Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will coordinate and monitor the resolution of grievances and appeals cases, investigate issues, and collaborate with cross-functional teams to ensure compliance and satisfactory resolutions for members.

Key responsibilities:

• Manage and resolve moderately complex grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with various stakeholders to address member challenges related to health care delivery and benefits
• Provide customer service by communicating case statuses and outcomes to members and diffusing challenging situations

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 plus 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 demonstrate adaptability in high-pressure situations
• Proficiency in Microsoft Office and data entry tasks