Incident Management Specialist III

Job Summary

Managing grievances and appeals cases, the full-time Incident Management Specialist III will investigate issues, communicate with members and their advocates, and prepare documentation for medical committees while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and communicating with stakeholders
• Perform incident case management and research, ensuring compliance with internal and external regulations
• Provide customer service by delivering accurate information regarding case statuses and outcomes while addressing member concerns

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 related field AND minimum two (2) years of experience in health care or health insurance
• Alternatively, a minimum of five (5) years of experience in health care, health insurance, or a related field
• Knowledge of health care compliance and incident management processes
• Proficiency in Microsoft Office and data entry