2016 Agent – Great Customer Service Stories

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Status Quo is NOT an Option

“Many in the company ask, 'What would Alex do on this call?'”

Alex Beeks has been recognized as a World Class Advocate for the fourth consecutive year. Last year, she was recognized as one of the top Advocates in North America by SQM. Although Alex considered this an honor to be on the stage at the SQM Awards Banquet, she took it as a challenge to not only get back on stage, but to see several of her coworkers recognized as World Class Advocates and World Class Finalists.

This is likely the last time Alex will be recognized as World Class. Earlier in 2016, Alex moved to a coaching role within her division. Although she still helps with escalations, she understands in 2017 she will probably not receive the number of surveyed calls to be recognized as World Class. However, she is happy to be able to use her World Class knowledge to help the advocates grow and assist her members. Before Alex transitioned into her new role, she was able to spend over half the year assisting members on the phone. Every one of Alex’s calls can be used as examples to the team on how to handle a situation. Many in the company ask, “What would Alex do on this call?” as a way to coach and train new employees.

The following is an example of how Alex takes a typical call and turns it into a great experience:

Alex received a call where a daughter was trying to assist her elderly mother with a health insurance claim issue. Alex started off the call by recognizing the frustration in the member’s voice. She let the daughter vent while she listened. This is one of Alex’s best traits; our members feel a sense of calm to be able to talk and tell their story to her. The caller said her mother had tried to resolve the issue several times with the doctor and had called into our call center. The daughter visited her mother and the mother would not leave the house because she was so worried about this unpaid medical claim. The mother had just received a notice for $800 bill. Alex then stepped in and stated she was the mother’s advocate and would get the issue resolved.

Alex had been researching the issue during the call and knew immediately what the issue was but knew that the issue could not be resolved while the member was on the phone. Once the phone call ended, Alex jumped into action. The issue had to do with the doctor’s office not sending the claim to the health insurance company. Alex immediately called the provider and asked why the claim had not been filed. The response was that their eligibility check showed the member was not covered so they did not file the claim. Alex verified though the web request that they had not checked anything online with this patient, so she asked what ID number they used and discovered the issue. The provider was using an incorrect ID number. When Alex updated them with the ID number, they were able to see eligibility and submit the claim. The next day the claim was submitted and Alex had the claim processed. Once this occurred, she contacted the daughter and mother and let them know the issue has been resolved. Both were very thankful that Alex took ownership of the issue.

Alex had many opportunities in this case to turn the issue back to the member and cause more member confusion and make a bad experience worse.

1. Right from the beginning she could have just stated the claim was not on file. Even if she would have stated that information, she would have still had to reach out to the provider after the fact and then followed up with the member once again.
2. When Alex researched and saw that the mother did not call in to the service center, she could have stated that back to the member. Instead, knowing that this would not make a difference in the outcome, she kept that to herself focusing on the issue at hand.

Alex said that if she was in a similar situation, she would want herself and her mother to be treated the same. Alex’s thoughts on this call hit home: “As our parents have taken care of us, it is our responsibility to step in and help parents.” This not only applies to parents, but to all customers.

Alex Beeks – BlueCross BlueShield of South Carolina

 

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This is a Member That I Always Will Remember

“The outreach and caring nature meant more than words could express to the member.”

Ceomara Timmons works in the Marketplace call center, which handles phone calls from Affordable Care Act health care recipients. These members can spend hours on end on the healthcare.gov website trying to find out information about health care policies and subsidy information. One fall day, Ceomara received a call from one of these members who was distraught about enrolling in a health plan with BlueCross BlueShield of South Carolina, effective 1/1/17. The member was looking to move to a particular Silver 14 plan but advised Ceomara that she could not afford the premium of $147.87. After careful questioning, the member advised that she was not working and her husband was the only source of income for their family of three. Unless Ceomara was able to help her find coverage that she could afford, she would no longer be able to have insurance for herself and her daughter, age 20. Ceomara advised her to contact the Federal Marketplace and she would follow up with her to ensure she was able to get the information she needed.

The member contacted the Federal Marketplace about a lower premium option and the Bronze 1 plan was recommended to her at a cost $93.71; unfortunately, this was still not affordable for the member. She had previously applied for Supplemental Security Income and Medicaid to help with her health care costs, but was turned down. Ceomara was concerned for the member and wanted to ensure she was able to get the health care for her daughter, so she continued to follow up to see if there were any updates on the additional assistance from Medicaid.

A week later, Ceomara reached out to the member to see if she had heard any additional information from Medicaid, but the member had not received any new information. She was very emotional and also happy that Ceomara had taken the time to follow up with her. Ceomara promised to follow up again soon and kept her promise in a week. Ceomara reached out again to check on the member and the status of her Medicaid. The member advised again that she was still awaiting a response but was extremely appreciative of Ceomara following up with her as promised.

Ceomara called one last time to check on the member. This time the member had received the best news in a long time and was so thankful of Ceomara’s continued caring efforts to reach out to her. She found out she was eligible for a Silver 14 plan with a premium of $34.56 effective 1/1/17. The member was so happy and grateful to receive this news and for the continued communications from Ceomara. She can now continue to get her anxiety medication due to the persistence of Ceomara.

Although Ceomara could not control the cost of the medical plan, the outreach and caring nature meant more than words could express to the member. This was a difficult time for the member so the feeling of someone being there for her and checking on her was special.

Ceomara Timmons – BlueCross BlueShield of South Carolina

 

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Negative into Positive

“Michelle had two options. One, take the next call, or two, take accountability and get the issue resolved.”

Michelle has worked extremely hard to become a World Class Advocate over the past several years and is now a first-time World Class Advocate. She has embraced coaching and looks for ways on each call to resolve the issue and make the experience memorable. The following is an example of how Michelle can take a negative call and turn it into a positive experience for the member.

Michelle received a call from a member that was not showing as having any coverage. Since coverage was not active, the member was highly upset. The member was receiving treatment and said the provider refused to see her that day. The member said if she did not receive the treatment there was a possibility she could die. After research, it was determined that the member did indeed no longer have coverage, but COBRA coverage was offered and the entire COBRA premium had not been paid in full. The member became highly upset and hung up on Michelle.

Michelle did not let the issue end; she took the issue as her own. She immediately called the member back and acknowledged the member’s emotions and explained the issue and how to resolve it. She connected the member to the COBRA vendor to get the payment updated. Later that day, Michelle contacted the COBRA vendor to get the eligibility updated. She then called the member back as well as the provider, and let them know everything was updated. Michelle made sure the member had her treatment service back in place to ensure the member suffered no additional medical effects.

Michelle turned this negative experience into a positive. After having the member hang up on her, Michelle had two options. One, take the next call, or two, take accountability and get the issue resolved. A World Class Advocate takes the second option, which is what Michelle does each and every time she receives a call.

After the issue was resolved, the member called a member of management and said the following about her experience:

Michelle Dobson – BlueCross BlueShield of South Carolina

 

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Gone was the Worry and Concern

“What began as a stressful situation, turned into a rapport and friendship that I respect and am thankful for.”

Imagine being in a foreign country and having a medical emergency that requires you to pay upfront about $18,000. Regardless of financial status, this would be overwhelming. This is how my story began with the kindest of members.

I had been a call center representative for about a year and one particular September morning had been going really well. I was geared up and ready to tackle whatever came my way when I answered the next call. The call started right off with a welcomed introduction, it wasn't until I asked the member, "How can I resolve your call today?" that I began to feel a little nervous. With a deep sigh, she began to describe to me her trip to visit family overseas. One evening while travelling she was ill enough to end up in the emergency room, and was admitted inpatient, resulting in her having to pay $18,000 upfront. I can’t imagine how scary and stressful this experience must have been. To be away from home, sick in a foreign land, and asked to pay such a large amount of money must have been so overwhelming.

Luckily, the member had already worked with Blue Card World Wide and was able to obtain the necessary prior approvals and guarantees for coverage of service. This made the payment process between Blue Cross Blue Shield of Vermont, the member, and the international provider much easier. I explained how the process works and was able to provide her with the confidence that she would be reimbursed her $18,000 by the provider. The member was very relieved and expressed her appreciation for the people she had already been in touch with at Blue Card World Wide.

We then reviewed several claim’s that were being processed. Not only did the member incur several large claims while overseas, she had paid for them at the time of service in Swiss Francs and wanted to ensure her reimbursement amounts were correct. I hadn't encountered this type of call before and I explained that I wanted to research the claims and the exchange rates to ensure she received the correct reimbursements. I promised a prompt follow-up call after my review. The member was so appreciative because she had a lot on her plate.

After reviewing the claims, we identified a payment discrepancy. By working as a team with our Blue Card Claims department, we were able to quickly make the correction and resolve the issue, resulting in correct reimbursement to the member.

I contacted the member back to give her the good news and she was so happy and relieved. Gone was the worry and concern I had heard when accepting her call. We chatted briefly when she shared that she had a medical condition that would require her to take a medication daily for the next five years. She wanted to check on the monthly costs. I thought to myself, "I've got this." After reviewing with a supervisor who had access to the pharmacy system, my heart sank. The medication in question cost $5,000 per 30-day supply. As a customer service employee in different settings over the last several years, the emotion you feel when you must advise someone who is already having a hardship of more difficult news is indescribable. I went back to my desk, my mind racing for the best way to approach this.

