YESENIA LOZANO
CONVERSE
Summary
Customer Service Representative with over 15 years of experience in optimizing customer interactions and enhancing operational efficiency. Expert in data entry, office management, and insurance verification, with a proven track record of driving customer satisfaction through multilingual communication in English and Spanish. Passionate about leveraging administrative skills and advanced organizational strategies to foster long-lasting client relationships and streamline service delivery.
Overview
15
15
years of professional experience
Work History
UM Administrator
Humana
Louisville
04.2025 - Current
- Improved patient care by efficiently coordinating authorizations for medical procedures and treatment plans.
- Reviewed authorizations from the payer to determine approved and denied items.
- Managed day-to-day office operations, ensuring efficient workflow and adherence to policies.
- Identified needs of customers promptly and efficiently.
- Enhanced communication between healthcare providers and insurance companies reduces delays in patient treatment approvals.
PATIENT CARE COORDINATOR
Optum
Eden Prairie
10.2024 - 04.2025
- Coordinate patient care, enhance scheduling efficiency, and improve communication.
- Managed patient records. Ensuring HIPAA compliance and protocol adherence.
- Monitor care metrics, implementing solutions for improved healthcare delivery.
- Lead documentation improvements, enhancing care coordination, and resource use.
- Assist with medication orders and insurance updates, boosting service satisfaction.
CUSTOMER SERVICE ADVOCATE/PROVIDER SERVICES
Centene
Farmington
10.2022 - 10.2024
- Assist members with health insurance inquiries, benefit summaries, and provider searches.
- Support providers with member eligibility, claim status, and credentialing checks.
- Facilitate phone payments, appointment scheduling, and web portal access for members.
- Verify CPT codes and medical authorizations, ensuring compliance and approval.
- Deliver web portal support and resolve credentialing issues for providers.
- Streamline provider inquiries on benefits, eligibility, claims, and authorizations, enhancing operational efficiency and reducing response times.
- Guide providers through web portal navigation and credentialing processes, fostering stronger relationships and improving system utilization.
- Meticulously verify CPT codes and prior authorization requirements, ensuring accurate billing and minimizing claim rejections.
DISPATCHER/CUSTOMER SERVICE
Air and Plumbing Today
San Antonio
02.2021 - 07.2021
- I worked as a Dispatcher/ Customer Service for Air and Plumbing Today with job duties of inbound calls and outbound calls answering customer questions providing great customer service.
- Scheduling customers for AC and Plumbing Problems and verifying their appointments for the next day.
- Putting them on the schedule for their yearly AC summer cleanings.
- Working with the technicians on both ends AC and plumbing making sure they get to their appointments on time calling the customers for them.
- Handling any emergency situations that they might have.
- My other job duties were office work as well Faxing making copies making sure the technicians and plumbers have their papers and supplies.
- Keeping the office clean and up to date.
- Processing payments for customers online and over the phone.
ADMINISTRATIVE ASSISTANT/CUSTOMER SERVICE REPRESENTATIVE
Friedrich Air Conditioning
San Antonio
03.2019 - 09.2020
- My duties were managing and distributing information within the office. This generally includes answering phones, taking memos and maintaining files also be in charge of sending and receiving correspondence, as well as greeting clients and customers, filing papers and scanning.
- My job title was also working in the order entry department of Friedrich as receiving emails for purchase orders I will log orders and distribute them to our order service employees.
- I also did the order entry as well and check the orders for customers too.
- Coordinate patient care, enhancing scheduling efficiency and communication.
- Manage patient records, ensuring HIPAA compliance and protocol adherence.
- Monitor care metrics, implementing solutions for improved healthcare delivery.
- Lead documentation improvements, enhancing care coordination and resource use.
- Assist with medication orders and insurance updates, boosting service satisfaction.
- Assist members with health insurance inquiries, benefit summaries, and provider searches.
- Support providers with member eligibility, claim status, and credentialing checks.
- Facilitate phone payments, appointment scheduling, and web portal access for members.
- Verify CPT codes and medical authorizations, ensuring compliance and approval.
- Deliver web portal support and resolve credentialing issues for providers.
- Streamline provider inquiries on benefits, eligibility, claims, and authorizations, enhancing operational efficiency and reducing response times.
- Guide providers through web portal navigation and credentialing processes, fostering stronger relationships and improving system utilization.
- Meticulously verify CPT codes and prior authorization requirements, ensuring accurate billing and minimizing claim rejections.
- I also did receptionist duties for Friedrich and worked the switchboard when I need too.
- Customer Service answering inbound calls helping customers with any questions they have and also helping consumers with purchase orders and checking for availability as well.
SEASONAL CUSTOMER SERVICE REPRESENTATIVE
Qvc
San Antonio
07.2018 - 12.2018
- Assist members with health insurance inquiries, benefit summaries, and provider searches.
- Support providers with member eligibility, claim status, and credentialing checks.
- Facilitate phone payments, appointment scheduling, and web portal access for members.
- Verify CPT codes and medical authorizations, ensuring compliance and approval.
- Deliver web portal support and resolve credentialing issues for providers.
