Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will manage grievances and appeals by investigating cases, collaborating with members and stakeholders, and ensuring compliance with regulations while preparing documentation for medical committees.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, ensuring thorough investigation and communication with members
• Analyze case tracking databases to identify and resolve moderately complex incident cases while maintaining compliance with internal and external rules
• Provide customer service by delivering accurate information and managing communications with members regarding the status of their cases

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 related field AND minimum two (2) years of experience in health care or health insurance
• Alternatively, a minimum of five (5) years of experience in health care, health insurance, or a directly related field
• Knowledge of health care compliance and incident management processes
• Experience in stakeholder management and conflict resolution