Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time Incident Management Specialist III will manage case investigations, communicate with members and their advocates, and prepare documentation for medical committees while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, ensuring compliance with internal and external regulations
• Investigate claims and customer interactions to make determinations on moderately complex incident cases
• Provide customer service by communicating case statuses and resolving issues for members in emotionally charged situations

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or related field, or equivalent experience
• Minimum of two (2) years of experience in health care, health insurance, or a directly related field, or five (5) years of related experience without a degree
• One (1) year of experience in customer service or a directly related field
• Knowledge of health care compliance and incident management processes
• Proficiency in Microsoft Office and data entry tasks