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, investigate member issues, and collaborate with cross-functional teams to ensure satisfactory resolutions while adhering to compliance regulations.

Key responsibilities:

• Manage the resolution of moderately complex grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with cross-functional partners to resolve member challenges related to health care delivery and benefits
• Document case management activities and ensure 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, Economics, Health Care Administration, or related field AND two (2) years of experience in health care or health insurance, or five (5) years of related experience without a degree
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and effectively communicate with stakeholders
• Experience with data entry and maintaining confidential records