Exception Specialist II - Onsite - Charleston, WV

Modivcare • Charleston, WV

1d • Onsite

About The Position

Modivcare is looking for an experienced Exception Specialist II to join our team. This role is responsible for the accurate fulfillment and approval procedures related to transportation service requests and reservations before and/or after the transport has taken place. It involves the use of internal and external resources, as well as direct outreach to members, facilities, clients, and other stakeholders to ensure service efficiency and resolution. The Exception Specialist II will provide comprehensive support in customer service, exception handling, and issue investigation, while contributing to continuous process improvement and supporting team collaboration.

Requirements

• High School Diploma required.
• One (1) plus years of experience, or an equivalent combination of education and experience.
• Excellent customer service and interpersonal skills.
• Ability to work independently or within a team setting.
• Fast learner with adaptability to new technologies and workflows.
• Strong comprehension and ability to follow complex instructions.
• Proficient in reading, writing, and speaking English fluently.
• Exceptional attention to detail and accuracy.
• Capable of managing multiple tasks while maintaining service quality.

Responsibilities

• Ensures accurate trip data input and resolution in alignment with service guidelines.
• Investigates benefit utilization issues, pre-authorizations, process denials, mileage validation, meals & lodging, level of service, and provides effective solutions.
• Advises management on customer service concerns and exception trends.
• Manages and recommends improvements to the denial and appeal process.
• Assists with handling inbound and outbound requests via fax, mail, email, and web.
• Suggests enhancements for the department’s phone operations and overall efficiency.
• Investigates complex service issues to ensure proper utilization.
• Identifies and monitors trends in utilization and billing to detect abusive practices.
• Reports potential abuse or fraud and supports follow-up actions as needed.
• Escalates member dissatisfaction to the appropriate team or management personnel.
• Conducts outreach to medical facilities regarding member transportation and education.
• Supports peers by sharing knowledge, mentoring, and contributing to team development.
• Participates in additional projects and duties as assigned.

Benefits

• Medical, Dental, and Vision insurance
• Employer Paid Basic Life Insurance and AD&D
• Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts
• Pre-Tax and Post --Tax Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• Paid Time Off
• Paid Parental Leave
• Short-Term and Long-Term Disability
• Tuition Reimbursement
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED