Incident Management Specialist III

Job Summary

Resolving grievances and appeals for members, the full-time remote Incident Management Specialist III will manage case investigations, collaborate with cross-functional teams, and ensure compliance with regulations while providing exceptional customer service.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
• Investigate claims and customer interactions to make determinations on moderately complex cases
• Provide accurate information and support to members and stakeholders regarding case statuses and resolutions

Required qualifications:

• Minimum one (1) year of experience in customer service or a directly related field
• Bachelor's degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, 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, sales and marketing, or a directly related field