Prior to getting back on the phone, I conducted more research to ensure I had uncovered everything. After momentarily scrolling through a desk procedure I came across some wonderful news! Our lovely state of Vermont has a mandate that provides medication treatment for her particular diagnosis at no cost to the member. What a huge relief. I explained that while the cost of the medication is $5,000 per month, it is covered at 100% for her with no member liability. She of course was feeling very relieved as having to pay out of pocket for a medication while managing a challenging diagnosis was not an additional stressor that she needed.

At this point in my experience with this amiable member, we had discussed a worrisome diagnosis, international claims, Swiss Francs, and even the apple orchard across from her home. Assisting this caller was an easy-going and rewarding experience. The member and I were able to work together, organize her billing records, receive high dollar reimbursement, and gain a better understanding of her benefits and pharmacy coverage. What began as a stressful situation, turned into a rapport and friendship that I respect and am thankful for. Soon after this call I received a big box of fresh Vermont apples for my family and I to share, shipped straight from the orchard next to her home.

I am thankful for this call and it is a daily reminder of the important work we do as Customer Service Representatives. We help others through very stressful situations and alleviate some worry, stress and concern. I find this to be extremely meaningful and rewarding. I wouldn't want to do anything else.

Alyssa Pratt – BlueCross BlueShield of Vermont

 

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Advocating on Member's Behalf

“I earned his trust, explained that BCBSVT is different, and that he could count on me to see this through to resolution.”

The role of a customer service representative is an important one. We impact the lives of our customers in what we hope is a positive and supportive way. This can be challenging at times but it is always rewarding. One afternoon, I received a call from one of our members who sounded very upset and emotional. His wife was sick, she’d been in and out of the hospital, and was in need of diabetic medications and supplies. This customer had purchased his BCBSVT plan through our State Exchange. Our State Exchange processes all enrollment and disenrollment transactions.

Even though he had paid all of his premiums to the Exchange, they still did not have any active coverage for him and his wife. To ensure his wife was getting the care she needed, he had been paying out of pocket for all of her medical and pharmacy expenses, which had proven to be quite costly and he was running out of funds and hope. It had become a financial hardship and he now couldn’t afford to pick up the medications and supplies she needed.

This member called BCBSVT looking for any help he could get. I told him that I would take care of this and ensure he and his wife had active coverage. He was understandably apprehensive as he had called the State Exchange so many times previously and had been told multiple times that it would be resolved. I could tell that given his previous experience, he was not feeling confident that he would hear back from me. I acknowledged how frustrating it must have been to be paying insurance premiums, have no active coverage, and have to make multiple calls to the State Exchange, all while trying to get his wife the care she needed. I earned his trust, explained that BCBSVT is different, and that he could count on me to see this through to resolution.

I then spent hours on the phone with our State Exchange on behalf of our member, advocating on his behalf. I also worked with our internal enrollment team at BCBSVT, who process the transactions we receive from the State Exchange. After several hours of working with the State and our enrollment team, I was able to get our member’s coverage reinstated back two months.

Before I called him back with the good news, I first proactively outreached to the pharmacy to ensure his wife’s medications were processed and had them run her previous prescriptions through as well; he now had a reimbursement coming to him. I then called the medical equipment supplier to advise that the member was now active and made sure they had her supplies in stock before the member went to get them. I also called her doctors and the hospital to ensure they were aware the coverage was now in effect and claims should be billed to BCBSVT.

When I called the member back and explained what I had done, he was in shock and didn’t say anything for a minute. He went on to tell me how grateful and relieved they were for all my help and how he wished he had called BCBSVT sooner for help. The member even called back to give me a compliment and say how thankful he and his wife were for my help.

He said “I spent half an hour on the phone with Amy today on an issue that was quite complex. She was spectacular, patient, smart, and figured out our issue. Please let your staff know how amazing her service has been.”

I am proud of this call and the positive impact I had on this family’s life. The work we do is important. I am thankful to work for a company that puts our members first, and allows us the time we need to truly resolve issues and see a member through.

Amy Duhamel – BlueCross BlueShield of Vermont

 

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She Didn't Know Why

“It is the call requiring work and attention along with brightening a customer’s day that makes providing excellent customer service easy.”

In an insurance call center you get asked numerous questions. The majority of the time the questions are what are my benefits? Why was this claim denied? What do I owe? This is exactly what I was expecting Monday, January 2nd when my phone rang. “Thank you for calling BlueCross BlueShield of Vermont, my name is Bridgette, how can I help resolve your call today?” A young woman explained her frustration after receiving multiple medical bills and she didn’t know why. She went on to explain she has Medicare for the disabled, BlueCross BlueShield of Vermont and BlueCross BlueShield of Pennsylvania, and she didn’t understand why she was receiving bills.

She read off the ten dates of services and rejection notifications she had received. I listened to her carefully and assured her I would look into the claims. I explained two of the claims pulled up from providers here in Vermont but I was not seeing the claims for the other dates. I let her know that the two we had on file had denied as ‘other insurance primary’ and explained what other insurance primary meant, “I see you have Medicare as your primary insurance and we received these from your doctor without Medicare processing the claim first. The doctor needs to submit to Medicare first and then we can process as your secondary carrier.” She explained that the other bills she was receiving were stating the same thing, ‘other insurance primary.’ We went over each individual claim, one at a time. I could hear the frustration in her voice worsening as we realized each claim was for a different doctor and facility, each one being sent to a different insurance company. I could hear the quiver in her voice the more she told me how much she owed and that she needed to call each doctor and give them her insurance cards (all over again), and have them submit. At this point I could hear her crying. I offered to take down all of the service dates and providers’ information to outreach and get the claims submitted to the correct companies tomorrow morning. She was so grateful that I had offered to help her, “Thank you so much, you have no idea how much I appreciate this.”

The next morning I began making calls on her behalf. I called BlueCross BlueShield of Florida and started explaining the member’s situation. I gave them the date of service, the provider’s information, along with Medicare, BCBSVT, and BCBSPA identification numbers, they advised they would get the claim submitted. I did this for each one of her claims calling different BCBS plans in different states. It took a full week to get in touch with each BCBS plan and the providers to get this request done.

I expected it would take a couple of weeks or more before I would hear from Medicare; however, about a week later I saw the claims started coming to us and BCBSVT started processing as secondary. Each time a claim came in and processed I could see her financial responsibility decreasing. I waited another week for all claims to finalize through our system. Around the 22nd I got the notification that all claims have been processed and the statement would be sent on the next Wednesday.

I called her up on January 24th and told her Medicare had processed these claims as well BCBS VT had also received and began processing. The providers assured me they would pass them along to BCBSPA, and I could hear tears again. I tried assuring her this was a good thing, that because we have begun processing she wouldn’t owe so much and that the doctors would be sending her an updated bill. She began assuring me that she was crying because she was happy. She was panicked the day we first spoke, fearing she would owe thousands of dollars and that she would never be able to pay it or figure out how to reach the doctors to get this straightened out. I told her I had contacted everyone she had bills from and they are all being taken care of, I told her to call me in the future if she had any other claims she needed help with.

On the day I closed the case, I realized it is situations like this and the people that make me love working in the call center. 90% of the time the questions and situations are the same. It is the call requiring work and attention along with brightening a customer’s day that makes providing excellent customer service easy.

Bridgette Draper – BlueCross BlueShield of Vermont

 

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Team Work

“This was just as much a priority for me as it was for her.”

I received a call from a member’s sister-in-law. She was calling after having received a garbled message from her brother-in-law who was currently in India. Once getting in touch with him, which was difficult due to the 11 hour time difference, she found out that he had undergone emergency surgery for a heart related issue and needed help getting authorization for another surgery because the foreign provider refused to schedule the necessary surgery without a guarantee of payment from the insurance company. She quickly got in contact with our partner Blue Cross Blue Shield Global Core, who can negotiate a guarantee of payment between BCBSVT and the foreign provider and they advised that they would then get in contact with BCBSVT to start the process. When I received her call she was calling to verify that the process had been started.

This is where we hit a road block, as there was no authorization from the member allowing us to speak to his sister-in-law about anything other than how the process works. I advised that I could get a verbal authorization from the member if possible and then I would be able to go over what was happening in detail. I let her know that he could give us a call and gave the reference number for our conversation so she could call back in with it or if she had his phone number I advised I would be happy to try and give him a call with her on the line to get the required OK from the member. Unfortunately, she didn’t have his phone number, her husband had the number but he was at work. So, she asked if I could stay on hold with her while she sent him a text to let him know what was going on. After about 10 minutes, she confirmed that her husband sent a text to the member letting him know that we need the verbal authorization in order to give either of them any detailed information. As you can imagine, she did not want to end our call until she knew she had assisted her brother-in-law. Here he is, alone in a hospital in India and awaiting much needed treatment as the provider waited on their guarantee of payment. She rightfully needed that peace of mind that Blue Cross Blue Shield Global Core had sent the guarantee of payment request, so I remained on the line with her for a half hour while we waited for the verbal authorization to come in.

The member did call in and gave his verbal authorization from his hospital bed in India while he awaited the guarantee of payment for his lifesaving procedure. Understanding the severity of the situation caused my heart to drop and my stomach sink. This was just as much a priority for me as it was for her. I couldn’t even imagine how scared he must be in another country waiting for the provider to get what was needed from his insurance company to have his surgery.

