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Exception Specialist


  • LogistiCare
  • 04/15/19
  • Southfield, MI
  • 48033
  • Full-time
The Exception Specialist receives, researches, and processes transportation service requests for a reservation that requires approval procedures to be executed before and/or after transportation has taken place. In addition, the Exception Specialist is required to identify and monitor utilization and billing trends that may signal abusive practices. The Exception Specialist will leverage internal and external resources as well as outreaching to members, facilities, clients and other parties to accurately fulfill reservations.

ESSENTIAL FUNCTIONS
Ensures accurate trip data input and resolution as it relates to the service guidelines
Observes and advises management team on issues relating to customer service and the exceptions process
Researches and resolves work that requires further action (e.g. benefit utilization issues, verification, waivers, urgent trip requests, pre-authorization, process denials, eligibility, mileage validation, meals & lodging, level of service exceptions).
Manages the denial and appeal process
Processes faxes, mail, email and web requests (inbound and outbound)
Oversees the department's phone activity (inbound and outbound) for quality and efficiency
Investigates all issues to confirm the actual utilization
Reports to management the need to address abusive or fraudulent situations
Report Member Experience dissatisfaction to appropriate team members and/or management.
Provide outreach regarding members, transportation, education and other subjects as needed to medical facilities
Additional duties as assigned including assisting and performing functions for other departments

POSITION QUALIFICATIONS
Competency Statement(s)
Accurate - Ability to perform work accurately and thoroughly
Communication, Oral - Ability to communicate effectively with others using the spoken word
Communication, Written - Ability to communicate in writing clearly and concisely
Customer Oriented - Ability to take care of the customers' needs while following company procedures
Detail Oriented -- Ability to pay attention to the minute details of a project or task.
Interpersonal - Ability to get along well with a variety of personalities and individuals
Problem Solving -- Ability to find a solution for or to deal proactively with work-related problems
Relationship Building - Ability to effectively build relationships with customers and co-workers
Reliability - The trait of being dependable and trustworthy

Education
High School Graduate or General Education Degree (GED)

Experience
2 to 5 years contact center customer service experience is strongly preferred

Skills
Excellent customer service and people skills and must be able to work independently or with a team
Ability to quickly learn new technology and processes
Must be able to understand and follow complex instructions
Read, write and understand English fluently

WORKING CONDITIONS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical Requirements
- Able to sit at and work on a computer for periods of time
- Able to use the phone for periods of time
- Able to lift up to 10 pounds and reach/bend to retrieve items in cabinets and shelves
- Required to be at the work location to perform job functions
- Ability to speak, hear and see for the assigned work day
- Repetitive key stroke/data entry for the assigned work day
- Ability to ambulate as needed for the assigned work day

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Entire work time is conducted in an office environment in a controlled atmosphere building.
The noise level in the work environment is usually moderate.

LogistiCare is an Equal Opportunity Employer.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

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