Exceptions Specialist I

Modivcare

About The Position

Modivcare is looking for an experienced Exception Specialist I to join our team. In this role, you will be responsible for ensuring the accurate fulfillment and approval of transportation service requests and reservations before and/or after transport, through internal systems, external resources, and direct outreach to members, facilities, clients, and other stakeholders.

Requirements

High School Diploma required.
Zero (0) plus years of experience. Or equivalent combination of education and/or experience.
Excellent customer service and interpersonal skills.
Ability to work independently and within a team environment.
Strong ability to learn new technologies and follow complex processes.
Proficient in reading, writing, and understanding English.
Demonstrates strong problem-solving, adaptability, and organizational skills.
Able to remain professional and composed under pressure.

Responsibilities

Ensures accurate input and resolution of trip data in accordance with service guidelines.
Monitors and advises management on customer service and exception processing issues.
Researches and resolves actions such as benefit utilization issues, eligibility, pre-authorizations, mileage validations, level of service, meals and lodging, denials, and appeals.
Manages the denial and appeal process for transportation service requests.
Processes inbound and outbound communications including faxes, emails, web submissions, and mail.
Oversees phone interactions for quality and efficiency within the department.
Investigates and verifies actual utilization for service claims and requests.
Identifies trends in utilization or billing that may indicate abusive practices and reports them accordingly.
Escalates reports of member dissatisfaction or potentially fraudulent behavior to the appropriate team or management.
Provides outreach on transportation and member education to healthcare facilities as needed.
May participate in additional projects or 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!)