funds when she simply transferred the funds to an RRSP account. I also had to find our why the payment was not done as per her instructions on the initial application. I was told they will look into it, and that I should get an answer the next day. Keeping my promise to the client, I called her back and advised her of the status of her inquiry and reassured her that I was on it! The ensuing investigation determined a system error incorrectly withheld 30% in taxes. I was advised this would be reversed within 3-5 business days.

For the payment, unfortunately the answer was not in client’s favor. I was told that since the client did not follow up on the payment, it was not paid out. It struck me that there was more at stake here for both client and firm; more than just ensuring that we simply adhere to our service delivery model. The client was relying on the funds for her livelihood and this represented her only source of income. Knowing how important this was to the client I decided to escalate the matter further so that all relevant parties are involved. It was deemed that existing provisions allowed for us to fully accommodate client’s request. A payment was issued and sent to her bank account on the same day. Furthermore, the initial tax treatment was revisited and reversed.

I reached out to the client once again, and I shared the good news with her. I was able to resolve all of her issues promptly and that her maximum payment would be in her bank account the same day. By this time she was nearly in tears. She said that she is convinced that I am an individual who is not simply out there doing my job, but that there’s genuine care in my service; and that this was clearly evident on every level of my interaction with her. It is reactions like this that make me love what I do!

Melliza Beroy – Scotia iTRADE

 

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Turning Around the Client Experience

“Nothing motivates me quite like turning someone’s negative experience into a positive one.”

The primary goal of a customer service representative is to get the call resolved. The primary goal of an SQM World Class Certified representative is not only to get the call resolved, but to provide a unique, memorable and pleasant experience whether starting with a blank slate or turning around an experience that started badly. When faced with a new situation, I take the steps necessary to find a permanent solution and to educate the client of all applicable information and consequences. With situations where I am not the first contact regarding a situation, I take extra care to ensure that I am the last, most accurate and most helpful person the client speaks to. Nothing motivates me quite like turning someone’s negative experience into a positive one. In situations where the client gets the short end of the stick, I work on behalf of the client to come to a reasonable and speedy solution the client can be satisfied with.

One example of this is when I had a client who was confused about a transaction that occurred on an account. There was a movement of assets from her husband’s non-registered account to her son’s Tax-Free Savings account as a contribution. She has authority on both accounts so she was able to see this transaction but could not remember asking for the transactions. Upon further investigating I found a letter of direction she had sent attempting to set up power of attorney (authority to transfer shares and cash between these two accounts on an ongoing basis), signed by all three family members. It was not the required Power of Attorney form, I confirmed with her that it was not an instruction to transfer specific assets, but rather an attempt to set up sufficient authority to do so in the future. The damage was done and assets were already contributed from the husband’s non-registered account into the son’s TFSA, causing a taxable over contribution. Someone else had interpreted the letter differently.

I empathized with the client’s shock and disappointment and guaranteed that everything will be resolved as soon as possible in a method that inconveniences her least. As a permanent solution to her original problem, I showed and explained the Power of Attorney form to set up authority for the future, and the proper procedure and letter format required for movement of cash or securities between ownerships. I apologized, explained to the client what went wrong, confirmed the original request with her, and corrected the incorrect or incomplete information she received before ensuring that she understood my message as I intended her to. I requested the client to allow me what I believed was a reasonable time frame to resolve the issue, committed to keeping her informed along the way.

I pulled all available strings, provided proof of error and expressed the client’s point of view while coordinating and negotiating a solution with other departments involved, and the solution was found quicker than expected. I called her the next day to let her know that the correction will be processed within days, and the contribution will be cancelled. As the letter provided originally was misinterpreted, no further action by the client or her family members would be required. Again, I committed to call her with updates and leave messages as required. Within the same week, on the Friday just before leaving work for the weekend, I was pleased to receive an email informing me that the error was corrected and the client has been made whole. With a smile on my face, I called and left a message with her husband (as instructed) to let his wife know that the issue was resolved, and to wish her a happy and stress-free weekend. Leaving on vacation the next week, I put the situation out of my mind. As it was resolved I did not expect for the client to communicate with me again. To my pleasant surprise, upon my return to work, I had received a hand-written thank you card from this client. For me, it was just a regular part of my daily duties, but to her it was so much more.

