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 advocates, and prepare documentation for medical committees, all while working remotely.

Key responsibilities:

• Manage and resolve moderately complex grievances and appeals cases by collaborating with cross-functional partners and ensuring compliance with regulations
• Investigate claims and customer interactions to make informed decisions on incident cases, documenting all findings accurately
• Provide exceptional customer service by communicating effectively with members and stakeholders, particularly in emotionally charged situations

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
• Demonstrated knowledge of health care compliance and incident management processes
• Strong interpersonal skills with the ability to manage diverse relationships and resolve conflicts
• Proficiency in Microsoft Office and data entry tasks