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Customer Service Representative

Irving, TX
October 21, 2018

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Sonya Rushing

Claims Representative - Tower Watson/One Exchange

Irving, TX 75062


Qualified Claims/Customer Service Representative able to investigate claims, verify information and facilitate a resolution. Result driven, friendly and upbeat team player with an organized and disciplined approach. Seeking a permanent role with company that values not only their customer but employee and promotes within.

Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Claims Representative

Tower Watson/One Exchange - Richardson, TX

August 2016 to Present

Actively listen and facilitate first call resolutions for Medicare eligible retirees to the highest level regarding any HRA account related issues, claim processing issues, and medical benefits Initiate telephone calls to the carrier or other departments to further facilitate a resolution Clearly convey with confidence a comprehensive understanding of the company services over to customers to assume ownership.

Respond to general technical issues and assist customers with setting up online accounts Review and analysis plan benefits and account information to recommend other products or services offered.

Examine supported documents to capture vital information needed to process claims Convey information needed to re-process adverse claim decisions resulting in denying claims Expedite claims processing for pending or denied claims Issue void/re-issues or stop payment on refunds where as check is know longer negotiable.

Member Service Representative

Dialog Direct/BCBS - Fort Worth, TX

March 2016 to August 2016

Assisted company with maximizing production by utilizing BIBS software and systems to respond to customer inquiries regarding their plan benefits

Processed daily invoices and billed renewed invoices to clients. Documented all customer inquiries and comments thoroughly and quickly. Processed cash and credit payments rapidly and accurately. Initiated 3-way phone calls to outside parties and other departments to further assist members Escalated incident tickets to the next level when unable to provide a resolution Processed new ID cards, insurance policies, endorsements, policy renewals and cancellations in a timely manner.

Clearly convey plan benefits and products with confidence and take ownership and suggest product change

Records Coordinator

Alcorn State University - Lorman, MS

September 2013 to January 2016

Implemented new electronic records management system that ensured swift and accurate information/ records retrieval and delivery service for the campus community Implemented policies and procedures to protect the privacy of personal information

Maintained and updated records through a dedicated digital database. Documented daily interaction via incoming and outgoing Assisted IT department with troubleshooting records database or any other technical issues.


Bachelor of Science in Criminal Justice

Grambling State University - - Grambling, LA



BUSINESS DEVELOPMENT, CLIENT RELATIONS, CREDIT CARD, DATA ANALYSIS, DOCUMENTATION, Call Center, Customer Service, claims examination & processing Additional Information


Documentation review Customer-oriented

Policy understanding Credit card processing

Results-oriented Quick learner

Business development Creative problem solver

MS Office Medical terminology knowledge

Analytical Multi-line phone talent

Data analysis MS Windows proficient

Proactive team player Strong client relations

Time management Exceptional communication skills

Personable strong interpersonal Computer literate

Goal-oriented People-oriented

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