BARRY JYNES
Lodi,CA
Summary
Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty. Seeking to gain a rewarding position that will challenge my skills and abilities.
Overview
21
21
years of professional experience
Work History
Customer Service Representative
Blue Shield of CA
10.2021 - Current
- Met customer call guidelines for service levels, handle time and productivity.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Enhanced customer satisfaction by efficiently resolving claims and addressing policyholder concerns.
- Documented customer interactions and transactions for accurate, up-to-date records.
- Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
Appeals & Grievance Case Manager
Pleasanton
08.2016 - 10.2018
- Responsible for resolving member and provider complaint and appeals issues, including eligibility, access to care, claims, benefit, and quality of care concerns
- Identified gaps and performed outreach to internal departments, Plan Partners, IPA/PPGs, facilities and vendors to gather information, medical records and other documentation as needed by nurses and in compliance with PP/PPG contracts
- Completed non-clinical aspects of Clinical Grievance Resolution Letter using appropriate template for type of case, providing completed letter with attachments for nurse to approve, arranging for translation of letter, utilizing mail letter using department protocols, and perform any other duties as assigned
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
Customer Service Representative/Financial Liaison
Blue Shield of California
10.2008 - 03.2016
- Processed and resolved complex financial issues regarding Medical plans, claims, and benefits
- SME for Medical Plans and Benefits (Employee-based, Individual/Family plans, Medicare, etc.)
- Demonstrated strong customer service skills over the phone
- Handled escalated calls
- Responded to member benefits inquiries
- Processed claims using all lines of business (Employer Large and Small Group plans, Individual & Family plan, Medicare Supplemental plan)
- Explained eligibility and benefits to customers
Customer Service Representative I
Teletech
11.2006 - 10.2008
- Conferred with customers by telephone to provide information about products and services
- Resolved customer service complaints
- Recorded detailed interactions including, inquiries, complaints and comments
- Updated account information
- Gathered and researched information
- Trained new employees as needed
- Answered a high volume of inbound customer calls
Customer Service Representative
Cingular Wireless LLC
01.2004 - 11.2006
- Involved with all aspects of customer service and order entry
- Handled large call volumes in a professional and courteous manner
- Resolved customer complaints and inquiries
- Communicated with customers over the phone
Education
GED -
Merced Adult School
Merced, CA01.2001
Skills
- Extensive Appeal/Grievance experience
- Medical Plan Benefits
- Customer Relations
- Customer service
- Medical Claims
- Financial
- Excel
- Microsoft Word
- Telephone soft skills
Career Overview
To gain a rewarding position that will challenge my skills and abilities.
Timeline
Customer Service Representative
Blue Shield of CA
10.2021 - Current
Appeals & Grievance Case Manager
Pleasanton
08.2016 - 10.2018
Customer Service Representative/Financial Liaison
Blue Shield of California
10.2008 - 03.2016
Customer Service Representative I
Teletech
11.2006 - 10.2008
Customer Service Representative
Cingular Wireless LLC
01.2004 - 11.2006
GED -
Merced Adult School
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