Incident Management Specialist III

Job Summary

Managing grievances and appeals, the full-time Incident Management Specialist III will coordinate case resolutions, communicate with members and advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Investigate and resolve moderately complex grievances and appeals by collaborating with cross-functional teams
• Monitor case tracking databases to identify and analyze specialty or flagged cases requiring resolution
• Provide accurate information and support to members and stakeholders regarding case statuses and outcomes

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
• Strong skills in negotiation and relationship building
• Proficiency in Microsoft Office and data entry