Incident Management Specialist III

Job Summary

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

Key responsibilities:

• Manage and monitor the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with cross-functional teams to resolve member issues related to healthcare delivery, benefits, and financial barriers
• Document and maintain confidentiality of cases while ensuring compliance with internal and external requirements

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 related field AND two (2) years of experience in healthcare or a directly related field, or five (5) years of relevant experience
• Knowledge of health care compliance and incident management processes
• Experience in negotiating and managing complex relationships
• Proficiency in Microsoft Office and data entry