Incident Management Specialist III

Job Summary

Resolving moderately complex grievances and appeals, the full-time remote Incident Management Specialist III will manage case investigations, collaborate with cross-functional teams, and ensure compliance with health care regulations while communicating effectively with members and stakeholders.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
• Perform case management by analyzing and resolving incident cases, ensuring compliance with internal and external regulations
• Provide customer service by communicating case statuses and addressing concerns of members and stakeholders in a timely manner

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, or five (5) years of relevant experience
• Experience in health care, health insurance, sales, or marketing
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and communicate effectively with diverse stakeholders