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 by investigating cases, collaborating with cross-functional teams, and ensuring compliance with regulations while addressing member challenges related to health care delivery.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
• Conduct research and analysis of moderately complex incident cases, ensuring compliance with internal and external rules
• 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, Health Care Administration, or a related field, with 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
• Experience in stakeholder management and relationship building
• Proficiency in Microsoft Office and data entry