Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time Incident Management Specialist III will coordinate investigations, communicate with members and advocates, and prepare documentation for medical committees, all while working remotely.

Key responsibilities:

• Manage and monitor the resolution of grievances and appeals cases, ensuring compliance with regulations
• Collaborate with cross-functional teams to address member challenges and service gaps
• Document case activities while maintaining confidentiality and providing timely updates to 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, 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 negotiating and managing complex relationships
• Proficiency in Microsoft Office and data entry