Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time remote Incident Management Specialist III will manage case investigations, communicate with members and advocates, and ensure compliance with internal and external regulations.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with cross-functional teams to resolve member issues related to health care delivery, benefits, and financial barriers
• Document and maintain confidentiality of case information while ensuring compliance with all relevant regulations

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, with 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 files and records
• Strong interpersonal skills and the ability to manage diverse relationships