Incident Management Specialist III

Job Summary

Resolving grievances and appeals in a remote full-time role, the Incident Management Specialist III will manage case investigations, communicate with members and advocates, and prepare documentation for medical committees while ensuring compliance with regulations.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, including conducting investigations and preparing presentations for medical committees
• Collaborate with cross-functional partners to resolve member issues related to health care delivery, benefits, or financial barriers
• Document and maintain confidentiality of member information while ensuring compliance with internal and external regulations in case management activities

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 related field AND minimum two (2) years of experience in health care or health insurance, or minimum five (5) years of relevant experience
• Knowledge of health care compliance and incident management processes
• Experience with stakeholder management and relationship building
• Proficiency in Microsoft Office and data entry tasks