Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will coordinate and monitor the resolution of grievances and appeals cases by investigating issues, communicating with members and advocates, and preparing documentation for medical committees to ensure compliance and satisfactory resolutions.

Key responsibilities:

• Manage and resolve moderately complex grievances and appeals by collaborating with cross-functional teams and stakeholders
• Monitor case tracking databases to identify and analyze incident cases requiring resolution
• Document case activities while maintaining confidentiality and ensuring compliance with internal and external regulations

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 interpersonal skills and ability to manage diverse relationships
• Experience in conflict resolution and customer service in health care settings