Incident Management Specialist III
Job Summary
To support the resolution of grievances and appeals, the full-time Incident Management Specialist III will coordinate investigations, communicate with members and their advocates, and ensure compliance with regulations while working remotely.
Key Responsibilities
- Manage and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
- Collaborate with cross-functional teams to resolve member issues related to health care delivery and benefits
- Conduct case research and documentation, ensuring compliance with internal and external regulations
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, or equivalent experience
- Minimum two (2) years of experience in health care, health insurance, or a related field, or five (5) years of relevant experience without a degree
- Knowledge of health care compliance and incident management processes
- Proficiency in Microsoft Office and data entry skills
Complete Job Description
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