Anna Gizicki – Scotia iTRADE

 

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A Life of Customer Service

“You could say customer service is my calling.”

Through my adult years, most of my career choices have somehow allowed me to help others. I guess you could say customer service is my calling. Sun Life Financial is the second company that I have worked for that celebrates just that customer service. Not just mediocre service, but World Class service. Through my years at Sun Life, I have been blessed with many skills to provide just that. I believe that the more you can offer your customer the better their experience. May it be from assisting them with their benefits coverage or providing them with guidance in selecting their plan, every little piece matters. With recognizing that, I have been fortunate enough to be World Class Certified for the past 4 years. I have always felt that knowledge and assistance is the key.

I had a member call into the customer care centre one morning that was on the brink of tears. She advised me that she had called Sun Life on multiple occasions, and she was at her wits end with the company. Every time she called in about her daughters declined claim she would keep getting the same answer: just have the pharmacy resubmit the claim and we will be able to process it”. But little did the member know, they were wrong. See, the member had been trying to get an expensive Cancer medication for her daughter approved through her pay direct drug card and it kept declining. She said it normally would not be an issue; she could have paid for it herself and mail in the receipts. But since this was a very expensive cancer medication and she had been off work, caring for her sick daughter, a $1200.00 out of pocket experience was not feasible. As she finished explaining her situation I quickly reviewed her claims, and saw what was happening. The codes that the pharmacy was submitting were mixed up. Now instead of just advising what to tell the pharmacy, I decided to resolve this matter once and for all.

As Sun Life is an incoming call center, outbound calls are not a part of our everyday call flow, but I took it upon myself to ask the member for her permission to contact her pharmacy to rectify the situation. She obliged, and I placed her on hold. I then proceeded to contact her pharmacy and was lucky to speak to someone who knew the members situation. When I was reviewing her daughter’s claims, I noticed that the code that the pharmacy was using to identify her daughter was in fact one that was supposed to be used for the member only. So at a quick glance of the claim, you would see the daughter’s correct name and date of birth which would lead you to believe everything was ok, except it was being declined. I then walked the pharmacist through the claim submission, which was able to reflect in our Sun Life system right away. The pharmacist then apologized for the inconvenience caused to the member and asked if I could let her know it was approved and ready for pick up.

When I came back on the line and apologized for the wait. I told her everything was fixed. As she started to speak I could hear the hesitation in her voice. I ensured her that I walked the pharmacist through the claim and I saw the approval myself. I gave her the full claim details right down to the penny to reassure her it was approved. I also advised what happened with the past claims so she was aware for all future ones. I then proceeded to happily advise that the pharmacy has the prescription ready for her. The member then thanked me with the sound of happy tears in her voice, and wished me a wonderful rest of my day. After we disconnected the call. I had an overwhelming sense of pride in myself. Not only was I able to resolve an ongoing issue for our member and hopefully relieve some burden, but I believe I was able to bring some confidence back to our member regarding our customer service. It is moments like these that make me love my job. I truly enjoy providing excellent customer service and helping people.

Erica Kelloway – Sun Life Financial

 

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Going Above and Beyond to Ensure a Memorable Experience

“I knew my job was done and that I had gone to the lengths that were within my reach to provide the service that was needed from Sun Life Financial.”

Every time a call comes in there is one thought that comes to mind, “How can I go above and beyond to answer their question?” At the end of every call there is one thought that comes to mind, “Did I do everything I can to answer this members inquiry?” This is why I am certified again in 2014. My members come first. I always find a way to go above and beyond to make sure that this experience was not only a memorable one, but one in which I was able to resolve their issue. Considering I do this on every call, this particular instance was one that was easy to remember. A few months ago a call came in and I felt the nerves and sadness in the caller’s voice as soon as I responded. I knew this was going to be a call to remember. I followed the same routines as usual, identifying, authenticating, and the logging, but I completed it with patience to make sure the caller did not feel more stressed than need be.

