Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time Incident Management Specialist III will coordinate case investigations, communicate with members and advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Manage and monitor the resolution of moderately complex grievances and appeals cases, preparing documentation for medical committees
• Collaborate with cross-functional teams to resolve member issues related to healthcare delivery and benefits
• Perform case documentation and maintain confidentiality while ensuring compliance with internal and external requirements

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 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
• Strong interpersonal skills and ability to manage diverse relationships