Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time Incident Management Specialist III will manage case investigations, communicate with members and their advocates, and collaborate with cross-functional teams to ensure compliance and satisfactory resolutions in a remote work environment.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, preparing necessary documentation for medical committees
• Perform incident case management by analyzing case tracking databases and processing moderately complex cases
• Provide customer service by communicating case statuses and resolving issues for members or employees in emotionally charged 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 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
• Experience with data entry and maintaining confidential records
• Ability to manage diverse relationships and effectively communicate with stakeholders