When asked how I could be of help, the caller started expressing her personal barriers and panics, letting me know that she suffered from cancer. Usually this is not something people automatically share as openly, however she felt I could be trusted. She has recently been diagnosed and had no idea what steps to follow, what she had to do, or who she had to call. I made sure to acknowledge the unfortunate events she was experiencing as well as provide during this difficult time. I promised her I would not disconnect the call until she felt comfortable and at ease with the information I was to provide. I needed to know everything to be able to respond to what was needed. I asked for her permission before hand and asked her about her situation and where she was with her knowledge towards the newly diagnosed disease. Once all of this was gathered together I confirmed EVERY detail possible that was needed to my knowledge for cancer patients. We started going through a list of medical equipment that might be needed, such as wigs or living aids. I made sure to confirm the coverage even if services had not yet been prescribed to inform her as best I could about her options.

Even though we currently were not aware of which drugs she would be prescribed, I educated the member on how to confirm her own coverage instead of having to call every time. I had even researched online any other aspects I may have been missing to make sure there would be no other reason for this member to call in after the end of our discussion. Once I felt that every detail was discussed she started crying. I told her everything would be alright and asked if there was anything else I could have done to make her feel at peace. She said: “I am not crying because I am sad Gen, I am crying because you are the first person I have told since the news was broken to me and I would have never thought that my insurance company would be the one to make me feel like everything will be okay and I will survive. Thank you Genevieve for being the person you are and making this horrible experience a memorable moment even if just for 10 minutes.” I knew my job was done and that I had gone to the lengths that were within my reach to provide the service that was needed from Sun Life Financial.

Genevieve Tees – Sun Life Financial

 

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A Lasting Imprint

“This experience has helped me to decide that even over the phone you can touch some one’s life.”

I have been lucky enough to have an experience where I was not only able to help someone; but where it left a lasting imprint on my heart and brings a smile and a tear every time I think about it.

Back in May I received a call from a woman. She was quite shaken and was looking into withdrawing money from her retirement account due to hardship. As I looked through this I realized that she had already processed a withdrawal due to financial hardship two months earlier for low income. Knowing that a person can only process one withdrawal due to hardship in a calendar year for low income, it saddened me to have to communicate this to the member.

As I began to explain the rules indicating that this was not possible, she interrupted and explained that she had lost her job during a time when her husband was going through some medical treatments. They had the opportunity to take out more than they did at that time but she had just finished a job interview and at that time the position looked promising so they decided only on a smaller amount. She also indicated that she had spoken with her city counsellor and they had told her that it was up to the institution whether or not they would allow for a 2nd low income. Still being a newer employee I told her I would look into this and call her back. I followed up internally to see if there was any possibility that I might not be seeing. Administration replied to me advising me that there was no way. This did not seem right to me and I dreaded being the one to have to call the member back and break her heart.

I continued to mull over hardship withdrawal rules and sure enough, there it was, right in front of me. Although she could not apply for low income, I recalled her saying that she didn’t want to lose her house. I immediately emailed administration and had them confirm that as long as the hardship withdrawal was for a different reason she could apply under the different category to see if she qualified. Administration replied back just as fast confirming this. I immediately placed a call to the member and told her about this new possibility for applying based on her mortgage requirements. We both were ecstatic. I told her I would e-mail her the forms and she could submit them right away.

