Incident Management Specialist III

Job Summary

Working remotely in a full-time capacity, the Incident Management Specialist III will manage the resolution of grievances and appeals cases by investigating issues, communicating with members and advocates, and preparing documentation for medical committees while ensuring compliance with regulations.

Key responsibilities:

• Coordinate and monitor grievance and appeal resolutions, ensuring thorough investigation and documentation
• Collaborate cross-functionally to address and resolve member-related challenges and service gaps
• Provide customer service by communicating case statuses and outcomes to members and stakeholders in a timely manner

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, 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 interpersonal skills and the ability to manage diverse relationships
• Experience with conflict resolution and negotiation in a health care setting