Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will coordinate and monitor the resolution of grievances and appeals cases, investigate issues, and collaborate with cross-functional teams to ensure compliance and satisfactory resolutions for members.

Key responsibilities:

• Manage the investigation and resolution of moderately complex grievances and appeals, ensuring compliance with internal and external regulations
• Collaborate with stakeholders to address member challenges related to healthcare delivery and benefits, providing timely communication and support
• Document case management activities accurately while maintaining confidentiality and identifying opportunities for process improvements

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, along with two (2) years of relevant experience, or five (5) years of experience in health care or health insurance
• Knowledge of health care compliance and incident management processes
• Proficiency in Microsoft Office and data entry
• Ability to manage diverse relationships and communicate effectively with stakeholders