Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time Incident Management Specialist III will manage case investigations, collaborate with members and stakeholders, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
• Analyze case tracking databases to identify and resolve moderately complex incident cases, ensuring compliance with internal and external rules
• Provide customer service by communicating case statuses and resolving issues for members, customers, and stakeholders in challenging situations

Required qualifications:

• Minimum one (1) year of experience in customer service or a directly related field
• Bachelor's degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, or related field, along with two (2) years of relevant experience, or five (5) years of experience in a related field
• Knowledge of health care compliance and incident management processes
• Experience in negotiating and managing diverse relationships
• Proficiency in Microsoft Office and data entry skills