Incident Management Specialist III

Job Summary

To support a growing team, the full-time Incident Management Specialist III will manage grievances and appeals by investigating cases, collaborating with members and stakeholders, and ensuring compliance with regulations while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
• Perform incident case management by analyzing case tracking databases and ensuring compliance with internal and external regulations
• Provide customer service by communicating case statuses and resolving issues for members, customers, and stakeholders

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
• Strong interpersonal skills and ability to manage diverse relationships
• Proficiency in Microsoft Office and data entry