Exception Specialist I - Maine Only

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you!

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.

This role…

• 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.

We are interested in speaking with individuals with the following…

• 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.

Salary: $16 - $18/hr

Modivcare’s positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received.  We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to check back often for new postings. 

We value our team members and realize the importance of benefits for you and your family.

Modivcare offers a comprehensive benefits package to include the following:

• 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!)

Modivcare is an Equal Opportunity Employer.

• EEO is The Law - click here for more information
• Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
• We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law. If you need assistance, please reach out to us at hr.recruiting@modivcare.com

Salary : $16 - $18