Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will manage the resolution of grievances and appeals cases by investigating issues, collaborating with members and stakeholders, and ensuring compliance with regulations while leveraging expertise in health care and incident management.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals, preparing documentation for medical committees
• Investigate and analyze incident cases, ensuring compliance with internal and external regulations
• Provide customer service by communicating case statuses and resolving issues for members and 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, 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
• Experience in handling moderately complex grievances and appeals cases
• Strong interpersonal skills and ability to manage diverse relationships