Wanting to see this though and provide her and her husband with peace of mind I gave her my e-mail address so we could communicate more easily. A few days went by so I decided to take a look to see where things were at when I realized the forms had not been received. I called her back right away to try to rectify this and get her the proper forms. Once I was able to confirm that I was going to send her the proper forms right away, the member became very upset. She told me that even if I did this, she had no way to get the forms to us because she had no money to send them back to us by courier. I quickly offered fax; but she had no ink in the printer and no money to buy ink. A lump came up in my throat and tears in my eyes. I felt that I had to help this member any way that I could. I noticed that she lived in Kitchener, close to where our office is so without hesitation, I offered to bring the forms directly to her house and put them in her mailbox. I told her I would do whatever I could to help. After a very heartwarming conversation she said that she may be able to print them off at a friend’s house. I gave her the right fax number and within days she received the funds in her account.

After a few days I received a follow up email from her. “I would like to thank you again for all you have done for me regarding my situation. Words cannot describe how much this means to me and my family. You are a true example of outstanding customer service, listening and caring for your customers. Thank-you! This experience has helped me to decide that even over the phone you can touch some one’s life.”

Kerri Schebesch – Sun Life Financial

 

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An Experience to Remember

“This will be one I will never forget and I will continue to cherish my time working with Sun Life.”

My journey with Sun Life started just over a year ago, I had never worked in a call centre previously and wasn’t entirely sure what to expect. Working at Sun Life truly gives me the ability to help people and make their “Sun Life” experience outstanding. The most rewarding day I experienced, was when a disgruntled customer called in and I had no I idea what to expect! But let’s start with this email: “Excellent customer service Michelle! If there is one reason I am staying with Sun Life now, is because you kept and delivered on all your promises.” Sun Life Customer. I received that message from our customer after resolving a lengthy problem for him.

Our journey together began two days earlier, when I answered a call as per our process “Thank you for calling Sun Life Financial, you’ve reached Michelle…” The gentleman replied expressing his concern about a transaction that could not be processed from a previous representative. It seems he had a restriction flag on his account for bankruptcy, which he was not aware, and the discharge papers were never processed, which was his main purpose for calling in. Without hesitation I contacted the administrative team. Priority # one for me was to confirm what information was needed so I could remove the restriction flag (as many of you may now, with this restriction on the account I would not be able to process any of his requests). Therefore, removal was necessary. He expressed instantly, with threat, to remove all of his money within SLF and seek out services elsewhere. He had lost all confidence in SLF; this saddened me but also sparked the flame that fueled my ambition. It was clear to me that the key to a successful resolution was clear communication with our customer.

The outcome had to be resolution; therefore I pledged to him what my obligation to him was as a SLF representative, “I am very sorry sir, for the occurrence of this situation. This situation should not have come into existence, but I reassure to you, that I will do whatever it takes to resolve this problem.” Going above and beyond is what I pride my customer service on, take the steps necessary in order to exceed all expectations. I accomplished with essential composer the removal of the restriction within 24 hours. I remained in communication with him during the entire process, in order to give him the assurance and understanding he was undoubtedly looking for. I sent his discharge papers on high urgency. As soon as I gained knowledge of the forms being sent in, I contacted him immediately. I noticed that the funds were being sent out in the form of a cheque, which would take more time. Therefore I called him immediately and requested his banking information to have the funds deposited directly into his account. The member was not only happy that I was making this my number one priority but, was pleased to see I was making sure to take every measure to have this funds to him asap.

Once I received the message from my team to say the flag was removed I processed the withdrawal and called the member to give him the timeline as to when he would be seeing his funds and that he could rest assure that the problem had been fixed and he would not be having issues moving forward. The member was incredibly grateful for all of Sun Life’s hard work in the matter and that I had let him know what was going on every step of the way until there was a resolution. It is safe to say this will not be my last rewarding and touching experience. But, this will be one I will never forget and I will continue to cherish my time working with Sun Life.

Michelle Robinson – Sun Life Financial

 

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Changing the Future One Call at a Time

“Willing to go above and beyond.”

In my role as a customer service advisor, I am always willing to go above and beyond for my client, especially when they are in a situation of great distress. There have been multiple occasions where the reward of helping people has far exceeded my salary or recognition of “providing good customer service”. Below is one particular event that I will always remember and remind me that I love what I do.

