Incident Management Specialist III

Job Summary

Working remotely on a full-time basis, the Incident Management Specialist III will manage and coordinate the resolution of grievances and appeals cases, engage with members and advocates, and ensure compliance with regulations while leveraging expertise in health care and incident management.

Key responsibilities:

• Investigate and communicate with members regarding grievances and appeals, preparing documentation for medical committees
• Monitor case tracking databases to identify and resolve moderately complex incident cases while ensuring compliance with internal and external standards
• Provide customer service by delivering timely information and support to members and stakeholders regarding case statuses and outcomes

Required qualifications:

• Bachelor's degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, or a related field, or equivalent experience
• Minimum of two (2) years of experience in health care, health insurance, sales and marketing, or a directly related field, or five (5) years of relevant experience without a degree
• One (1) year of experience in customer service or a directly related field
• Knowledge of health care compliance and incident management processes
• Proficiency in Microsoft Office and data entry skills