Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will manage the resolution of grievances and appeals cases by investigating issues, collaborating with cross-functional teams, and ensuring compliance with regulations while providing exceptional member service.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals, preparing documentation for medical committees
• Perform incident case management by analyzing case tracking databases and ensuring compliance with internal and external rules
• Provide accurate information and support to members and stakeholders, addressing complex cases and service gaps

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 a related field AND 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
• Ability to manage complex relationships and resolve conflicts effectively
• Proficiency in Microsoft Office applications