KARINA TORRES
Brownsville
Summary
Seeking a position to use my functional Skills to Perform as an individual and help customers to resolve their problems leading a team with greater efficiency. I am a dedicated Customer Service Representative motivated in maintaining customer satisfaction and contributing to company success. I am a mature, hardworking, responsible person and driven to reach company goals.
Overview
20
20
years of professional experience
Work History
Bilingual Advocate & Claims processor
United Health Care
Harlingen
02.2015 - Current
- Educate customers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider
- Provide education and status on previously submitted pre-authorizations or pre-determination requests.
- Provided customer service support for Part D benefits, assisting members with their inquiries and issues.
- Intervened with care providers' offices to facilitate appointment scheduling for customers.
- -Assisted member in submitted Coverage Determination on drugs that are non-formulary, tier level exception, etc.
- -Help member with overrides in medications when needed for vacation, lost or stolen medication.
- -Contact pharmacies to provide member resolutions when there was denied claims.
- While in my current position, I was temporarily promoted to On-the-Job Training Assistant (OJT), in this role I provided support to our Customer Service Trainer by facilitating the delivery of training programs, assisting with course materials, evaluating trainee performance, and providing administrative support to ensure new customer service representatives acquired the necessary skills to deliver excellent customer service to our members.
- Maintaining training records, tracking attendance, and managing training schedules.
- Assist with Quality Evaluation for team advocates to ensure advocates are in alignment with UHC and CMS requirements.
- Facilitated group huddles for listening sessions to raise advocate awareness and enhance overall member experience.
- Processed claims efficiently using proprietary software systems.
- Reviewed documentation for accuracy and completeness.
- Collaborated with team members to streamline processing workflows.
- Maintained detailed records of claim adjustments and resolutions.
- Processed a high volume of incoming claims in accordance with established policies and procedures.
- Assisted customers via telephone inquiries related to their specific claim status or general questions about the company's services.
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
Customer Service Representative
T-Mobile
Brownsville
01.2010 - 06.2012
- Resolved customer inquiries, complaints, billing questions, and payment extensions, ensuring efficient issue resolution.
- Utilized tools and resources to deliver exceptional customer service.
- Assisted customers and collaborated with coworkers, fostering a positive and cooperative environment.
- Took charge of team operations during supervisor's temporary absence, ensuring continuity of service.
Customer Service Representative
Convergys
Brownsville
03.2006 - 01.2010
- Resolved technical and billing issues, contributing to increased customer satisfaction and retention.
- Managed in-bound customer service calls, ensuring timely resolution of inquiries and enhancing customer experience.
- Explained services, features, and promotions to over 80 callers daily, facilitating informed decision-making.
Education
Associates of Applied Science - Chemical Environmental Technology
Texas State Technical College
Harlingen, TX12-2014
Diploma -
Gladys Porter High School
Brownsville, TX05-2004
Skills
- Call center operations
- Customer service expert
- Speak Spanish Fluently
- Spanish literacy
- Data entry expertise
- Experience in fast paced environments
- Performance targets
- Problem solving
- Proactive communication
- Listening skills
- Verbal communication
- Great people skills
- Stress management
- Opening/closing procedures
- Fast learner
- Empathetic interaction
References
- George Green, current supervisor, (956) 622-0702
- Amada Bonilla, current team lead, (956) 626-5323
Timeline
Bilingual Advocate & Claims processor
United Health Care
02.2015 - Current
Customer Service Representative
T-Mobile
01.2010 - 06.2012
Customer Service Representative
Convergys
03.2006 - 01.2010
Associates of Applied Science - Chemical Environmental Technology
Texas State Technical College
Diploma -
Gladys Porter High School