I received a call from a young, single, brand new mother who was on disability prior to delivery. Due to a premature delivery, her newborn baby needed vital medications. It was after delivery that she discovered her benefit coverage was discontinued. The medication was extremely costly and was going to be a serious problem for a new mother whose child was already ill and at a high risk of additional health problems. During the call, it was emotionally difficult to absorb, and it was impossible to relate to what was happening to this young mother. I recognized immediately that this needed to be handled as quickly as possible, regardless where the error originated. I made the promise to her that I would take ownership and stay with her through the entire process. Although she was in tears and distraught beyond comfort, I listened carefully to what she was saying. She was able to give me some background information, such as when her coverage stopped, and that her healthcare provider advised they have not received necessary information from her employer.

I first contacted her ability advisor to ensure that the correct paperwork had been submitted to, and received by, the benefit department. This was instantly confirmed, but I still needed to confirm that the provider was notified. This process required a day or so in order to be confirmed. At this point, I informed my caller of our progress and assured her that I would do everything in my power to have this resolved as soon as possible. An extra sense of urgency kicked in when I learned that her newborns medications were almost gone. She could not afford the cost of additional medication right away. My attempt to understand and my compassion for her definitely gave her a sense of support and helped to alleviate some of her stress. The following day the benefits resolution specialist followed up and advised that there was an error with the providers interface. This was not the news that she wanted to hear, and the fix could take days before her benefits would be reinstated. I escalated the ticket to my resolution specialist and my management immediately in hopes that we could resolve this sooner. Fortunately, our departments saw the urgency of this situation and contacted the manager of the benefit department. Hours later, my resolution specialist, along with my manager, and the client, advised me that the information on the providers interface was corrected and that she would be able to use her coverage the following day. While I was waiting for an update that day, I called her to let her know at what stage in the process we were at. That alone changed her emotional status and she felt that she finally had support. When I relayed that her coverage would start again the next day, she was finally able to relax and enjoy being a new mom. She said she felt so relieved and was so grateful that I was patient and understanding of her situation and that I was quickly able to address her problem.

The most rewarding feeling of this experience was after learning that because of this situation, our client put a practice in place to have management notified of special circumstances like this. I take a lot of pride in knowing that my actions have helped others and will continue to help others. A new process has been put into place by our client to address sensitive issues and we now have a team of individuals who personally follow up and monitor issues like this. The client worked closely with our contact center and together both teams developed training and reference materials to identify sensitive issues and ensure timely resolution moving forward.

Davor Ilic – Telus Sourcing Solutions

 

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Committed to Make a Difference

“Going above and beyond is what led to getting her retirement information to the correct contacts in such a timely manner.”

I want all employees to understand that we are here for them and care about their needs and concerns. I enjoy taking ownership and following through on my commitments. I had received a call from a Registered Nurse whom had submitted her retirement application months previous and wanted to know when to expect payment. The employee advised me that she had worked with her manager to ensure that the retirement documents were submitted for processing well in advance of her retirement date. At this point, she had not yet heard back from anyone for follow up, and was very concerned, which prompted her call.

She told me of her 25 years worked as a Registered Nurse and how much she and her husband were looking forward to their dream cruise vacation, once she was officially retired. I immediately searched for the retirement request, which had been processed correctly in the system, and therefore was already reflecting as “pending retirement”. After asking the employee for the specific dates in which she submitted the documents and how they were submitted, I was able to determine the underlying cause. The employee had submitted the retirement documents directly to Local Authorities Pension Plan (the pension plan administrators), prior to submitting to her own HR for approvals first. This in turn, holds up the retirement process for the employee, which can cause delays in payment. I then reviewed the system data and I was able to see that the employee’s Manager was new to the organization. In this case, the Manager had signed off on the sections in which the pensions department should have approved, and then submitted the documents directly to the Local Authorities Pension Plan based on the address on the top of the form. It was an honest mistake, and it was now my job to help explain the situation to the employee, which understandably upset and frustrated her. The thought of their dream vacation being cancelled or postponed brought her to tears as it had been booked almost a year in advance.

