Incident Management Specialist III

Job Summary

Resolving member grievances and appeals, the full-time Incident Management Specialist III will coordinate and monitor case resolutions, investigate issues, and collaborate with cross-functional teams while working remotely.

Key responsibilities:

• Manage the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with stakeholders to resolve complex member issues related to healthcare delivery and benefits
• Ensure compliance with internal and external regulations while documenting case management activities

Required qualifications:

• Minimum one (1) year of experience in customer service or a directly related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field AND two (2) years of relevant experience, or five (5) years of experience in a related field
• Knowledge of health care compliance and incident management processes
• Experience in negotiating and managing diverse relationships
• Proficiency in Microsoft Office and data entry