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, investigate complex issues, and collaborate with cross-functional teams to ensure compliance and satisfactory outcomes for members.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Resolve member and employee incident cases by making decisions and collaborating with business leaders and stakeholders
• Provide customer service by communicating case statuses and outcomes to members and stakeholders in a timely manner

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 health insurance
• Alternatively, minimum five (5) years of experience in health care, health insurance, sales and marketing, or a directly related field
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and facilitate stakeholder engagement