I talked to my research department who confirmed that we had indeed received the guarantee of payment request and that they were working on it as we were speaking to get it sent back immediately. Now with the verbal authorization in place I was able to confirm with the sister-in-law that we did indeed receive the request and were working it as a high priority. I assured her that I would monitor her brother-in-law’s account and let her know when that information was sent to finish the process.

A few hours later, I checked the account and our research department had sent the guarantee of payment over to BCBS Global Core. I waited and monitored a while longer but then decided to proactively outreach to Global Core because this case was such a huge concern for me that was just eating away at my stomach and my thoughts. Global Core assured me that once they receive it back they immediately forward it on to the provider. However, shortly after the conversation, Global Core called back asking for an authorization number as they needed to give it to the provider for confirmation. We triaged over to our Integrated Health Department to set up the authorization, got the authorization set up, and provided the authorization number. We explained that in order for the authorization to be finalized, we needed to have the clinical documents to review. The representative with Global Core advised that all the provider needed to go forward with the procedure was an authorization number from the insurance company and asked that we call them back once the review was completed.

I called the member’s sister-in-law back to let her know that everything that needed to happen was in place, we have the authorization in place and are ready to review once we receive the clinical documentation and assured her that she had done everything she needed to do to make sure her brother-in-law was able to have his surgery. The provider had their guarantee of payment and authorization number and her brother-in-law would be able to get the care he needed.

This call was a very stressful one as our member’s health and well-being depended on team work and quick action. Thankfully, by working with multiple departments, and proactively outreaching to Global Core, we were able to expedite the request and do the right thing, take care of our member and provide his sister-in-law with some peace of mind during a very challenging time.

Rebecca Lee – BlueCross BlueShield of Vermont

 

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The Moment of Truth is a Turning Point

“I’d love the chance to make your day better.”

One of our members was exasperated after unsuccessfully signing up for an online account. She was upset, frustrated, and ready to close her account after trying for two days. Her confidence was shattered and she shared with me she wasn’t good with computers, she felt like she was going around in circles. She told me she felt defeated.

I listened to everything the member shared, and acknowledged her feelings confirming with her that I understood her feelings. I knew I needed to bring her back before helping her solve her technical problems. “You’re a great customer! I’m sorry you’ve been having a hard time registering.” The tension in her voice immediately abated, “Finally someone who understands,” she sighed.

That was my opportunity as the moment of truth presented itself – “If you like, I can stay with you on the phone and we can go through each step together to get you in online. I’d love the chance to make your day better.”

To summarize, I quickly identified the error and together we registered her for her online account. I made sure she understood the problem reassuring her that it wasn’t something she could have fixed and that I was glad she called to give me the chance to make it better.

We ended the call with a hearty chuckle. The member said, “Maybe an old girl like me can fit into the computer world after all, especially when I have ladies like yourself showing me great patience and encouragement.” She shared that she was so happy with my customer service and that I was the reason she would not be cancelling her account. She made sure I knew that despite several choices in her wallet, that I secured her decision to pick our card over the rest going forward.

Chastity Driscoll – Millennium1 Solutions

 

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A Smile and Positive Attitude can go a Long Way

“Smile, while you’re on the phone....it comes through your voice and is felt on the other end of the line.”

I was very happy to hear that I achieved World Class Certification for 2016. My story isn't necessarily recalling a past call, it's about a belief. What do I truly believe customer service is? I've always had what I describe as a strong sense of respect and an old-school style of thinking, which I try to bring to every phone call.

I have a history of striving for a goal, at times almost to a fault. Prior to my contact center career, I was goal oriented, so much so that it led to injury and a few surgeries. Needing to change from employment of a physical nature to something less physically demanding, I attended a job fair and ended up having a conversation with M1S Recruiter, Nicole Barry. Soon after that I was training at Millennium1 Solutions. I will admit there were times I had some reservations about whether I could do this; a 45-year-old father of 4 starting over in a new career can seem daunting. Even after training was complete, I was still wondering if I had what it took to succeed on the floor. Thanks to my trainers Kristi and Cecile, I was able to move onto the production floor with some confidence. The most important message I took from training was to strive for first call resolution.

I've had to incorporate some experience from many different aspects of my life; being a parent, being an athlete and a coach, and those old-school values (like holding doors), that I mentioned earlier; there are many transferrable skills that I bring to my CSR career:

• Being married for 26+ years and raising 4 children teaches patience which I am often told I have by members on the phone.
• Being an athlete gives you determination and coaching gives you an ability to read people. Determination to see the call through and the ability to read people, helps determine the approach in resolving the call (how much time you need to spend with each member for them to succeed).
• The old-school values, respect and understanding. When I'm on the phone my number one concern is helping our members resolve their issue. I know my handle time sometimes takes a hit when I give the extra effort and then offer to help the member add a card, change a setting or load their offers instead of just sending a knowledge article to enable self-service. Reading people really helps here, as you have to get a feel from the member to know if instructions for self-service is enough and they'll succeed. I really strive to avoid unnecessary repeat calls and spend more time solving their issue if needed, which prevents the experience from feeling difficult which can turn members away from the program.

Every day I check my performance dashboard and my 1st concern is my CSAT and Call Resolution results. I love seeing it at 100% but the feedback I receive when I don’t earn 100% helps me learn and grow. “He was pleasant enough just didn't have a 'personal' touch.” Is one piece of feedback that stands out for me. This customer went on to add more descriptive detail and this was more important than comments from the many favorable surveys I had received. This drove me to improve and I’m pleased that the needle is moving in the right direction.

I believe another key to being named "World Class Certified" is enjoying what you are doing, I've always told my kids, "Find a career you like. There are 24 hours in a day, 8 hours of sleep, 8 hours of work and 8 hours of play. If you like your 8 hours of work, you've got life figured out, if not, your 8 hours of play have to be awesome." I love helping people, making them happy makes me feel great, and when you like what you do it transcends to the member on the other end of the phone line.

I try to bring a fun attitude to work. Having fun and a little laughter is contagious to co-workers. I think leadership is also a big factor in performance (thanks to my TL Nicolle).

In closing, I'll sum up my customer service attitude by quoting others - including my wife, who say "Smile, while you’re on the phone....it comes through your voice and is felt on the other end of the line."

 

Peter Stewart – Millennium1 Solutions

 

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Above the Call of Duty

“I have worked in customer service all my life and Derek is a true depiction of what it means to service the customer. Take care of Derek. I hope you know that he is one of your biggest assets.”

Following is the story of a true customer service hero. Derek Therrell, a genuine American Veteran, works with Medicare Part D recipients on a daily basis. Derek once told me that for him, it is not enough that a person’s diagnosis be precise, nor enough that the medicine prescribed will work, it is equally important that we find the best pricing for the medicine prescribed. If you have ever had the occasion to check into pricing of some of the most effective medicines in the marketplace today, you might be aware that they can sometimes be fairly expensive. Derek has made it his mission to learn all he can about Medicare Part D benefits. He prides himself in being well versed on how to best utilize the insurance policy to the member's advantage. He understands that it is a serious provision for our people’s well-being within our United States.

I would like to share one of Derek's call center interactions which resulted in a world class experience for one of our Medicare members. But before we get into the call details I believe it relevant to outline a picture of how Derek exemplifies a work ethic to emulate. On this particular day we started out unusually busy. Our city suffered some inclement weather; making many of us behind our normal start time. This was not the case for Derek. He was almost half an hour early. He began his day as he always did: taking one call at a time, explaining insurance benefits, taking orders to mail medicines to our members, creating detail to our clinical staff on behalf of our member. He stayed on task and then the call came in. The call was about a co-pay issue of a very expensive life-sustaining medicine which could only be ordered one month at a time, and only from specific pharmacies. The person calling was someone who worked with an organization that helps qualified people pay for their life-sustaining medicines. Many of the recipients are without financial resources. He said that the member received a bill of $1853.00 for his medicine but their records showed the assistance was approved and submitted. He told Derek, in his experience, the member has never had to pay anything. He said he has been working on this for 2 weeks and is now at a loss of whom or where to call.

Derek assured the caller that he was the right person to help; and he knew that the research would be extensive so made a commitment to call him back. In the end, Derek found that the member had two profiles. The insurance policy was under one version of the member’s names but the doctor sent the prescription under members other name. He partnered with the physician’s office to clarify the name on record as well as worked with our data entry/order team to merge the two profiles. Derek pulled an accounting of the submitted claim and worked through the link with the insurance provider. He called the pharmacy and waited on the phone with them while they worked through all the corrections and resubmitted the claim. He partnered with four different resources, took the 40 plus minutes and the end result was a zero balance to the member.

Derek met his commitment and called the Assistance Coordinator back. He explained what happened and advised him that it was fixed. Then he took it upon himself to call the member as well. When Derek spoke with our member, he assured him that his balance was zero, explained what happened and advised him how to prevent this from happening again. The member’s voice was tearful as he explained how much it meant to him that someone finally figured it out. The member insisted on speaking to someone in our senior staff. A paraphrase of the member's comments are as follows: "I just want to make sure Derek is recognized. I can tell he cares about the customer. He is sharp, polite, informative and respectful. I have worked in customer service all my life and Derek is a true depiction of what it means to service the customer. Take care of Derek. I hope you know that he is one of your biggest assets."

Derek Therrell – Prime Therapeutics

 

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Connecting the Dots

“We will run through brick walls and fire to get the member the medication they need to feel better and live well.”

