Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will manage grievances and appeals by investigating cases, communicating with members, and preparing documentation for medical committees to ensure compliant and satisfactory resolutions.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals, ensuring compliance with regulations
• Perform case management by analyzing incident cases and resolving issues through collaboration with cross-functional teams
• Document case activities while maintaining confidentiality and providing accurate information to stakeholders

Required qualifications:

• Minimum one (1) year of experience in customer service or a related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field, plus two (2) years of relevant experience, or five (5) years of relevant experience without a degree
• Knowledge of health care compliance and incident management processes
• Strong interpersonal skills and ability to manage diverse relationships
• Experience with conflict resolution and managing complex cases