Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will manage grievances and appeals by investigating cases, collaborating with cross-functional teams, and ensuring compliance with regulations while providing support to 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 moderately complex incident cases while ensuring compliance with internal and external rules
• Provide customer service by communicating case statuses and outcomes effectively to members and stakeholders, especially 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, or a related field, along 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
• Strong interpersonal skills and ability to manage diverse relationships
• Experience in conflict resolution and managing complex situations