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 ensure compliance with regulations while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate cross-functionally to resolve member issues related to health care delivery and benefits
• Document and maintain confidentiality of case information while ensuring compliance with internal and external requirements

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or a related field, or equivalent experience
• Minimum of two (2) years of experience in health care, health insurance, or a directly related field
• At least one (1) year of experience in customer service or a related area
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and demonstrate adaptability in high-stress situations