A member called in October and wanted to know why the cost for his 30-day supply of medication went up to $265 when he had been paying a flat $15 Tier II copay before. I advised him that his drug phase went into the gap since his last refill. That caused him to incur a 58% copay for the generic brand he was filling. The contracted rate of this medication was $458 per month, so his current copay was now $265. I advised the member of alternatives and he stated the doctor only wanted him on this medication. He had tried other medications and they had adverse effects on the member and as a result, caused him to go to the emergency room.

The member was sobbing and stated he was on a fixed income and just won't take the medication because he could no longer afford it. I could hear his wife in the background and she wanted to talk to me. I advised her of the situation and she too sounded distraught that her husband could not get the medication he needed. I informed them of the LICS program, because if approved, the worst-case scenario would be a 15% copay. She stated they didn't qualify when they had previously applied. It was heartbreaking to listen to this couple struggle to simply get the medicine they need.

I had one more option to look into and checked our Benefit Edit Tool to see if they had gap coverage. He DID have Gap coverage, but it only applied to Tier 1 medications and this was a Tier II medication. I informed the member that I would submit a Tier exception request to see if we could get it approved as a Tier I so that he would just have a lower flat copay of $2 per month, if approved. I informed the member I would personally track the progress of the request as often as I could so that I could update him as soon as we had a result. The member was crying and thanked me so much and said he would look forward to hearing from me.

After submitting the expedited request to our Clinical Review department, I sent them an email explaining the situation and asked if they could add extra priority to the request. I checked the progress every hour for the member and it was approved that afternoon. I called the local Pharmacy and had them rerun the refill and it went through as a $2 dollar copay instead of $265 for the 30-day supply.

When I called the member back to tell him it was approved as a Tier I medication, he was sobbing again, but this time it was out of joy that he could afford to get his medication. When he told his wife, I could hear her being emotional also. I informed the member that he would pay a total of $6 for the rest of the year instead of $795. For 2017, his cost for this med would be $2 per month instead of $15 and would carry over through the gap coverage again if it remains a Tier 1. The member was extremely emotional and kept thanking me. I told him it was my extreme pleasure and my voice was cracking at the end of the call.

After the call was over, I had to log off and go for a short stroll because I too had tears of joy and was so grateful that I could get this member his medication. Thinking back on the experience while writing this it is happening again. There are those times when we get like that after calls because we care so much for these members. And we are so glad that we are given everything we need to assist these members to protect their health and get them what they need.

Our motto is "To get the member the medication they need to feel better and live well". All of us at Prime read that as "We will run through brick walls and fire to get the member the medication they need to feel better and live well." In every training group I assist with, I always inform them to check the BET for this process to see if it is available when the member goes into the gap. Perhaps it will allow us to have even more success stories like this.

Sebastian D’Agosta – Prime Therapeutics

 

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Going the Extra Mile

“Most days we have to think outside the box to find a solution that will help the member.”

I had a member that called in about her medication costs. She said she was trying to get three generic medications and the pharmacy was telling her it was over $200. She said she didn’t have that kind of money and did not qualify for the financial assistance programs available to Medicare members.

I checked her plan and it had the deductible of $290 that was causing the high cost, but with a little research I realized that all three meds were tier 2 generics and she was paying toward her deductible. The deductible applied for all tiers except tier 1 on her plan.

After checking for tier 1 alternatives, I suggested we could put in a tier exception for all three medications. If the tier exceptions were approved, that would mean these medications would be moved from tier 2 to tier 1 where the deductible doesn’t apply and her copay would only be $3 per medication for a 30-day supply. After verifying that she still had enough meds for this process, we submitted tier exceptions for all three medications. I advised her of the expected turn-around time for a decision and assured her I would keep an eye on them and call her once the decision was made. The member shared with me that the consequences of not taking one of these medications is that she could go blind.

Even though we promise a 72-hour window for decisions, I checked these throughout the day and they were approved by the end of that same day. I called the pharmacy to reprocess all three meds, bringing her total due from over $200 to around $9 for all three. I called the member back to advise her of the outcome and that her pharmacy would have these ready in 45 minutes. The member was elated and knowing that I helped her get her medication and saved her so much money was a great feeling!

Every day, we have an opportunity like this to make a difference in a person’s life and that is what makes this job so rewarding. There is always an option. We just have to be willing to search for the opportunities for that specific situation. Most days we have to think outside the box to find a solution that will help the member get the medication they need. You have to be willing to go the extra mile and be creative to help the customers resolve their unique situation. I do everything I can to help our members every day. This is just one example, but I accept the challenge every day to do the best I can for everyone reaching out to us for assistance.

Stacey Boone – Prime Therapeutics

 

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One Issue at a Time

“Fortunately, Bernice was there for her.”

Cambia has eight values that we instill in our employees – Hope, Courage, Empathy, Trust, Commitment, Collaboration, Innovation and Accountability.

Bernice Gutierrez demonstrates these values in her work every day. She is committed to helping our members with empathy and compassion and follows through until an issue is resolved.

Bernice demonstrated these values when she received a call transferred from another customer service professional who was having language difficulties with a member. Bilingual and fluent in Spanish, Bernice listened as the caller, a sobbing 92-year-old Spanish-speaking member who lived alone, recounted how she was struggling to take care of herself after suffering a fall in her home.

She told Bernice that while going to the living room to get her medicine, she got dizzy and fell. She hit the chair and was unconscious. When she woke up she was on the floor. She got her apartment manager’s attention, and he had called an ambulance that transported her to the hospital.

Later, she was released from the hospital and sent home to take care of herself. Unfortunately, she was unable to walk and had been sent home without a walker or wheelchair. She clearly needed help. Due to the language barrier, she was frustrated, did not understand her options, was panicked and didn’t know where to turn. Fortunately, Bernice was there for her.

Bernice comforted her in Spanish and listened to her concerns about her hospital bill and the care she needed going forward. She was unable to walk, cook, get to doctor appointments or even reach her medications.

Bernice set out to tackle each issue one at a time. She contacted the member’s daughter, the doctor that cared for her, and durable medical equipment providers to arrange for a walker and wheelchair. She coordinated with taxi companies to provide rides for doctor appointments, then contacted the member’s church and other community resources to find help with getting her medications and provide other care. She helped the member get in touch with a business partner to get financial assistance and help from Medicaid. The member was proud and resisted asking for help herself but allowed Bernice to reach out on her behalf.

Bernice also checked back with the member frequently to ensure the assistance she arranged was working out. Bernice assured the member that she could call her directly and speak in her native language. The member felt she truly had a friend – “an angel” – at the other end of the phone line.

Bernice enjoys being able to help “her members” with whatever they need. Helping people is her passion and what drives her. This member was fortunate Bernice answered her call that day, and we are fortunate to have such a powerful advocate for our most vulnerable members when their “golden years” turn difficult.

Bernice Gutierrez – Regence BlueCross BlueShield

 

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We Put the Member First No Matter What

“Jason is what makes companies like Regence perform and resonate with their customers.”

I believe customer service can make or break a company. At Regence Medicare Advantage, we pride ourselves on our customer service. We put the member first no matter what. That’s what I love about my job as a customer service representative at Regence. When the company says it cares about the member, they mean it. My favorite calls are when members tell me they will never leave Regence because they love our customer service. When I hear that, I know I am I doing a good job, as is our customer service department as a whole.

Sometimes members and their families need an experienced advocate to help resolve a difficult issue. That was the case when I answered the phone that day and heard our member’s son talk about the nightmare he and his mother were going through. I listened as he explained that he was receiving collection notices from several companies for his parents’ health care bills. He’d made numerous calls, but wasn’t getting anywhere, so he turned to Regence for help.

His ordeal was heart-wrenching. Both his parents had been involved in a serious car accident. His father passed away in the hospital the day of the accident, and his mother had been hospitalized for more than a month. Following the accident, she underwent several surgeries and had multiple follow-up visits with doctors. The care his mother and father received resulted in several claims, some very large and many smaller ones. This already difficult situation was made even more difficult because multiple insurance companies were attempting to coordinate payment.

Providers wouldn't talk to the son because he wasn't the patient. To make it more difficult, his mother was just getting her life back together, and he dreaded telling her about the collections notices and bringing up the accident. I listened while he explained all he had been trying to work through. He couldn’t understand why two insurance companies couldn’t work together to pay his parents’ claims. He felt caught in the middle and didn’t know what to do. When I heard about the families dilemma, I knew I had to step in and help resolve the issue quickly.

I expressed to him my deepest sympathy for the loss of his father and his mother’s condition. I acknowledged that things can get complicated when working with multiple insurance companies, and even more complicated when services are rendered outside the service area. I told him to focus on his mother’s recovery and to let Regence and I deal with the billing and claims issues.

When I ended the call with him, I went right to work. My goal was to remove any and all barriers and allow his family to move on from the accident.

I called our Other Party Liability (OPL) and Claims departments. I contacted multiple providers, spending hours on the phone. It took several follow-up calls to providers and internal departments to get things sorted out. This was a complex issue and required a lot of patience. I kept in touch with the member along the way so he knew where things stood. In the end, he and I created a relationship built on trust. He knew he could call me with new questions or issues. It gave me such pride to help him during this difficult time and get everything handled for his parents.

Shortly after our last conversation, he sent a letter to Regence. “Truly, Jason is what makes companies like Regence perform and resonate with their customers, and I am extremely pleased that my parents chose to work with your company for their Medicare Advantage plan,” he wrote, “I can't even imagine what I'd be going through if I was working with Medicare directly.”

