Trinese Rushing
Charlotte,NC
Summary
Experienced and reliable customer service officer with extensive experience providing assistance in a busy call center setting. Strong dedication to helping customers resolve issues and cultivating a positive image of the company. Excel in both team environment and alone. Proven ability to listen attentively, solve problems quickly and efficiently, and create high-quality professional relationships with callers. Fully committed to following company procedures and winning loyal customers. Authorized to work in the US for any employer Results-driven professional focused on delivering exceptional support for customer needs. Successfully manages concerns and resolves conflicts to maximize customer satisfaction. Offers strong background in customer relations and communication.
Overview
12
12
years of professional experience
Work History
Member Service Representative
S3 Shared Service Solutions
07.2022 - Current
- Respond to member and potential member phone inquiries on membership, products and services
- Navigate system applications as needed to resolve inquiries
- Provide timely, friendly, and accurate service in building member relationships; determine member eligibility; provide guidance to members in order to meet their financial needs
- Accurately verify, document, and process all member transactions
- Prioritize workload based on mandatory requirements and member service level agreements
- Safeguard member accounts and information for privacy and accuracy
- Resolve complaints by communicating with other departments and/or partners as needed
- Provide extraordinary service by resolving problems thoroughly
- Perform and process account maintenance, fulfillment requests, research requests, etc
- Work in collaboration with other team members
- Recognize and escalate issues
- Email Inquiries: respond to, resolve and troubleshoot members’ questions /issues
- Adhere to response time and quality goals
- Bill Payment: research and resolve complex payment issues
- Interact with vendors, payees and members to research issues
- Uncover root cause of problems, correct accounts and communicate actions taken to members
- Educate members on proper use of service
- Other duties as assigned
- WITS Program process international and domestic wires
Medical Coding Specialist
Cigna
05.2020 - 07.2022
- Assembles medical record data
- Evaluates eligibility, benefit amounts based on contract policies, including determining multiple benefits that may or may not be payable on individual claim.
Financial Crimes Specialist II
Wells Fargo
06.2016 - 04.2020
- Participate in complex initiatives and identify opportunity for process improvements within scope of responsibilities
- Perform risk assessment and modeling to provide input and recommendations for financial crimes strategies and models
- Evaluate the adequacy and effectiveness of policies, procedures, processes and internal controls
- Conduct data and onsite reviews, review findings, determine risk level and recommend fraud prevention strategies
- Review and assess business, operational, or technical assignments or challenges that require research, evaluation, and selection of alternatives, and exercise independent judgment to guide medium risk deliverables
- Perform investigative research, root cause evaluation and consulting regarding complex financial crimes transactions, policy violations and suspicious situations with moderate to high risk
- Perform detailed examination to detect transactional and relationship patterns, trends, anomalies and schemes across multiple businesses or products
- Act as an escalation point for more complex cases
- Present recommendations for resolving more complex situations and exercise independent judgment while developing full knowledge proficiency in the function, policies, procedures and compliance requirements
- Take action on control failures in bank processes and procedures
- Represent organization in handling court appearances, depositions, mediations, and arbitrations
- Collaborate and consult with associates on all levels
- Lead, participate in and provide support for projects and initiatives
- Provide input to development and delivery of a wide range of individual education for financial crimes awareness
- Prepare documentation and refer cases for Suspicious Activity, Identity Theft Operations and Suspected
- Financial Abuse, reports to government agencies and makes recommendations to management
- WITS Program process international and domestic wires
Pharmacy Help Desk
Connextions Inc
10.2012 - 09.2015
- Respond to inbound pharmacy/customer calls
- Insurance authorization, benefits, claims, and general assistance
- Deliver the highest quality customer service through the execution of responsiveness, reliability, assurance/confidence, accuracy, and professionalism on every pharmacy/pharmacist interaction in a fast-paced call center
- Performs duties related to the resolution of adjudicated prescription claims with regards to member eligibility, benefit parameters applied, determination of prior authorization or overrides and exceptions in the system
Cashier/Customer Service
Bojangles' Restaurants, Inc
04.2011 - 07.2012
- Preparing foods
- Ringing up purchases
- Explaining menus
- Cleaning dining and kitchen areas
- Handling money
Education
High school diploma -
Al Brown High
Kannapolis, NC06.2012
Skills
- CRM
- Excellent Communication
- Good Telephone Etiquette
- Customer interaction
- Accounting systems and software
- Compliance, banking laws and regulations
- Relationship building and management
- Rapid 10-key data entry
- MS Office
- Attention to Detail
Timeline
Member Service Representative
S3 Shared Service Solutions
07.2022 - Current
Medical Coding Specialist
Cigna
05.2020 - 07.2022
Financial Crimes Specialist II
Wells Fargo
06.2016 - 04.2020
Pharmacy Help Desk
Connextions Inc
10.2012 - 09.2015
Cashier/Customer Service
Bojangles' Restaurants, Inc
04.2011 - 07.2012
High school diploma -
Al Brown High
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