Incident Management Specialist III

Job Summary

Responsible for coordinating and monitoring the resolution of grievances and appeals, the full-time Incident Management Specialist III will investigate cases, communicate with members and advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Manage and resolve moderately complex grievances and appeals by investigating claims and collaborating with cross-functional teams
• Document case management activities and maintain confidentiality while ensuring compliance with internal and external requirements
• Provide customer service by communicating case statuses and outcomes to members and stakeholders, particularly in emotionally charged situations

Required qualifications:

• Minimum one (1) year of experience in customer service or a directly related field
• Bachelor's degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, or a related field, along 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
• Strong interpersonal skills and ability to manage diverse relationships
• Experience in conflict resolution and stakeholder management