Theresa C Irizarry
Summary
Reliable Customer Service Representative with an extensive track record in demanding sales and account management environments. Strong presenter, communicator and problem solver working effectively and productively with diverse customers and individual needs.
Overview
20
20
years of professional experience
Work History
Complex Customer Service Representative, PA, SME, Team Captain
UMR/GEHA
08.2025 - Current
- Asked targeted questions and listened actively to identify member needs, documenting essential information in computer systems for effective issue resolution.
- Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member/Provider.
- Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
- Applied appropriate processes and procedures to ensure accurate benefits application for each claim, adhering to claims processing policies, grievance procedures, and CMS/Medicare guidelines.
- Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding.
- Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.
- Demonstrating ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a respectful, timely manner, consistently meeting commitments)
- Having the ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member/provider.
- Proficient conflict management skills include the ability to resolve issues in a stressful situation and demonstrate personal resilience.
- Proficient problem-solving approach to quickly assess current state and formulate recommendations
- Led team in delivering assistance as requested by supervisors and served as subject matter expert for onboarding new hires.
Senior CSR
VISION FINANCIAL SERVICES
La Porte, US
10.2022 - 08.2026
- Provided excellent customer service to customers with diverse needs and backgrounds, resolving complex inquiries in a timely manner.
- Managed high volume of incoming calls while maintaining positive attitude and professional demeanor.
- Developed relationships with members, customers, and clients as primary contact for inquiries and feedback, fostering customer loyalty.
- Communicated effectively and professionally with customers, representing the company and brand in a positive and customer-centric manner.
- Utilized effective communication skills to respond to customer inquiries.
- Collaborated cross-functionally with departments to resolve customer issues, enhancing overall service efficiency.
- Interacted regularly with senior management to assess goal achievement and identify improvement areas for customer service initiatives.
- Created detailed reports summarizing customer interactions and key performance metrics.
PATIENT SERVICE REP/CUSTOMER SERVICE
LIVEOPS
09.2021 - 10.2022
- Tend to IB and OB calls regarding patient/HCP orders requested and placed for Cologuard Cancer screening
- Input patient demographics as well as insurance coverage in EMR, navigating and utilizing EPIC systems
- Assessed and addressed individual patient needs to ensure satisfaction and compliance.
- Transferred calls to appropriate units and documented requests for efficient follow-up.
- Collaborated as contractor on team projects, contributing to successful project outcomes.
CNA/HHA
PRIVATE CLIENT
, US
05.2006 - 03.2020
- Provided comprehensive care for individuals by assisting with ADLs, monitoring vitals, performing bathing and personal grooming, administering medication, and delivering specialized care for Alzheimer's, CHF, and seizure disorder patients.
- Provided personal care and support to clients in daily activities.
- Assisted clients with mobility, transfers, and positioning for comfort.
- Monitored vital signs and reported changes to healthcare professionals.
Education
NURSING - Nursing Education
IN-TRAINING
IN03-2002
Skills
- Claims processing
- Regulatory Compliance
- Client Standards
- Customer Service Standards
- Call handling
- EMR navigation
- Cross-functional collaboration
- Organization
- Mentoring Team Members
- Teamwork
- Active listening
- Conflict resolution
- Problem solving
- Adaptability
- Interpersonal Skills
Closing Statement
I'm interested in discussing how my qualifications could align with other opportunities at this company, and look forward to continuing to grow within, hoping the above may be enough to prove the worthiness of the job skills that I possess. Thank you for providing me with the opportunity to continue to support and serve the clients, customers, providers, as well as my team members. I look forward to being a part of this company for the long-haul.
Accomplishments And Skills
- Providing individuals with empathy, dignity, and pride while implementing the best healthcare possible.
- Ensuring HIPAA compliance, meeting client standards, and organization.
- Prioritization, interpersonal skills, and teamwork are the sources of excellence for me.
- Utilizing and embracing challenges, by creating value.
Timeline
Complex Customer Service Representative, PA, SME, Team Captain
UMR/GEHA
08.2025 - Current
Senior CSR
VISION FINANCIAL SERVICES
10.2022 - 08.2026
PATIENT SERVICE REP/CUSTOMER SERVICE
LIVEOPS
09.2021 - 10.2022
CNA/HHA
PRIVATE CLIENT
05.2006 - 03.2020
NURSING - Nursing Education
IN-TRAINING