Incident Management Specialist III
Job Summary
Resolving moderately complex 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 the resolution of grievances and appeals by investigating cases and preparing documentation for medical committee reviews
- Collaborate with cross-functional teams to address member issues related to health care delivery and benefits
- Monitor and analyze case tracking databases to identify and resolve specialty or flagged incident cases
Required qualifications:
- Minimum one (1) year of experience in customer service or a related field
- Bachelor's degree in Business Administration, Health Care Administration, or a related field, plus 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
- Strong interpersonal skills with the ability to manage diverse relationships
- Experience in conflict resolution and customer service in emotionally charged situations
Complete Job Description
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