**** ******** *** ********, ** *****

Phone 614-***-**** * Email: ad08se@r.postjobfree.com

DAVID A. CLOPTON

QUALIFICATIONS

Results oriented, self-motivated health professional with over 12 years of experience with Telecommunications line of business. Excellent oral and interpersonal communication skills, with a strong background in de-escalation, crisis calls, conflict diversion and problem-solving for the retention of a large customer base. Over all enthusiast in communication retention policies and goals. Extraordinary focus in leadership, team building and alignment with my direct business leads for the visionary goals of the corporation in which I will be employed.

EMPLOYMENT

CARESOURCE HEALTH CARE, Columbus, OH 12/6/2021 To Present

Provider Service Representative 1

•Assist provider with routine service inquires including but not limited to; confirming a member a primary care physician, member identification number, transportation arrangements, issues with provider accessibility, eligibility inquires, resolving, identifying and filing provider grievances.

•Provide quality service by immediately responding to the member and or providers requests and complaints, and appropriately routing issue to the correct department for a timely resolution.

•Assist a provider with routine service inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures.

•Capture member grievance, and relay appeals instructions for the appropriate line of business. Including future line of business

•Ensure all HIPPA and STATE requirements, regulations are adhered to at all times, in existing and future line of business reached, follow up, and resolve all open and pending issue in a timely manner to ensure provider satisfaction.

•Build and strengthen member relationships by providing quality customer service.

•Maintain knowledge and understanding of all processes and procedures.

•Adhere to all departmental and company policies and procedures.

•Maintain complete and accurate documentation all of telephone and written communications.

•Screen members to determine Case Management’s needs, and refer when appropriate. To better assist the provider with their needs.

•Appropriately route calls to support departments including pharmacy, and Triage, for proper/ expedited resolution.

•Assist with non-phone work such as incoming faxes and web inquires.

Perform any other job-related instructions, as requested.

MOLINA INSURANCE, Columbus, OH 8/2014-4/2021

Member Service Representative 1

•As a customer service representative at Molina, I passed all mandatory training at 100% accuracy to meet state Medicaid/Medicare mandates.

•Respond to incoming calls from members and providers and explain the benefits, eligibility guidelines and status workflow to help customer select insurance coverage.

•Keep detailed records of phone calls.

•Understand and interpret contractual agreements based on Medical and Healthy Family policy and contract guidelines.

•Work with peers and other departments and respond to sensitive health issues with extreme diplomacy and accuracy.

•Make outgoing calls to members and maintain an accurate paper trails for follow-up and review by other coworkers.

•Utilize good listening skills, empathy and compassion for the customer that allows me to achieve exceptional customer satisfaction.

DISCOVER CARD SERVICES, New Albany, OH 8/2011-8/2014

Account Manager

•Answer incoming and make outbound calls to current accounts offering our automatic payments and hardship programs to card members to help prevent future delinquencies.

•Make outbound calls to card members who are delinquent on their accounts and transfer card members to account specialists who set up payments to bring accounts current.

•Answer incoming calls and make outbound calls for card members who are 30-120 days delinquent on their credit cards.

•Educate the card member on how to resolve the delinquency and how to improve their payment history.

•Collect payments through electronic checks and enroll card members in programs who are experiencing extreme financial difficulties, which will help reduce their debt and lower their payments.

•Enroll card members in automatic payments which will help eliminate late fees on accounts, as long as the funds are available in the card member’s bank account.

EDUCTION

•Ran Security Academy, OPOTA certification Cleveland, OH

•Northwestern Vocational Automotive Science Columbus, OH

•Wehrle High School Columbus, Ohio