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 support to members and stakeholders.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by preparing documentation and presentations for medical committees
• Perform case management by analyzing case tracking databases and resolving moderately complex incident cases
• Provide customer service by communicating with members and stakeholders regarding case statuses and outcomes, 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, Health Services, Communications, or a related field AND minimum two (2) years of experience in health care or a directly related field, or five (5) years of relevant experience
• Knowledge of health care compliance and incident management processes
• Strong interpersonal skills and ability to manage diverse relationships
• Proficiency in Microsoft Office and data entry