Incident Management Specialist III

Job Summary

Resolving moderately complex grievances and appeals, the full-time Incident Management Specialist III will investigate cases, communicate with members and stakeholders, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Manage and monitor the resolution of grievances and appeals, preparing documentation for medical committees
• Collaborate cross-functionally to resolve member issues related to health care delivery and benefits
• Document and maintain confidentiality of case information while ensuring compliance with internal and external requirements

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 a related field
• Knowledge of health care compliance and incident management processes
• Strong interpersonal skills and ability to manage diverse relationships
• Proficiency in Microsoft Office and data entry