Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time remote Incident Management Specialist III will manage case investigations, communicate with members and advocates, and prepare documentation for medical committees while ensuring compliance with regulations.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, including case tracking and documentation
• Collaborate cross-functionally to resolve member-related issues and escalate complex cases as necessary
• Provide customer service by communicating case statuses and addressing concerns from members 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, along 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 handling moderately complex cases and stakeholder management
• Proficiency in Microsoft Office and data entry tasks