- Streamline provider inquiries on benefits, eligibility, claims, and authorizations, enhancing operational efficiency and reducing response times.
- Guide providers through web portal navigation and credentialing processes, fostering stronger relationships and improving system utilization.
- Meticulously verify CPT codes and prior authorization requirements, ensuring accurate billing and minimizing claim rejections.
- As a customer service representative working in a call center environment providing good customer service for all inbound calls.
- Helping customers with their orders and monthly payments.
- Troubleshooting and making new accounts.
- Doing refunds and exchanges over the phone.
- Making new orders for customers resolving any issues they might have with our products.
DISPATCHER/CUSTOMER SERVICE
Greater San Antonio Transportation
San Antonio
03.2014 - 07.2018
- As a customer service representative working in a call center environment providing good customer service for all inbound and outbound calls.
- Making sure we get the correct information so we can service them with our taxi service.
- Maintain up to date information on our prices and services for customers.
- As a dispatcher for San Antonio, Austin, Houston, its a step up from customer service representative, helping customers and drivers, receiving messages and organizing movement of people or vehicles.
- Taking control of any emergency calls from drivers.
- Handling any accounts that we have with hospitals, EMS, police stations and much more.
- Knowing the maps for San Antonio, Austin, Houston pretty well so we could assist both the customers and the drivers.
- Besides assisting drivers on multiple phone lines we also had to assist them in our San Antonio office in person with any questions about their payments and accounts or with their vehicles as well.
- We were also trained to conduct urine drug tests for car accidents or renewal or new drivers.
- We were also in charge of taking reports for lost and founds, complaints, over charged payments.
SEASONAL KEYHOLDER/SALES ASSOCIATE
Torrid
San Antonio
11.2013 - 03.2014
- I worked with upper management to ensure the appropriate changes in floor sets and promo changes.
- Learned the opening and closing procedures.
- Learned how to run the reports for sales for the day, week, month, and year.
- Making sales providing the best customer service being an example to the sales associates.
- Handling returns and exchanges, price adjustments.
- Provide accurate information for any customer questions.
- Check in freight put out any new merchandise.
- Count the money in the registers make the deposits.
- Respond to emails and take conference calls.
KEY HOLDER/SALES ASSOCIATE
New York and Company
San Antonio
03.2010 - 03.2014
- Give Great Customer Service to our customers help them with their outfits and checking for sizing making sure they know about our promotions throughout the store and give customers information about our rewards credit card and opening new accounts for them and make sure all information is up to date.
- Be on top of our sales.
- Making promotional changes and floor sets checking in freight, and processing freight also.
- Making sure our sales associates are doing their job checking emails taking conference calls and complaints.
- Opening and closing procedures.
- Count the money in the registers, make the deposits.
- Make sure everything is organized and clean for the next day.
- Be on top of refunds and exchanges, price adjustments.
SEASONAL PART TIME ASSISTANT MANAGER
Motherhood Maternity
San Antonio
09.2013 - 12.2013
- In this position I worked with upper management as a part time assistant manager.
- Learned the opening and closing procedures.
- Had to handle the store by myself sometimes until the next manager will come in.
- Checked in freight, put out new merchandise.
- Making floor changes throughout the store.
- Checking emails and respond to emails.
- Making promotional changes as well.
- Calculating the sales for the day, week, month and year.
- In charge of the payroll.
- Taking conference calls when I had back up in the store.
- Counting the registers, make the deposits.
- In charge of exchanges and refunds any price adjustments as well.
Education
HIGH SCHOOL DIPLOMA -
South Texas Leadership Center
San Antonio, TXSkills
- Medical Terminology
- Microsoft Outlook
- Leadership
- Payroll
- Order entry
- Office management
- Phone etiquette
- Customer service
- Insurance verification
- Multi-line phone
- Organizational skills
- Microsoft PowerPoint
- Dispatching
- Data entry
- Microsoft Word
- Filing
- HIPAA
- Microsoft Excel
- Administrative
- Sales
- Cold calling
Languages
- English, Native
- Spanish, Native
Timeline
UM Administrator
Humana
04.2025 - Current
PATIENT CARE COORDINATOR
Optum
10.2024 - 04.2025
CUSTOMER SERVICE ADVOCATE/PROVIDER SERVICES
Centene
10.2022 - 10.2024
DISPATCHER/CUSTOMER SERVICE
Air and Plumbing Today
02.2021 - 07.2021
ADMINISTRATIVE ASSISTANT/CUSTOMER SERVICE REPRESENTATIVE
Friedrich Air Conditioning
03.2019 - 09.2020
SEASONAL CUSTOMER SERVICE REPRESENTATIVE
Qvc
07.2018 - 12.2018
DISPATCHER/CUSTOMER SERVICE
Greater San Antonio Transportation
03.2014 - 07.2018
SEASONAL KEYHOLDER/SALES ASSOCIATE
Torrid
11.2013 - 03.2014
SEASONAL PART TIME ASSISTANT MANAGER
Motherhood Maternity
09.2013 - 12.2013
KEY HOLDER/SALES ASSOCIATE
New York and Company
03.2010 - 03.2014
HIGH SCHOOL DIPLOMA -
South Texas Leadership Center
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