Incident Management Specialist III

Job Summary

Resolving moderately complex 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 the resolution process for grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with cross-functional teams to address member challenges related to healthcare 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 directly related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field, plus two (2) years of relevant experience, or five (5) years of experience in health care or health insurance
• Knowledge of incident management and health care compliance
• Ability to handle moderately complex cases and make informed decisions
• Experience with documentation and maintaining confidentiality in case management activities