Service Representative Health Care

DAVID A. CLOPTON

**** **** ***** ** *, Columbus, OH 43232

Phone: 614-***-**** * Email: ***********@*****.***

QUALIFICATIONS

Results oriented, self-motivated, professional trained by the Ohio Department of Correction. Excellent

Oral and interpersonal communication skills, with a strong background in de-escalation, crisis calls,

Intervention, conflict diversion and problem-solving. A health care professional with over 12 years

of experience with Telecommunications line of business, With the retention of a large customer base,

in alignment with my direct business leads for the visionary goals of the corporation in which I will be employed.

EMPLOYMENT

Juvenile Correctional Officer, Circleville OH 1/2024-Present

Youth Specialist

Provides safety, security, custodial care, and surveillance of assigned youth.

Adheres to all DYS policies, procedures, rules, and regulations.

Exhibits strong management skills.

Completes all required documents, reports, logs, evaluations, etc.

Observes the behaviors and social interactions of youth and intervenes to de-escalate youth

Conflicts.

Trained to maintain awareness of unusual behavior and crisis situations.

Collaborates and provides information to division leadership.

CareSource Health Care, Columbus, OH 12/12/22 - 3/2023

Provider Service Representative 1

Assist provider with routine service inquiries including but not limited to, confirming a

member a primary care physician, member identification number, transportation

arrangements, issues with provider accessibility, eligibility inquiries, resolving, identifying,

and filing provider grievances.

Provide quality service by immediately responding to the member and or provider’s

requests and complaints, and appropriately routing issues to the correct department for a

Timely resolution.

Explanation of benefits, claims and appeal procedures. Assist providers with routine services

to fit their needs.

Ensure all HIPPA and STATE requirements and regulations are adhered to at all times.

Maintain knowledge and understanding of all processes and procedures.

Adhere to all departmental and company policies and procedures.

Maintain complete and accurate documentation of all telephone and written

Communications.

Screen members to determine Case Management’s needs and refer when appropriate to

better assist the provider and their needs.

Molina Insurance, Columbus, OH 8/2014-4/2021

Member Service Representative 1

As a customer service representative, passed all mandatory training at 100% accuracy to

Meet state Medicaid/Medicare mandates.

Worked with peers and other departments to respond to sensitive health issues with

Extreme diplomacy and accuracy.

Utilized good listening skills, empathy and compassion for the customer that resulted in

Achieving exceptional customer satisfaction.

Discover Card Services, New Albany, OH 8/2011-8/2014

Account Manager

Answered incoming and made outbound calls to current accounts offering automatic

Payments and hardship programs to card members to help prevent future delinquencies.

Made outbound calls to card members who are delinquent on their accounts and

transferred card members to account specialists who set up payments to bring accounts

Current.

Collected payments through electronic checks and enrolled card members who are

experiencing extreme financial difficulties in programs to help reduce their debt and lower

their payments.

Enrolled card members in automatic payments which helped eliminate late fees on

accounts.

Ran Security Academy OPOTA Certification Cleveland, OH

Northwestern Vocational Automotive Columbus, OH

Wehrle High School Diploma Columbus, OH

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