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Exception Specialist

Company: LogistiCare
Location: Oklahoma City
Posted on: June 15, 2019

Job Description:

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

Keywords: LogistiCare, Oklahoma City , Exception Specialist, Other , Oklahoma City, Oklahoma

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