Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will manage grievances and appeals by investigating cases, collaborating with members and stakeholders, and ensuring compliance with regulations while providing effective resolutions for moderately complex issues.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals, preparing documentation for medical committees
• Perform incident case management by analyzing case data and processing flagged cases to ensure compliance
• Provide customer service by communicating case statuses and resolving issues for members and stakeholders

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 AND 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
• Experience with data entry and maintaining confidential records
• Ability to manage complex relationships and provide effective resolutions