Our members and their families are like my own family, and I always give 100 percent on every call. That means making sure members get the answer and resolution to the issue no matter what it takes. Even if it takes more than a dozen phone calls, I will do it! That’s why I enjoy being a part of our Customer Service team.

Jason Chapman – Regence BlueCross BlueShield

 

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Maintaining Confidence

“One of the goals that I always have is being able to resolve a client’s inquiry in the first call.”

One of the best aspects of being a customer service representative at Scotia iTRADE is that I can interact with a wide array of different clients every day. The calls that I receive can range from simple cash transfers to much more complex scenarios. As such, since each call received is different, I am able to adapt myself to each scenario which provides a learning opportunity for personal growth and development. One of the goals that I always have is being able to resolve a client’s inquiry in the first call.

One day, I received a call from a very frustrated client at Scotia iTRADE. When I inquired on the issue that he was facing, he said that he was trying to fund his account and place a trade online but was unsuccessful in doing so. The client was informed that his account was fully approved and everything was set to go to. However, when he tried to access the app to begin his trading activities, he was still unable to proceed. This triggered him to make a second phone call to the call center within the same day. However, his interaction with the representative was abruptly disconnected. In turn, this made him distraught and he began to question on whether he still needed the account. As such, the client told me that he wanted to transfer his accounts to another institution and inquired on the procedure for doing this. After hearing this statement, I knew right away that I would have to apply my expertise in retaining this customer and assisting him with the initial request. To do this, Hearing this, I applied a concept that was introduced during my team meetings and it is known as the Client Experience Model (CEM). This entails the notion of actively listening to a client’s request at hand and finding the best possible solutions.

I informed the client that I would definitely assist him with the problem and ensure that his trade is placed. He replied with these words which were “I hope so and please do not lose connection with me over the phone”. I assured the client that if the call was disconnected, I would call him back immediately so that he does not have to repeat himself to another representative. The first thing I asked was whether the account was visible on the app. He said yes, but was unable to tap and interact with it. From that I knew immediately that the client was using the Scotiabank app, which is used for branch accounts, instead of the Scotia iTRADE app, which is used for trading accounts. I proceeded to walk the client through his mobile device to download the appropriate app. Once that was completed, there was another roadblock that was faced. However, when the client entered his card number and password to sign on, he was unable to proceed to the screen that would allow him to begin trading. He once again became disgruntled but I was not ready to give up since I wanted to stick to my goal of always resolving the problem. After placing the client on a brief hold and analyzing his account on the internal system, I discovered the issue. He was a new client and did not complete the ‘Terms of Access’. I explained to the client on what he needed to do and I walked him through step by step of this setup. Once it was completed, the app was launched again and suddenly there was a burst of excitement. The client could fund his account and place an order for a stock he wanted! The tone of his once went from someone being discouraged and wanting to move to another institution to someone who was ready and willing to begin using our platforms for future trades. He thanked me numerous times and applauded my patience as well as maintaining control and ownership over the call.

After listening to the client’s comments, this provided me with a sense of accomplishment since I was able to turn his experience from being discontented to extremely satisfied. The client explained to me that he is new to trading since his son would always assist him in placing orders on his behalf. However, the son had to relocate to a different country for a job opportunity and he was left on his own. He also apologized for the way he interacted with me when I received his call. By hearing this, it allowed me to empathize and understand his feelings even more. Before the call ended, I guided him through the educational section of our homepage since he was a new client. The client was grateful for this information since his goal was to become a more savvy and active investor. He also wanted me to transfer him to my manager. A detailed voice message was left on my manager’s phone and it was shared during my next team meeting. This was very momentous and meaningful since I had recently joined the company a few months prior. Whenever a new customer service representative job shadows with me, I use this particular call as an example and I provide them with advice and information on how to deal with complex scenarios and a hostile client. I also inform new CSR’s to always try and create an emotional connection with a client, show empathy and always maintain firm confidence in their voice when aiding a caller.

Mark Gobardhan – Scotia iTRADE

 

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Building Trust is a Challenge, Rebuilding Trust is Twice a Challenge!

“I was determined to bark up every tree and leave no stone unturned to remedy the situation.”

Working as a customer service representative is a job that can be quite challenging. However, the satisfaction and fulfilment derived from resolving clients’ issues can’t be overstated. Clients can get quite frustrated, and this is usually portrayed in their reaction towards representatives on the phone. Nonetheless, the key to ensuring that clients’ issues are addressed is intertwined in iTRADE’s core principles of relating, adapting, showing empathy, committing and ultimately resolving clients’ issues.

From the moment a representative picks up the phone and starts talking to a client, the client makes an assessment as to the representative’s willingness and ability to help resolve the situation. This assessment usually ascertains the trust that the client should have in the representative in a fiduciary relationship between the client and the representative and enhances a smooth relationship between both parties. Having been on both sides of such a fiduciary relationship, it is very enlightening as it enables me to view things from different perspectives. That being said, I believe that my success in providing the highest standard of service to clients is that I understand the repercussions of a negative client experience on the client, as well as the business as a whole, and I do what needs to be done to avoid such an experience at all cost.

In my personal interaction with clients, one of the aspects I pay particular attention to is ensuring that their expectations are properly managed. I believe this is the foundation for establishing trust in dealing with clients and could determine whether clients get a positive or negative experience. Once the element of trust is broken, it becomes really difficult to ensure the highest standard to service.

I’ve had quite a few experiences with clients but the one which stands out for me was a situation in which the client’s expectations were not properly managed. The case in question involved a client who just opened up an account with our firm and put in a paper request at one of our branches to transfer approximately $40,000. The client was advised at the branch that his transfer request would take approximately 2 business days. In the client’s mind he was expecting to have the funds available to place an order to buy stocks in his brokerage account after that time frame. As expected, the client called in after said time frame to report his funds had not been deposited into his account. The client was very frustrated at this since he was looking to buy a stock and with the delay in funds being deposited into his account, the stock price kept moving up against him.

The first thing I had to establish was where the transfer request was initiated. I asked the client to provide me with the name of the branch, the contact person at the branch who helped complete the transfer request, as well as the department where his account was held. Based on the client’s responses, I quickly established that the information given regarding the transfer timeline was inaccurate. I advised the client of the right time frame which was in fact up to 10 business days as an internal wire transfer which would have taken 2 business days and was probably how the branch representative expected the transfer request would be processed, could not be used for accounts held at that branch. Having corrected the time frames, it was still an impossible task to erase that from the client’s mind as he was persistent on what his expectations were. I knew immediately that I had to take extra steps to try as much as possible to deliver on those terms or close to it. Once I had all that information, I gave the client my name and extension and advised him I was going to make it a point of duty to ensure that his issue was resolved as quickly as possible. I empathized with the client as I considered the fact that he had made his investment plans based on inaccurate time lines he had received from the branch, and now it felt like he was going to get punished for something which was entirely not his fault. I was determined to bark up every tree and leave no stone unturned to remedy the situation.

I tried to reach the branch representative by phone but got an automated message that he was on vacation so I reached out to the branch manager and advised him of the situation. The branch manager located the transfer form and confirmed the balance which was requested for transfer. We both concurred that the client’s expectations had not been properly managed as the transfer would in fact take up to 10 business days. We knew regardless something needed to be done to help rebuild the client’s confidence in the organization.

While brainstorming on the next step to take, an idea came to mind. I asked the branch manager to send me an email confirming the client’s balance held at the branch with an attached copy of the transfer request form signed by the client. Once I received all the documents, I took them to the senior manager and explained the whole story to him and asked what we could do for the client in the meantime. I was able to get approval for an overdraft for the client to the tune of the amount being transferred to enable him purchase the stock in advance of receiving the funds. I also came to an understanding with the branch manager to cover any interest charges applicable. The senior manager also signed off on having our transfer department initiate the transfer process in advance of receiving the original forms while the branch manager undertook to mail in the forms.

Having put in all that work to get things right for the client, it reminded me of what Warren Buffett once said “It takes 20 years to build a reputation and five minutes to ruin it.” I felt great giving the client a call back with the positive feedback on a resolution to his problem. I explained to him all the steps I had taken to ensure that his issue was resolved. The client was able to place his order, and he was extremely satisfied with the dedication I put towards resolving his issue and rebuilding his trust in the firm in the process.

It’s experiences like these that make me love what I do, as I derive the highest level of fulfillment knowing that I can turn clients’ frustrations into joy, gratitude, and complete satisfaction. How much more rewarding and motivating could this get!

Roy Wefuan – Scotia iTRADE

 

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No Situation Too Complex

“Thank you for always being there; I always knew I could talk with you about anything and you would always listen with your heart!”

Janet possesses one of the most enduring qualities a CSR could have, and I quote, “I absolutely love my job. I get the privilege to help people every single day, how powerful is that.” Janet defines concierge service by consistently being asked by our members if they could reach out to her directly when they need to call back. I can’t think of a better way to be recognized then by that request. The value Janet places on her customer service skills is not timeliness of response, but of the highest quality interaction of first call resolution and member engagement.

Part of Janet’s service excellence is her innate ability to breakdown complex insurance lingo and processes that people can easily understand. Janet has all of the gold star service characteristics that has to be part of CSR’s DNA: empathy, kindness, patience, being mindful, listening without judgement, and best of all, her 30 years of experience in our great industry. These qualities may be taught and understood but it is how a person is able to apply them in practice that separates the average from the great ones. She has what I call the IT factor. Janet has IT, just like the Great Wayne Gretzky had IT in hockey; no situation is too complex or too demanding. She has practiced and practiced to be the very best of the best.