I reassured her I would do everything I could to address this issue. By being empathic and compassionate, we formed a real connection, and this is when she was able to let her guard down a bit and open up. I really wanted her to feel that I was there to help and not just there to listen. I informed her that although a mistake was made, we were going to have this resolved together very quickly. She told me she still had blank copies of the retirement application forms on her home desk top and saved copies of the forms submitted. I stayed with her on the line and walked her, step by step, through filling out the forms. Furthermore I ensured she had the correct fax number to the Pensions Department and waited on the call with her until she received confirmation her fax went through. She was very grateful for the assistance and guidance. I had committed to change this bad situation into a relatively positive one. She had earned that dream vacation and I was going to see that happen. I then contacted the Pensions department to ensure that they received this application and to expedite it to Local Authorities Pension Plan for further processing. I then contacted the employee’s Manager. I explained the situation, and we walked through the retirement process guidelines. I gave the Manager my personal contact information for follow up as I wanted to let her know that I would be there if she had further questions or concerns. The manager was so grateful that we were able to assist her friend and colleague with the process.

Going above and beyond is what led to getting her retirement information to the correct contacts in such a timely manner. It was then that I was able to call the employee back, to advise that her application had been received and forwarded and was processing with Local Authorities Pension Plan. She was beyond ecstatic, and this to me is what retirement should be about! Recognizing the challenges experienced with retirements, I brought the issue forward to my management team. After working very closely with the Client for three months, the process for retirements has been thoroughly reviewed by the Client. At the request of the Contact Centre management team, the retirement sessions for employees were reinstated after being cancelled in 2012. The retirement package for employees is being fully reviewed and a retirement team is in place at the client level to ensure that all retirement tickets have personal involvement from an HR Advisor to ensure a seamless path to well-deserved retirement. Can one person make a difference? I like to think so!

Jennifer Ryan – Telus Sourcing Solutions

 

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Quick Thinking to Resolve a Unique Situation

“Rachael immediately realized she was going to have to forgo general processes to assist this couple.”

Losing the ability to speak would be absolutely terrifying. Add being forced into retirement and having to call your HR contact centre for assistance with this in depth process. This situation occurred to a client who had been diagnosed with Primary Progressive Aphasia. This is a debilitating condition of the brain that affects the ability to comprehend information and form speech. Rachael received the phone call from the clients husband. Immediately she could tell that he was extremely frustrated and worn out. He explained that his frustration stemmed from calling the contact centre numerous times previously and being told he was not able to speak on behalf of his wife. Furthermore he could not be provided with any details of her account. He fully explained his wife’s medical condition to Rachael and was adamant that the process needed to change. Rachael immediately realized she was going to have to forgo general processes to assist this couple. She explained to him that she would answer any and all questions regarding his spouse’s retirement process, as soon as she could verify her identity.

Verification is a process of four questions; name, job title, union, and employee ID number are the most common. The client had provided her name and ID number; Rachael just needed two more pieces to move forward. Determined, Rachael asked the 3rd question in hopes to get them on the right track. The client appeared to be struggling, repeating the question over and over, trying to formulate the words “Nursing Assistant”. Rachael realized that these two questions, although simple for most, would not be for the client due to her condition. With quick thinking, she changed up her line of questioning. Rachael was able to get through verification by asking the client her Date of Birth and her Home Phone Number. The verification process that normally takes 30 seconds took nearly fifteen minutes. Rachael accepted that challenge with patience and compassion. Once verification was complete, Rachael was able to receive verbal confirmation from the client, that going forward her husband would be able to speak on her behalf. With her husband back on the phone, Rachael answered all questions they had about the Retirement process and Pension. She then explained that she would create a ticket on the clients file, and he would be able to provide this ticket number with all future calls to the Contact Centre. This would provide proof of permission for the client’s husband to speak on her behalf. At the end of this conversation, he expressed his satisfaction regarding the result of this phone call. Rachael let him know that in the future he could request to speak with her directly as they had built a great rapport.

