Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will manage the resolution of grievances and appeals cases by investigating issues, communicating with members, and preparing documentation for medical committees to ensure compliance and satisfactory outcomes.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals, ensuring compliance with regulations
• Perform case management by analyzing and processing moderately complex incident cases while collaborating with cross-functional teams
• Provide customer service by communicating status updates and resolving issues for members and stakeholders in emotionally charged situations

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, or 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
• Ability to maintain confidentiality and manage complex relationships effectively