Janet will always go above and beyond for members. If a senior citizen reluctantly shares their very personal story that they sometimes have to sacrifice paying for necessities like food or their insurance, she will go out of her way to connect these folks with live representatives from an array of social programs that she has personally researched on her own to assist them in stretching out their fixed incomes. Security Health Plan is extremely fortunate to have someone of her caliber assisting one of our most vulnerable membership segments. It is no wonder that she has been sent flowers, chocolates, knitted mittens and scarfs, numerous thank you cards, and even having her value as a CSR being mentioned by two different members with comments such as “I wish I could buy you an island for all that you’ve done for me.”

Let’s talk about an example. One day the receptionist says, “Hey, I’ve got a letter that came in today about some expenses for a dental bridge—I know it’s already a busy day for you, but would you mind checking it out?” The letter states: “I don’t know if you can help me or not, but I just want to ask, because I don’t know who else to talk to about this. I checked all those booklets I always get from the Plan and I can’t find anything that says my insurance will pay for some work my dentist needs to do to repair a bridge. Trouble is, my dentist said it could be repaired but then he gave me this estimate I’m sending in to you and there is no way I can pay for this but I can’t find anything in this plan that says you’ll pay for it either, so I’m hoping you can help me.”

The sender was an elderly member who’s had been enrolled for quite some time but there were very few contacts entered over the past several years. She was amazingly healthy for her age, or one of those who just toughs it out and may not actually be getting all of the care she needed because she’s too independent to ask. We have a lot of those in the golden years population. They’ve survived the Great Depression, endured the greatest Wars the world has ever witnessed, outlived most of their friends and family members and they’re generally ready to tackle almost anything except asking for help.

The member answered right away when I called her, but there was definitely caution in her tone. I introduced myself again and explain that I received her letter. I politely convinced her to turn the TV down enough so we could both hear and I tell her I’d really like to help her.

I noted that all her dental procedures are Medicare Exclusions. The member sighs deeply, and says she’d gotten used to hearing those words in the months since she lost her husband. Suddenly we’re plunging headlong into a touching life story of two people who were very lucky in love for a very long time, but everything’s been on a down-hill slide since he died.

I empathized and explained that even though I could not offer her any good news about those dental costs right now, I may be able to offer other suggestions to assist her. I noted her location and asked if her late spouse ever served in the Armed Forces, and if there might be any VA Benefits available for her, but she says “no—he was one of those guys who stayed home to take care of the farm—thank God”! I inquired if she had ever considered completing an income screening with the local Aging & Disability Resource Center, and I explained that the staff at her ADRC may be able to offer financial assistance, as well as information on other local programs that could help with basic expenses such as her home heating costs and groceries.

The member responded that she hadn’t been at that office in years, and explained that when her late spouse became very ill, they went to that office together to check on help with their medical and medication costs, but they were over the income limits for any programs. She said, “I was so disappointed that I couldn’t get some help to for him and after he died, friends told me that I should go back, but I just couldn’t take any more bad news.”

I explained that I would really like to help her arrange another income review—but the member said she doesn’t have any way to get to that office now, because she doesn’t drive anymore. I explained that the ADRC Representatives could schedule in-home consultations for people in her situation, and I asked if she would like assistance with those arrangements. I explained that if she qualifies for Medicaid, there would be some dental benefits included with her coverage, but if that program is not available, I could conference her with representatives from another local, grant-funded program and provide preventive and restorative dental benefits. I explained their representatives would be able to help initiate the dental repair services with a payment arrangement that would fit her budget. She said that sounds too good to be true, but she would definitely like more information; so we conferenced the ADRC office together and were able to schedule a home interview the next day.

The member said, “That will be very helpful,” and I explained that since she qualifies for that assistance, she would also qualify for the other program we discussed. I asked if I could assist with arrangements for that as well, and she replied, “That would be wonderful!” Lucky for us we were able to have her enrolled before the end of the month and the staff at that dental office would help her with the financial arrangements she needs for the bridge crisis that brought us together in the first place.

Over the next several years, I had the pleasure of assisting this member again whenever she had benefit inquiries and she would always she say, “You were one of my luckiest finds ever.”

During one of the last calls we shared, she said, “Thank you for always being there; I always knew I could talk with you about anything and you would always listen with your heart!” The member doesn’t need to call me anymore as she is now up there laughing with the angels, as well as probably dancing every day with that “drop dead handsome man” who used to “sweep me into his arms and waltz me around the haymow after chores, every night!”

Janet Cramm – Security Health Plan

 

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Making a Difference

“In a few minutes this member's experience had gone from being unpleasant to being an extremely satisfying one.”

I took a call in summer of 2016 that involved a complex situation with a member I could tell was very upset from the tone of her voice. When I asked her how I could help the member said she was calling in regarding an issue she was having at the pharmacy. When she went to her local pharmacy she was being told that she had other medical coverage and therefore her prescriptions were not being paid through her drug card.

The member advised me that this issue had been going on for months now and she always had to call in about it but nothing was ever done. This situation had been extremely frustrating for her and she advised me that she was upset as she felt she was getting the run around from Sun Life and from her employer. She also mentioned that she recently began taking a very high cost medication and had been paying out of pocket for this expense. I could hear that the member was tearing up and I truly sympathized with her situation. She was currently at the pharmacy and needed to get medications right away and did not have the money to pay for them. She had called in previously and was told everything was fixed but was shocked and surprised to again have to pay out of pocket. After reviewing her file I confirmed that this had been an ongoing issue and I knew I needed to ensure this was taken care of right away for her.

She informed me that each time she called that she was referred back to her employer to update her coordination of benefits information. When I looked at her plan I unfortunately saw that this was not the correct course of action. I offered my sincerest apologies to the member for this confusion. When I looked deeper into her plan I saw that the reason she was having problems had to do with an error on her claim forms. When she was submitting the paper forms in the mail she was indicating that she did have another policy when in fact she did not. I informed the member of this and went through the claim form step by step with her to ensure that the mistake would not happen again. The member was very happy that this was a simple step to take and that I was able to provide her with the correct process.

I had now taken care of part of the problem but still had to figure out what I could do to help her right now at the pharmacy. Our standard process is to send an update to our maintenance team and this will be updated within 4 calendar days at the most. I knew that this was not an option for this member. The other option would be for the member to pay out of pocket and then have the pharmacy rebill once the update is completed. She had already advised me that paying today was not possible. I knew I needed to think outside the box and do whatever I could to help her and to make up for her previous negative experiences. I asked the member if I could place her on a brief hold while I looked into this further for her. When she agreed I decided that I would personally call our maintenance team while I had her on hold and try and get this updated live on the call. While I was waiting for maintenance to answer I was crossing my fingers that this would be an attainable solution. I informed the representative of the situation and they were luckily able to update it right away. They advised me that the pharmacy could now submit.

I was so excited to go back to the member and advise them of the great news. I informed the member that the pharmacy would be able to resubmit the claim electronically so she would be able to pick up her medication today. The member’s tone and demeanor changed right away. I could tell that I really turned this call around. The member first was in tears due to frustration and anger and by the end of the call was crying because she was happy and relieved. She advised me that she was so grateful that I was able to give her the correct information so this error would not happen again and that I had fixed everything for her while she was on the phone.

In a few minutes this member's experience had gone from being unpleasant to being an extremely satisfying one. I was not only proud of myself with how professionally I handled and helped this caller, but I knew that I was making a difference in the Group Benefits Call Centre.

Amber Moore – Sun Life Financial

 

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Someone Calling For Help

“I immediately made her complete resolution my only priority.”

I received a call from an elderly member who was trying to submit a few claims online. I assumed right away that it would be a long call, as she was hard of hearing and kept asking me to “speak up.” As I logged into her account, I saw through her summary tab that she had called three times before the end of the business day, all for the same reason – all web-related. This was unacceptable. I immediately thought of my own parents, who are on the phone all the time with various companies, trying to handle their affairs. They’re not the best with computers, but they try, just like this caller. I immediately made her complete resolution my only priority.

The caller felt embarrassed, and kept saying she “didn’t want to take up any more of my time” – I reassured her over and over again that she had nothing to apologize for, and that as long as we were making progress, no matter how small, that was all that mattered – I wasn’t going anywhere.

More than 30 minutes later, after moving her from a tablet (which wasn’t loading the site properly), to getting her to the sign-in page, and walking her through the online access registration (with a few minor hiccups along the way), she was logged in. I will never forget how grateful she was at that point. To reassure her further, and to show her how easy it was, I asked her to log out, close her browser, and log back in, which she did. Once she was back in, I gave her a quick tour, showing her where she could view her coverage, claim statements, and submit her claims.

Now, onto phase two! She had two claims she was trying to submit, a paramedical e-claim, and lab work which was not something that was compatible through the desktop site. I gave the option for the mobile app, where she let out a memorable laugh, saying that she uses a flip phone. Now that she was logged in, we managed to keep the momentum going and have her paramedical e-claim submitted. Being able to confirm receipt of her claim immediately, and hearing her relief was rewarding for us both. Now, for that lab work…I remembered her tablet! She confirmed it was an iPad. I let her know if she had a few more minutes, I’d be able to walk her through the download, and show her how to submit a picture. She was very grateful, but was laughing (she had to go), and her laugh had me smiling. She declined to follow through with the app, opting to mail the lab-work instead.