One week later, Rachael answers another call and immediately recognized the husband’s voice. Without preamble he went on to explain that earlier that day, prior to her shift starting, he had called the Contact Centre and was not assisted as she had promised. Rachael immediately asked if she could have a moment to review the file notes. The previous agent had not been comfortable releasing information, as he had not called with his wife. Communicating with the nearest supervisor, Rachael explained the entire scenario and was given permission to answer any questions he had regarding his wife’s Retirement Application. Following this conversation, Rachael emailed Management and her Resolutions team, explaining the situation in full. With persistence she fought to have a solution to this situation as it was a fairly sensitive issue. After a review, it was found that there was no clear process in place for a situation where an Employee needs to have someone speak on their behalf. Due to this situation, and the persistence Rachael had ensured that he could speak on his wife’s behalf, Management was able to clearly outline a new process and sent it to the client for approval. The process was approved and going forward, when the client’s husband calls the Contact Centre, an email will be immediately sent to Senior Management, who will call him directly to address any questions or concerns.

Rachael’s attitude towards work challenges is only one of the great qualities she brings to the table. Rachael was able to build trust between the client and the contact centre which is vital for ensuring the customer experience is exceptional. Rachael constantly puts forth enthusiastic energy and is a pleasure to work with. Her ability to interact positively with the clients transfers onto the floor and influences those around her. Combined with extensive knowledge on Alberta Health Services procedures and practices, Rachael is an absolute asset and is relied upon for more than what her job title states. Rachael is a pleasure to work with and is always happily available to help in anything asked of her. I’m happy to sing Rachael’s praises as they are well deserved.

Rachael Clarke – Telus Sourcing Solutions

 

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Going Above and Beyond One Last Time

“His last wish was a simple one.”

A social worker who worked in a nearby hospital called us one day with a compelling story of one of their clients. The client in her care was a 19 year old with a terminal illness who was nearing the end of his life.

Due to the various treatments he had undergone, the client’s vision had become impacted and he had been unable to see clearly for months. The client shared with his family and his social worker that his last wish was a simple one, but would mean the world to him. He wanted to be able to see clearly for his last days of life. While his parents had taken him to get an eye exam, the competing priorities surrounding the young man’s struggle made it difficult for them to find time to order glasses for him. His social worker reached out to VSP and spoke with one of our CSRs, Kelly Durkee.

Inspired by the clients story and wanting to help, Kelly reached out to his VSP provider, spoke with the office manager, and was able to secure approval for the social worker (who had agreed to pay any copays and cover any out of pocket expenses) to pick up a pair of glasses for their client. The solution was appreciated by all parties involved, but it weighed heavily on Kelly as she felt there was more that could be done to help both the social worker and their client. After reaching out to her supervisor to share her concerns, she contacted the provider’s office again and learned that anti-reflective coating was recommended to help reduce glare of the harsh hospital lighting. Kelly, empowered to make a decision, chose to provide the office with a new authorization to bill for the glasses with anti-reflective coating fully-covered and all copays waived. Not only did this help increase the client’s quality of life in the hospital, it also cancelled all out of pocket expenses for the social worker. The social worker called VSP back to share that she was brought to tears by Kelly’s generosity. She also shared that when she spoke with her clients parents about what Kelly had done for their son, they were inspired to go pick up the glasses themselves. While the client did pass away two days later, the social worker explained that his final days were happy ones. He was able to enjoy his favorite TV shows and play with his tablet. More importantly, he was able to see his family clearly before passing.

Helping people see is VSP’s mission, and Kelly went above and beyond to ensure that the client’s last wish came true. We are truly inspired and proud to have her with our company.

Kelly Durkee – VSP Vision Care