Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will coordinate and monitor the resolution of grievances and appeals cases, investigate issues, communicate with members, and ensure compliance with regulations while collaborating with cross-functional teams.

Key responsibilities:

• Manage and resolve moderately complex grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with cross-functional partners to address member challenges related to health care delivery and benefits
• Document case management activities while ensuring compliance with internal and external regulations

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or a related field, or equivalent experience
• Minimum of two (2) years of experience in health care, health insurance, or a related field
• At least one (1) year of experience in customer service or a directly related field
• Knowledge of health care compliance and incident management processes
• Strong interpersonal skills and ability to manage diverse relationships