We said our goodbyes which overlapped, and lingered with some more laughs and smiles, then the call was over. There are the calls where you can tell members are on the go, squeezing a call to the CCC into their already busy schedule, then there are calls like this one, where it’s someone calling for help. Here was a lovely lady who had put aside nearly an entire day dealing with the phone-system, speaking to multiple reps, all to try and submit their claims. This was a person who knew they could mail their claims, but wanted to try and take advantage of a service Sun Life offered, a service that was supposed to make things easier for this person. She was completely understanding and hopeful, and once she was in, sharing in her accomplishment on, and understanding of the site was as welcome an experience as one could hope for in the CCC.

Daniel Arnold – Sun Life Financial

 

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My Brighter Way

“... anticipating their needs and providing solutions as well as next steps.”

My SQM story is about a change that I helped to implement at Sun Life Financial that now affects millions of Canadians all across the country. This change was inspired by a simple question from a member:

"Why can't I see my personal investments as well as my Group Retirement on the Sun Life mobile app?"

I have worked in customer care for upwards of ten years, but I had no idea how much of an impact I could have in my role as a customer care representative at Sun Life Financial. Working here in the call center is so much more than just answering phones. It's providing members with peace of mind with their investments. It's anticipating their needs and providing solutions as well as next steps. It's creating a client-for-life experience that makes our members happy to call in about their retirement.

I'll never forget a conversation I had with a member who simply called in for some assistance using the Sun Life mobile app. They wondered why their personal investments weren't listed alongside their Group Retirement. At the time, the app only showed members' Group Retirement accounts. I thought that having everything together was a great idea; after all, we want to give our members the best customer service experience possible, so having all their financial information in the same place would make perfect sense.

Luckily, Sun Life has a program called “The Brighter Way”, which strongly encourages its employees to submit suggestions they think would help the company grow. I knew that by submitting this idea to Sun Life, I would be going the extra mile for this member, bolstering her relationship with us and providing her with peace of mind. We call this type of suggestion a “quick win”, because both the member and Sun Life benefit from it!

Later that day, I approached my team leader for some help with submitting this "CI", or “Continuous Improvement”, as we call them. She encouraged me to submit my CI, and provided me with the tools and knowledge to do so.

After a little research and some advice from our best practices team, I nervously submitted my idea. About a week or so later (and much to my surprise), my suggestion had moved from “in review” to “completed!” It was then immediately implemented on mobile apps across the country. Still shocked, I opened the Sun Life app on my cell phone, and there it was: my own retirement account, separated by “Workplace” and “Personal!”

Well, I can barely describe how excited I was to call the member back. Not only had her suggestion come to fruition, but it only took a matter of weeks for the entire process! When I spoke to her, I asked her to open her phone and take a look at her investments screen on the Sun Life mobile app. She was beyond blown away at seeing her suggestion implemented, and wondered how I made this happen so quickly. She actually thought that I had set this up just for her phone – and was flabbergasted when I told her millions of Canadians could now see the same thing on their mobile devices!

The member was overjoyed. She described to me how much it meant to her that even at a big company, her voice was heard. I knew that by going the extra mile for her, I was making this member a Client for Life. At Sun Life, I am not only a client care representative; I am empowered to make changes based on the client’s needs. I am a client advocate.

Isaac Gillan – Sun Life Financial

 

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Achieving Balance

“... a call that changed a bad day into a day of personal satisfaction.”

Working in a call centre can sometimes be difficult to handle at the end of the day. It is important, when we leave work, to let it go and not think about it anymore. If, during the day, there were a few difficult calls that made you sad or put you in a bad mood, it is also important to talk about it once and then move on. On the other hand, working in a call centre can bring you joy, inner peace, and satisfaction at the end of your day. When a day went well, you also need to express it because each day is different and it’s important to talk about it even if it was positive. After four years in the Sun Life Financial client service centre, there are multiple stories that come to mind and remind me that if a day went bad, one call can completely turn it around. Here is the story of a call that changed a bad day into a day of personal satisfaction.

The client contacted the call centre in order to validate some information that, for her, was not clear. According to her, she would have had a limited service in the past when she contacted us. She did not get answers to her questions. The elderly woman first asked me to speak slowly in order to understand me properly. I can say that taking your time can make a big difference for us and for others. Sometimes it can be hard to deal with both efficiency and quality during a call and trying to balance both can make you feel pressured. For my part, it took a few years in the call centre to maintain this strength. I had to work on my self-discipline day after day. I had to work on my patience and my concentration. Once these two strengths are well handled, then it becomes possible to achieve the balance between quality and efficiency.

The lady therefore asked me to speak slowly. It was a great opportunity to demonstrate compassion and respect during a call that could be difficult to control. Self-control and compassion for others are two important qualities in this field of work. The lady was so sweet and I think she had just been misunderstood in the past. She made me understand her needs and what she was looking for right at the beginning of the call. There was no reason to me not to understand her, so it was a great start for this call. When someone is clear and accurate, everything is easier.

The story: The client had received a cheque with a specific amount on it. She wanted to know the reason why it had been sent to her and if she was allowed to cash it. The last time that she had contacted the call centre, she had gotten no answer to her questions. She was expressing herself properly, but she talked very slowly. She was easy to understand. She also repeated the same information five or six times during the call. She was irritated by the fact that the last person she spoke with apparently did not take the time to explain things as I was doing. Furthermore, she had been transferred four times before she was able to find someone on the proper queue.

First, we have to ask ourselves: what was she was really looking for? I started to confirm that I would be able to help and assist her. My tone of voice suddenly changed. I was talking slowly and made sure that she was able to hear me well. The key is to adjust your tone to the client’s mood and needs. To speak louder and faster would not have helped the situation. I could see clearly that the lady was concerned about something. “Today, we will take the time to find out the reason why you received a cheque.” I started to authenticate the client in order to access her file. I thought that the cheque was probably explained by dividends or a loan taken on her policy. I did not expect what I was about to discover.

The lady told me that she was very happy to finally get help with her search. I started to take a look at the client’s file in the appropriate service request. After reviewing it, I realized that we have never issued a loan or dividends cheque to the client. In fact, the client had not called the call centre for many years. “Did you ever have shares with Sun Life Financial?” “No, sweetheart!” I was really starting to wonder what the reason was. She confirmed that the cheque had been sent by Sun Life Financial. I asked her the cheque amount and she answered that it was in the six digits.

“Oh my gosh! What could that possibly be?” I asked myself. I called our tier 2 department and asked them to help me find the answer for this client. The other agent had no idea why we had sent a cheque to this client either, but then she suggested that I call the Life Claims department, just to be sure. I began to wonder if that could really be the key to this mystery, if it could be a death benefit payment for which this lady was the beneficiary. If that was the case, she should have been aware of the circumstances, but she was very confused. Before I called the Life Claims department, I asked the client to verify if there was any description on the cheque that would explain why it had been sent. She answered with a man’s name, and said that it was the name of one of her sons. I asked her when she had received the cheque, but she did not remember. She then said that next to her son’s name, it said “deceased”. But still, she had no idea why the cheque had been sent to her. “Did your son recently pass away?” “I have not spoken to him in many months. Our relationship has changed. We don’t really talk anymore.” Her tone of voice suddenly changed and I realized that she was crying. Silence on the line. I gave her a moment to catch her breath and contain herself. “Were you aware of your son’s passing?”

It is only at that moment that she realized that her son had passed away since the last time that she had talked to him on the phone. That was the reason why she had received this cheque on the mail. She was the beneficiary of her son’s life insurance policy. This lady most likely suffered from type of memory loss. She did not remember that a financial advisor had contacted her three or four months earlier to give her the cheque.

Working in a call centre can sometimes be difficult to handle. That day, the client was calling to obtain answers to her questions. That day, I took the time to listen to what this lady had to say and to provide the answers that she was looking for. I did everything in my power to tell her what she wanted to know. I was able to listen, research and fulfill the client’s needs. There is no doubt that the news that she received on that day were very troubling, but at least she had now learned the truth. This lady could now mourn her son and find comfort in the knowledge that he had left her a gift that would make the rest of her life easier. Taking your time can make all the difference in the world. Patience, respect and coherence are vital strengths when working with other human beings. Empathy is also a quality that allows you to stand out, and people will be grateful for it.

Julie Dion – Sun Life Financial

 

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A Blood-Curdling Call

“I knew, right from that moment, that I would do everything I could to try to put a bit of hope in this client’s day.”

On May 1st, 2016, a wildfire began southwest of Fort McMurray, Alberta, Canada. On May 3rd, it swept through the community, forcing the largest wildfire evacuation in Alberta’s history. After sweeping through Fort McMurray, the wildfire destroyed approximately 2,400 homes and buildings, forcing more than 80,000 residents to flee and killing two people trying to escape the flames.

It was about a week later when I received his call. In the first seconds of the call I knew what was happening on the other side of that line and it was heartbreaking. I began the greeting of my call as usual, without knowing what was coming. Thank you for calling, my name is Katrine. May I have your account number or Access ID please? The caller told me had had absolutely no idea what it is, that he was an employee from Fort McMurray and every piece of paper he owned was now in a pile of ash.

