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 advocates, and collaborate with cross-functional teams to ensure compliance and satisfactory outcomes in a remote work environment.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Resolve moderately complex incident cases by collaborating with stakeholders and making informed decisions based on policy and guidelines
• Provide customer service by communicating case statuses and outcomes to members and stakeholders, particularly 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, Health Care Administration, or a related field AND two (2) years of experience in health care or health insurance, or five (5) years of relevant experience
• Knowledge of health care compliance and incident management processes
• Experience in negotiating and managing diverse relationships
• Proficiency in Microsoft Office and data entry