My blood turned cold. I knew, right from that moment, that I would do everything I could to try to put a bit of hope in this client’s day. I told him that Sun Life Financial and I were empathizing for what he and all the people impacted by the Fort McMurray fires were going through, and that we were going to do everything under our control in order to find the best solutions to meet their needs. I created a relationship with him right away – talking about how this must be difficult and that I would send him the money he needs without any problem. Sun Life Financial and his employer had waived the usual restriction on the Employee Savings Plan withdrawals, allowing me to give the best service possible for this poor man and his family. He almost cried when I explained that the restriction was going to be waived for him. He was so thankful!

While I was calculating the total amount that I would be able to send him, he told me that he was really happy to talk to someone that seemed to understand what he was going through. He told me that he and his family were safe, but he was feeling guilty about withdrawing all the funds he had saved in his Savings Plan. I re-assured him that the most important thing was the safety of his family, and that he was not impacting the amount he would receive at retirement. He still had a Defined contribution pension plan that was assuring a retirement income sufficient for him. After giving the total amount that I was withdrawing for him, which was $47,000, I began to enter his withdrawal. I have never put him on hold; I wanted to make sure he knew that I was staying with him and was taking care of him right away. While I was entering the transaction, the line was silent. He broke the silence because he needed to talk. He told me that he was standing in Wal-Mart’s parking lot right now, trying to figure out how to repurchase a quarter of the items he had just lost. He didn’t even have his cards with him and only had $30 left. He said he guessed he would be sleeping there tonight. His wife and him were hungry, and they had almost have no more gas left in the car and really didn’t know where to begin.

Wow. I honestly never thought that I would be confronted with a situation like this. We are used to empathizing with our clients when they are going through rough times, but I never thought I’d feel as bad as I felt in that moment. I told him not to worry about the money, that he would be getting $47,000 directly in his bank account first thing tomorrow morning. I told him to take it easy tonight, to go buy something to eat for him and his wife. The money he would get the next morning would be sufficient to fill his car with gas and buy the necessary items they would need. As he told me that he didn’t have his cards with him, I proactively asked the name of his bank. I told him to open his Notes in his cellphone and gave the Customer service phone number for RBC. He would call them right away after our conversation in order to make sure the deposit would be received in the morning, and that he would be able to withdraw money at any branch, even without his debit card. I explained that if he needed anything else, he could just call me back. I gave him my employee ID and told him that I would be praying for him tonight.

I am used to going above and beyond for my clients. I am used to trying to make them laugh and make their day joyous. I am used to taking care of my client’s requests efficiently and professionally. I am also used to giving the service I would want to be given each time I pick up the phone. I basically try as much as I can to put myself in the client’s shoes, to understand what they are going through in order to help them in the best way possible, and this is what made me feel this way with this individual. I still wonder how his life is going now, I care about him and this is why I chose this call to be my SQM story.

Katrine Gagnon – Sun Life Financial

 

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Above And Beyond For Our Customers.

“At that moment, I knew what I was going to do”

“She told me I had made her week and that she would be telling everyone how helpful Sun Life is and how we go above and beyond for our customers.”

I remember when a woman called in and I could hear right away in her voice she was very distressed. She told me that she was having a really hard time with some claims. I apologized to her and said I would do whatever I could to help resolve the issue. She told me she was calling about her son who was having orthodontic work done. She had submitted multiple claims, which had all been declined requesting the same thing, a treatment plan. When I pulled up the claims, I noticed they were the same claims that had been submitted multiple times, most had been submitted electronically and the most recent one through paper.

I could see from her file that she had called multiple times about these claims and could understand why she was frustrated; she was out of pocket a lot of money and had spent a lot of time on the phone. I expressed to her that the dental office needed to provide her with the treatment plan so she could send it to Sun Life, or the dental office could send it to Sun Life on her behalf. I said we could set up a file for a fax to expedite the issue and have the claims resolved as soon as possible. At this point, the woman got choked up and started to cry. She explained that she had gone to the orthodontist multiple times to ask for treatment plan, but the orthodontist office refused to give her one. They told her that ‘no orthodontist gives treatment plans’. I assured her that treatment plans were very normal as they give the overall picture of the treatment. She agreed and expressed she knew they were standard since her other child had orthodontics in the past. Her previous orthodontist had retired and the orthodontist her son was seeing was new. They also happened to be the only orthodontist close by since she lived in a small town. She was frustrated because they were giving her so much grief, she desperately wanted to go somewhere else but couldn’t because all the other offices were too far. She kept saying that she felt trapped and hopeless about the entire situation and was really stressed because she needed the claim payments to pay her bills and cash was tight.

I empathized with her and told her I was sorry. I had noticed the orthodontist office had never called about her plan. I told her that if they were confused they were welcome to call Sun Life and we could explain to them exactly what we require to pay the claim, so she wouldn’t have to keep being the middle man. It turns out she had begged them to call and they refused multiple times.

She then informed me she was going to the office later to speak to them one more time, even though it was hopeless. I asked her when she was going and she told me 4:30pm. At that moment, I knew what I was going to do. I told her my shift finished at 4:30 and that I would call her cellphone when she was at the orthodontist office and she could pass her phone to the receptionist and I would speak to them on her behalf. Since they refused to contact Sun Life, she would bring Sun Life (me) to them. She was very grateful and told me she was looking forward to my call and thanked me for giving my own time to help her. I told her it was no problem at all and that I would do whatever it takes to assist her.

At 4:30pm, I called her and she passed me over to the receptionist as instructed. They were very difficult with me, they kept telling me that treatment plans ‘weren’t normal’. I broke down exactly what was needed on the treatment plan and told them I would keep talking to them until they gave one to the woman. After talking to them for almost 20 minutes, they drafted up a treatment plan and gave a copy to the woman and passed the cell back to her. When she started speaking, she was choked up. She had tried for over a month to get this information and was denied every time yet she finally now had the papers in her hands. I then arranged to have the documents faxed in and told her I would keep an eye on her file to make sure the fax was received and sent for processing as well that I would call her again to touch base. I kept a note for myself and checked her file for the next few days, until I saw the fax. I reviewed it to make sure all the documents were accurate and forwarded for processing. After a few days, the claims were paid out.

I called her back and stated the claims were paid and she should see the money in her account within the next 24-48 hours. She said she had almost no words for how grateful she was and couldn’t say thank you enough and that no one had given their own time to help her before. She told me she was also sorry that I had stayed so long after my shift to speak to the dentist and spent more time to call her back. I told her it I was happy to help and she had nothing to be sorry for. She told me I had made her week and that she would be telling everyone how helpful Sun Life is and how we go above and beyond for our customers.

Melanie Luckhurst – Sun Life Financial

 

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A Difficult Time

“... in these moments, it becomes our job to bring some light to their day.”

Working in the Group Benefits Line of Sun Life’s Customer Care Center means we speak to a lot of people who are at different stages in their life, but when they call us they have one thing in common. They need us to help them understand their benefits to make the best decisions on proposed medical and dental treatments/services. Sometimes these calls come at our client’s darkest times, and in these moments, it becomes our job to bring some light to their day.

In 2016, a few weeks before Christmas, I got a call from a member’s wife asking if they had hospital coverage. As with all calls of this kind, I started by advising the caller that the question she was asking was a bit more involved. I asked if it would be ok if I asked some more detailed questions. There were quite a few of my questions that she was not able to answer. One of them being, what type of room the hospital would be charging. It was then that she started to explain the situation further.

About 2 weeks prior, her husband, our client, collapsed at home. He was rushed to the hospital via ambulance and put through a battery of tests to find out what was wrong. Unfortunately, the results came back that he had terminal cancer, stage 4 and the doctors were giving him only weeks to live. They weren’t even sure if he would make it to Christmas. Furthermore, their youngest son was in the middle of exams and they were holding off telling him as they wanted him to be focused on his grades. He would be finishing his exams at the end of the week and they were hoping to have a private hospital room in which to break the news to him and to allow their entire family to say their goodbyes.

The caller was quite emotional, and multiple times when explaining the circumstances she had to pause to regain her composure. Understanding how hard this situation must be for her and her family, I assured her not to worry about taking a moment and that we were in no rush.

After her explanation, I provided her as much information I could. I followed this up with clear steps that she needed to do to confirm what coverages would apply and next steps if the hospital indicated that they would be charging any other type of room. I wanted to make this process as easy as possible.

This is when I remembered a detail she had mentioned earlier, and I asked if the hospital had submitted her ambulance bill to Sun Life directly. She indicated they hadn’t, so I provided her the steps she needed to take to get the bill submitted to us for reimbursement and advised her of what her coverage was.

While providing this information, I took a quick second to confirm if the caller had consent to the financial details of her husband’s plan. I found that she didn’t. I immediately brought this to her attention and asked if she and her husband had set up a Power of Attorney. They hadn’t yet but were planning on doing that later in the week. I asked her to make a copy of that Power of Attorney and gave her the steps to submit this information to us to avoid any difficulties in submitting claims or gaining information on her husband’s policy at a later date.

Before ending the call, I quickly reviewed all the information we’d gone through, re-iterated all the steps we’d discussed and took the time to allow her to write down the key pieces to make sure she had it right so she wouldn’t have to spend any of the precious time she had calling us again. I know this was a very difficult call for her to make but, she expressed how thankful she was for Sun Life to have taken the time to understand the situation and not only attempt to give her the answers she needed, but also went above and beyond to provide her with valuable information she didn’t know she needed.

Its calls like these where you can make a difference in a client’s time of need that makes this job so rewarding.

Melissa McGahey – Sun Life Financial